The Health Divide: Abortion bans linked to rise in infant deaths and lower use of birth control.

Abortion bans linked to worsening contraception access and infant mortality

On the two-year anniversary last week of the Supreme Court decision allowing states to ban abortion procedures, many news organization reported on its sweeping effects. Fourteen states now have total or near-total bans. Yet the recorded number and rate of abortions is the highest it’s been in a decade, reports Lauren Mascarenhas at CNN. 

Most abortions are now achieved using medication rather than surgical procedures, and thousands of patients travel to other states to obtain care.

“Those changes have stretched the nation’s abortion network to its limits,” writes Shefali Luthra at The 19th. “Providers in many states report weeks-long wait times.”

More than half of OB-GYNs surveyed in abortion ban states have found ways to get their patients the care they need, report Rachael Robertson and Kristina Fiore in a MedPage Today investigation. Yet nearly one-third also said they’d had to turn away a patient seeking an abortion.

Abortion access is tightly tied to social inequities. “Reproductive justice is absolutely a racial issue,” Dr. Regina Davis Moss, president of In Our Own Voice: National Black Women’s Reproductive Justice Agenda, told Word in Black’s Anissa Durham.

Black women are three times more likely to die of pregnancy-linked causes than white women, Durham notes. 

“It’s an inequality story,” Caitlin Myers, a Middlebury College economist, told The 19th. “The poorest and most vulnerable people get trapped.” 

For example, Myers said, the challenges of a multi-day trip, including taking time off work, arranging child care, and the costs of the travel, are insurmountable for some. 

Others make hours-long journeys with children and pets in tow.

Travel is even harder, if not impossible, for women who are on parole or probation, notes Candice Norwood at The 19th. Women of color and women of low income are most likely to be affected by incarceration and criminalization as well as abortion restrictions, Norwood writes.

Abortion laws have impacted the health of women and infants in other ways, according to recent studies.

Women in states with strict abortion bans are less likely to access prescription birth control, such as the pill, or emergency contraception such as Plan B, according to a paper in JAMA Network Open. 

That’s likely due to the closure of family planning centers and confusion about what’s legal or not, reports Deidre McPhillips at CNN.

One in 9 women nationwide, and nearly 1 in 5 Black and Hispanic women, rely on family planning clinics for contraception, she notes.

And a JAMA Pediatrics study focusing on Texas, where abortion is illegal after a fetal heartbeat can be detected, found that deaths of newborns and infants went up by nearly 13% after the ban was implemented.

The deaths included babies who had genetic problems or birth defects. Such pregnancies would typically have been terminated, but there is no exemption to allow abortions in those cases in Texas.

“When you take away people’s ability to make decisions if and when they have pregnancies, you’re going to see outcomes like increasing infant and maternal mortality,” Dr. Tracey Wilkinson, an associate professor of pediatrics at the Indiana University School of Medicine, told Eduardo Cuevas at USA Today. 

The Supreme Court recently upheld access to one of the medications used in abortions, mifepristone, at least for now. Last week, the Court ruled that hospitals that receive federal funding in Idaho should provide emergency abortion care to protect pregnant women’s health while legal wrangling over the state’s ban continues.

Supreme Court takes on gender-affirming care

The U.S. Supreme Court will also consider a case involving transgender health. The Court will take on a challenge to Tennessee’s 2023 ban on gender-affirming care for minors. 

Tennessee’s law forbids physicians from providing medical treatment, such as puberty blockers or hormones, to help the patient identify with a gender “inconsistent with the minor’s sex.” It also forbids physicians from treating a minor’s gender dysphoria, the distress caused by a mismatch between one’s gender identity and assigned sex.

“These bans represent a dangerous and discriminatory affront to the well-being of transgender youth across the country,” said Chase Strangio, deputy director for transgender justice at the American Civil Liberties Union, one of the parties challenging Tennessee’s law, in a press release.

Both the American Academy of Pediatrics and American Medical Association support gender-affirming treatment, note Geoff Mulvihill and Carla K. Johnson at AP News.

Gender dysphoria has been associated with depression and thoughts of suicide, and two new studies support the link to mental health issues.

From 2014 to 2022, as states enacted anti-transgender laws, the rate of distress and depression has doubled among transgender and gender-diverse adults, according to a study published last week in JAMA Internal Medicine. 

Physical health also worsened among transgender and gender-diverse adults during the study period, reports Ernie Mundell at HealthDay.

Loneliness and stress are also more common among transgender and bisexual adults compared to cisgender individuals, according to a study by the Centers for Disease Control and Prevention. More than half of the transgender or bisexual adults surveyed reported sometimes, usually, or always feeling lonely. 

This social isolation may be self-imposed, if individuals are wary of coming out to those close to them, report Mary Kekatos and Dr. Abimbola Okulaja at ABC News.

Loneliness can threaten both mental and physical health; isolation has been linked to higher risks for heart disease, stroke and premature death.

Expert report slams ongoing inequities in health care

A new report from the National Academies of Sciences, Engineering and Medicine says the nation must address health care inequities in order to optimize health for disadvantaged communities.

In 2003, a landmark National Academies report exposed the worse care received by people of color. Two decades on, too little has changed. 

The U.S. health care system “is broken and by its very design, delivers different outcomes for different populations,” the current report authors wrote.

That flawed design contributes to millions of premature deaths among Americans of color and costs the nation hundreds of billions of dollars annually, the report added.

And these inequities are one of the main reasons U.S. health care quality lags compared to other high-income nations, Dr. Lisa Cooper of Johns Hopkins University, who reviewed the report, told Devna Bose at AP News.

The report pointed at the federal government to enact solutions including affordable health insurance for everyone, better collection of race and ethnicity data and more funding for research, the Office of Civil Rights and the Indian Health Service.

Another key solution suggested by the report is greater diversity in the health care work force, Bose reports. 

“People of color generally receive better care when treated by those who look like them” she writes.

Some health equity researchers said the new recommendations stop short of what’s needed, reports Usha Lee McFarling at STAT. Health inequities are linked not just to issues within the health care system, but also to social factors such as housing, poverty and education.

“The recommendations all have merit but they don’t go far enough,” said Louis Penner of Wayne State University, who has argued that health disparities won’t improve without addressing socioeconomic inequities beyond the health care system.

From the Center for Health Journalism

• July 10 is the deadline to apply for our Data Fellowship, taking place Oct. 7–10. The hands-on fellowship trains journalists to “interview the data”  to produce a major investigative or explanatory health reporting project or series of data-driven health stories. Fellows receive a $2,000 stipend and five months of professional mentorship. Learn more here!

• July 31 webinar, 10–11 a.m. PT: “Disappearing Options: Tracking the Story on Reproductive Health Care.” Featuring Shefali Luthra of The 19th, Maya Manian of the American University Washington College of Law, and Eleanor Klibanoff of The Texas Tribune. Free. Sign-up here!

What we’re reading

• “Young gay Latinos see a rising share of new HIV cases, leading to a call for targeted funding,” by Vanessa G. Sánchez and Phillip Reese, KFF Health News, and Devna Bose, AP News
• “Access to health care limited in rural and reservation areas” and “Rural and reservation health providers face major hurdles in South Dakota,” a two-part series by Bart Pfankuch in South Dakota News Watch
• “FDA issues long-awaited draft guidance for enrolling more people of color in clinical trials,” by John Wilkerson, STAT
• “FDA ban on shock devices for those with developmental disabilities faces new hurdle,” by Michelle Diament, Disability Scoop
• “Older women are different than older men. Their health is woefully understudied.” By Judith Graham, KFF Health News
• “Gun violence is now a public health crisis. What does that actually mean?” By Jennifer Gerson, The 19th