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Discusses Women's Health

This week the Supreme Court heard the case on Texas’s abortion regulations which would close nearly half the abortion clinics in the nation’s second largest state. The Texas law stipulates that doctors working at abortion clinics must have permission to admit women at a hospital within 50 km of the clinic and that the clinics need the same building standards as outpatient surgery centers. This would require expensive modifications to increase room size and corridors. (Of note is the fact that clinics where patients get colonoscopies don’t have the same regulations and there are way more cases of complications with this procedure. I guess Texas guts, especially in men, don’t count…) The American College of Obstetricians and Gynecologists and the American Medical Association have filed an amicus brief urging the court to reconsider these requirements, stating that they have no medical basis. Instead of protecting women, the law jeopardizes women’s health by restricting access to abortion providers. If a majority is reached in the Supreme Court upholding the Texas law, the decision will affect all lower courts in the country. But if it’s a tie, it will only stand in Texas, Louisiana and Mississippi, the three states under the jurisdiction of the Court of Appeals that upheld the restrictions in 2013. A decision by the Supreme Court is likely to be made this summer.

I am appalled that there is a possibility that the Texas law will be upheld. So when I saw an article titled, “An Uncommonly Silly Law – contraception and disparities in the United States” in the section on the history of medicine in the February 25th issue of the New England Journal of Medicine, I was delighted. Good for the journal (which is pretty much the gold standard for medicine in the USA if not the world).

The author notes that even in 2016 there is no assurance that birth-control will be accessible to all US women regardless of their ability to pay. Our reproductive health is becoming more and more limited and we’re going backward in our reproductive history. In the 2014 decision in Burwell v. Hobby Lobby Stores the Supreme Court held that closely held corporations – those in which fewer than five people own more than half of company stock – it’s legal to choose to exclude contraceptive coverage from their employees’ health insurance plans created under the Affordable Care Act if the use of contraceptives violates their religious beliefs. And in 2015 there is a new tactic in a long-running attack on Planned Parenthood, extensively to target abortion. It has led to legislative efforts to discontinue all federal funding, including the organization’s non abortion activities. This would severely restrict access to contraception and many other important health care services for low income women. (Years ago I actually wrote the protocol for the treatment of menopausal women at Planned Parenthood here in Los Angeles. The clinics also offer female and male STD testing, treatment, Pap smears, pelvic exams, prenatal care and many other services…)

Looking at the history of our reproductive rights, we should remember that in 1972 the Supreme Court extended the right of privacy to an unmarried person seeking birth control in their ruling of Eisenstadt versus Baird stating, “if the right of privacy means anything, it is the right of the individual, married or single to be free from unwarranted governmental intrusion into matters so fundamentally affecting a person as the decision whether to bear or beget a child” and a year later the right of privacy was extended to cover abortion in Roe v. Wade.

Subsequent to Justice Scalia’s death last month, it appears that the decision of the current case will rest with Justice Anthony Kennedy. I hope the women in his life, the medical community, as well as the majority of Americans who do not want their reproductive rights taken away from them impact his decision. The New England Journal article brings up the fact that although this battle centers on abortion it poses a threat to contraceptive access as well. Planned Parenthood is the single largest provider of contraceptives services for women living at or below the federal poverty level. If federal funding is eliminated, it will put these services in jeopardy. More women will have to resort to abortion … where will they go?

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