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Tufts Public Health » Prenatal Health, Prevention, Reproductive Health, Sex Education » The importance of access to reproductive health care

The importance of access to reproductive health care

“We need to ensure that the next generation is as healthy as possible,” says Odilia Bermudez, PhD, MPH, Associate Professor of Public Health and Community Medicine, Tufts University School of Medicine and Associate Professor of Nutrition, Tufts Friedman School of Nutrition Science and Policy. “And that their children and their grandchildren are also coming into this world healthy and happy.” Public health professionals have an important role to play in education and policy work surrounding reproductive health, including contraception, fertility, pregnancy, and birth.

Nearly half of pregnancies in the U.S. are unplanned, with higher rates among ethnic minority groups and low-income populations. Unintended pregnancies are associated with low birth weight, later initiation of prenatal medical care, and other health concerns for women and fetuses. In addition, they correlate with lower income and education levels for women, as well as more arguments, depression, and anxiety for women and their partners.

Reproductive health concerns are not limited to a single gender or sexual orientation. Individuals who identify as transgender, gender non-conforming, lesbian, gay, or bisexual are at higher risk for a variety of health issues and may face challenges in accessing care. These challenges include acts of discrimination ranging from uninformed or malicious communication by doctors or nurses to refusal of care. In recent years, some states have passed laws targeting people based on their gender identity. However, a recent regulation related to the Affordable Care Act bars federally funded health facilities from discriminating against individuals on the basis of gender identity and may provide some protection from discrimination related to sexual orientation. While this post discusses reproductive care for cisgender men and women in general terms, it is important to note that gender identity may interact with reproductive care in a variety of ways; for example, an individual who identifies as a transgender man may seek contraceptive options to prevent pregnancy.

Contraception reduces rates of unplanned pregnancies and their impact on population health and wellbeing, but access to effective methods such as birth control pills has changed over time and still varies by location within the U.S. Federal regulation of contraception dates back to the 1873 Comstock Act, which prohibited interstate commerce involving contraception and sparked similar laws at the state level. In some states, for years or decades after oral contraception (also called “the pill”) was first approved in 1960, young unmarried women needed parental consent for a prescription. Over time, restrictions were lessened through court rulings and new laws.

Even when care is legal, individuals must have the education to understand their options, the independence and support system to make decisions, and a trusting environment to seek out a provider and ask questions about their care. “When we talk about reproductive health, we focus on women,” but we need to focus on family members, partners, and society as a whole, says Bermudez. Parents play a key part in determining whether adolescents are able to access care. In addition, violence against women and human trafficking are often overlooked as risk factors for harmful health effects, unintended pregnancy, and poor pregnancy outcomes.

The price of reproductive health care can also affect access. Many community health centers offer low-cost or free care. With certain religious exemptions, the Affordable Care Act mandates that insurance companies fully cover the cost of folic acid supplements and some screening and counseling services for maternal and prenatal health. It also requires complete coverage of many forms of contraception. However, insurance companies may limit coverage to certain types or brands, and are not required to cover fertility treatments, abortion, or interventions for men such as vasectomies.

One increasingly popular intervention is long-acting reversible contraception, or LARC. These methods include intrauterine devices (IUDs), apparatuses with hormones or copper that are placed in the uterus to deter pregnancy, as well as hormonal implants placed under the skin of a woman’s arm. They last for years and can be removed at any time. “Perhaps the biggest advantage of these types of birth control is that they are highly effective,” said Danielle Roncari, MD, Director of Family Planning at Tufts Medical Center to Boston Magazine, although they do not prevent sexually transmitted infections (STIs). Unlike some options, these methods do not require a woman to remember an action such as taking medication or using a device.

Researchers continue to explore new methods of contraception. A recent promising but unsuccessful trial of male contraception drew media attention in part because some men dropped out of the trial after experiencing side effects, such as acne and severe mood changes that were more common than those associated with approved forms of contraception for women. Men have their own reproductive health needs, including fertility and prevention of STIs. They play their own role in unintended pregnancy, and many participants in the trial they would want to use male contraception. However, about three times as many couples use female sterilization for contraception as compared with vasectomies, although both methods are safe and effective. This raises important questions about balancing the risks and benefits of contraception choices and about who takes responsibility for contraception.

With the future of the Affordable Care Act in question, it remains to be seen what will happen to measures related to reproductive health. Bermudez notes,We have to educate both girls and boys about the responsibility they have.” Educating individuals about their options and providing accessible, quality care allows people to make the decisions about their health that are right for them.

by Cayla Saret, MPH Candidate ’17

Filed under: Prenatal Health, Prevention, Reproductive Health, Sex Education

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