Guest Contribution from Samantha Herndon
First, what is CORE? CORE stands for the Collaborative for Reproductive Equity. We are a research center based in the UW-Madison School of Medicine and Public Health. The Center is led by Director Jenny Higgins, PhD, MPH, a Professor of Gender and Women’s Studies and of Obstetrics and Gynecology. CORE conducts and translates rigorous, interdisciplinary research to inform policies and programs so that all Wisconsin residents and families may live with reproductive autonomy–which I’ll discuss more below.
CORE’s team of investigators, students, and staff lead a variety of policy-relevant research projects. These include: a study of how health conditions influence when people can physiologically know they are pregnant, a survey of UW-Madison physician attitudes on abortion, and an investigation of how access to contraception and abortion has long-term impacts on men’s education and income. In today’s post honoring Women’s History Month (Note: every month is Women’s History Month, and every month is Black History Month!) I will focus on the particular challenges for reproductive health in the COVID-19 era. My main inspiration for this piece is a paper by CORE Lab director Dr. Leigh Senderowicz and CORE Director Dr. Jenny Higgins called Reproductive autonomy is nonnegotiable, even in the time of COVID‐19.
What is reproductive autonomy? Senderowicz and Higgins define reproductive autonomy as: “The ability for people to make decisions about their reproductive health and access needed services without interference or coercion.” The authors state that “this basic human right to control one’s own reproductive destiny endures regardless of the crisis.”
In the early stages of the pandemic, some states limited reproductive healthcare for patients, citing concern over spreading the virus and a critical lack of PPE (personal protective equipment). In one extreme example, Texas lawmakers banned abortion outright from late March to late April, in spite of the fact that abortion is legal in all US states. In their research, Senderowicz and Higgins found that, “Medically speaking, abortion can easily remain accessible throughout the pandemic without using precious hospital resources.” This is based both on the importance of these services, and on the fact that telehealth and medication that can be dispensed by pharmacies and by mail in many states help to make reproductive healthcare accessible and safe. But there’s a big if- this safe access can only be achieved if lawmakers expand adapt policy to methods such as medication abortion that have shown to be safe, but which are heavily restricted in Wisconsin and other states.
The non-coercive aspect of reproductive autonomy is also vital. People have a variety of birth control options available to them, and doctors and patients should have an open discussion about goals, side effects, and other factors to determine which method is the right choice for each individual. The American College of Obstetricians and Gynecologist (ACOG), a respected consortium in the family planning field, recommended that during the early months of the pandemic, removal of LARCS (Long-acting reversible contraception) could be postponed. LARCS have also been highly emphasized by health care workers as a birth control method that is cost-effective and pandemic-friendly. However, Senderowicz and Higgins note that the LARC-first that has been used by some clinicians is not a person-centered, rights-based approach. A LARC-first is not respectful of reproductive autonomy, and is not best practice. LARCs, such as IUDs (intrauterine devices), implants, and other long-acting birth control methods, have benefits such as use for up to seven years. Their use is convenient for some, but LARCs are not the right contraceptive choice for everyone. It is important that patients are not pressured to choose one method over another, but instead, that healthcare providers respect their patients’ reproductive autonomy. Attentive listening to patients, checking health records carefully, avoiding assumptions, and answering questions about various methods are all ways that healthcare providers can improve patient relationships and respect reproductive autonomy.
Senderowicz and Higgins emphasize the human rights of each person to make the health choices that are best for them. They write, “Yet even in the time of COVID-19 and its wake, it is important to affirm that neither providers nor public health authorities have the right to impose restrictions on the right to seek a pregnancy and carry it to term, to prevent a pregnancy, or to terminate a pregnancy. This right, regardless of the circumstances, rests with the individual who inhabits the body.” All sorts of factors, from the distance a person lives to a clinic, to the sex education people receive in schools, to affordability of contraceptive methods, influence reproductive autonomy and access. A public health crisis changes how we can relate to one another, but it should not limit something as life-altering as whether and when to become pregnant.
In addition to highlighting some of the challenges to reproductive autonomy during the pandemic, I’d like to offer some solutions. Here in Wisconsin, people seeking birth control can speak with their primary care doctor to get a prescription. Dr. Laurel Rice, Chair of the UW-Madison Department of Obstetrics and Gynecology and CORE Advisory Council member, in conjunction with University of Wisconsin School of Pharmacy Professor Dr. Marina Maes, has written about proposed policies to allow Wisconsin pharmacists to prescribe contraceptives. If you don’t have a primary care doctor, you can call the Well Badger Maternal and Child Health and First Step Resource line at 800-642-7837. If you are uninsured due to a recent layoff, COBRA prices to keep your insurance from a former employer have been temporarily lowered by the newly passed American Rescue Plan. If you need to apply for health insurance in Wisconsin, you can contact Badgercare at 800-362-3002. If you’d like to compare birth control options, this chart may be helpful. Options for Emergency Contraception (EC), which is not the same as abortion, include Ella, AfterPill, or Plan B One-Step. If you are pregnant and need to terminate the pregnancy, you can get an abortion at one of the four clinics in Wisconsin that provide it. Clinics in nearby states also offer abortion care services, and funding assistance is available.
As Senderowicz and Higgins write, “We can use the urgency of this time not only to resist rolling back pre-COVID reproductive rights, but as an opportunity to demand greater reproductive autonomy than we had before. These efforts could include repealing the Hyde Amendment, increasing access to both clinic-based and self-managed abortion, improving access to a wide array of contraceptive methods, expanding access to affordable treatments for infertility, transforming care to be inclusive of queer communities, and purging practices built on the assumptions of structural racism. In this uncertain time, we appreciate the need to take short-term, emergency measures to prevent the spread of Covid-19. And yet even in this time, we must remain vigilant and tireless advocates for a rights-based, person-centered approach to reproductive health.”
In the coming post-pandemic world, as always, reproductive autonomy is essential for individuals, families, and communities to thrive.
The views expressed in this blog post are solely those of the author.