The Health Divide: These state policies pose health risks for pregnant women, trans individuals

Abortion ban imperils women’s health care in Louisiana 

A new report describes how Louisiana’s abortion ban has made doctors so cautious, they are delaying treatment for women experiencing miscarriages and forcing others to undergo unnecessary cesarean section. 

Black and low-income women are particularly impacted, reports Rosemary Westwood at NPR. Louisiana already has high rates of maternal sickness and death. Most maternal deaths in the state occur among low-income women. And the death rate for pregnant Black women in Louisiana is more than twice that for white women.   

“We were stunned by just how much regular medical practice for pregnant people has in fact been disrupted,” said report co-author Dr. Michele Heisler, medical director of the nonprofit Physicians for Human Rights.  

The report was based on interviews with 30 health care providers and 13 patients, as well as focus group discussions with community-based organizations. These were conducted in 2023, one year after Louisiana was among the first states to ban most abortions. 

While Heisler’s group and the others behind the report — the Center for Reproductive Rights, Lift Louisiana and Reproductive Health Impact — support access to abortion, the authors said “they have simply documented the facts on the ground,” reports Westwood.  

The report is “among the most comprehensive research to date showing abortion bans are changing pregnancy care and worsening maternal health,” writes Westwood. 

Some OB-GYNs are refusing to see pregnant patients until they reach the 12-week mark, when the risk of miscarriage is much lower than in the first trimester. That allows them to avoid providing treatments for miscarriage, which mirror procedures for abortion. 

Such delays in prenatal care can lead to issues such as birth defects, stroke, heart attack or death, Westwood notes.  

Physicians may also delay treating miscarriages or ectopic pregnancies, in which the embryo is growing outside the uterus, until patients are so ill their lives are at risk.  

In other cases, when a woman’s water breaks too early and the pregnancy is not viable, doctors are performing C-sections instead of more routine procedures to clear out their uteruses, to avoid even the appearance of an abortion. 

The latter practice is “ludicrous, absolutely ludicrous,” said Dr. Nicole Freehill, an OB-GYN in New Orleans who was interviewed for the report. “The least safe thing we do, no matter if it’s early in pregnancy or full-term at your due date, is a C-section.” 

The situation could worsen, Westwood reports: Some physicians who participated in the research said they were considering leaving the state, which is already suffering from an obstetrician shortage. 

In Texas, Latino community exposed to toxic air takes monitoring into its own hands 

Citizens living in the shadow of Texas’s Houston Ship Channel, which includes one of the nation’s busiest ports as well as numerous fossil-fuel burning factories lining the shore, suffer from elevated rates of asthma and cancer, report Alejandra Martinez and Wendy Selene Pérez at palabra. 

In the nearby town of Cloverleaf, where almost four in five residents are Hispanic, citizens complain of a “poison-like smell” in air choked with particulates, aggravating breathing conditions. Chemicals such as benzene and formaldehyde irritate the eyes and throat and can cause cancer. 

It’s “some of the dirtiest air in the country,” the reporters write. 

Amnesty International found that the low-income communities of color living near the ship channel had life expectancies up to 20 years shorter than nearby white communities, and called the area a “sacrifice zone.” 

Yet it’s hard to pinpoint the toxins in the air, despite the presence of 23 monitoring sites in the area, the reporters found. Those sites don’t measure many of the pollutants known to be released from local plants. 

And the information that is released is usually limited to English and difficult for those in nearby majority Spanish-speaking communities to understand.  

Many residents said they were unaware of the air monitors. That means they don’t know when it is or isn’t safe to be outside. 

In response, locals have built their own community monitoring networks, posting the data online with a red-yellow-green system to indicate very unhealthy, moderate and good air quality, respectively. 

“We definitely see red (high spikes) happening a lot,” said Anthony D’Souza, a research and policy coordinator at Air Alliance Houston, a nonprofit advocacy group that organized the monitors.  

The community monitors arm nearby residents with “proof” of what’s in the air, allowing them to validate their concerns when bad air seems to line up with health issues, added Juan Flores, who manages the monitoring program for Air Alliance Houston. 

The palabra story was produced in collaboration with Altavoz Lab, a mentorship program for journalists of color, The Texas Tribune and Environmental Health News. 

Anti-trans laws may impact long-term health    

Attempts by state legislatures to redefine sex, allow gender identity discrimination, and block transgender people from public bathrooms have mostly gone unfulfilled — but they still cause ongoing anxiety and stress for transgender individuals, reports Orion Rummler at The 19th. 

The political climate makes people feel unsafe and isolated, which can have long-term consequences for both mental and physical health, said Dr. Carl Streed, president of the U.S. Professional Association for Transgender Health (USPATH). “We’re going to see worse health outcomes in probably the next five, 10 years, if not sooner,” Steed told The 19th. 

Isolation that keeps people out of public spaces and communities can reduce cardiovascular fitness, boosting cholesterol levels and blood pressure, and amplifying risk for strokes and heart attacks. Isolation can also diminish memory and worsen thinking ability. 

Trans teens and young adults are facing worsening mental health as states limit gender-affirming care, said USPATH president-elect Dr. Johanna Olson-Kennedy. Yet such gender-affirming care is a critical component of mental health, she added, helping counter despair caused by gender dysphoria.  

“It’s really important,” she said. “It changes people’s lives and saves their lives.” 

From the Center for Health Journalism 

• April 10 is the deadline to apply for the National Fellowship. This fellowship helps journalists report a major enterprise health or social well-being project with reporting grants of $2,000–$10,000, a week of intensive learning and discussions held June 24–28, and five months of additional mentorship and workshops. Learn more here! 
• April 11 is the deadline to apply for the Domestic Violence Symposium and Impact Reporting Fund. These grants, starting in May 2024, supports journalists covering domestic violence in California with reporting grants of $2,000–$10,000 and five months of professional mentorship. Find out more here!  
• On April 26, 10–11 a.m. PDT, the Center will host a webinar, “Can the Child Welfare System be Saved?” We’ll explore the ongoing crisis, the latest efforts at reform, and how journalists can tell urgent stories of young lives and families at risk. Panelists: JooYeun Chang, director of child well-being at the Doris Duke Foundation; Sixto Cancel, founder and CEO of Think of Us, a nonprofit dedicated to transforming the child welfare system; and Roxanna Asgarian, an independent journalist and author of the 2023 book “We Were Once a Family: Love, Death, and Child Removal in America.” Sign-up here! 

What we’re reading 

• “The attack on IVF is a Pandora’s Box for Black families,” by Margo Snipe, Capital B News 
• “Rapid rise in syphilis hits Native Americans hardest,” by Cecilia Nowell, KFF Health News 
• “Menthol killed a generation of Black smokers. It’s still not banned,” by Joseph Williams, Word in Black 
• “‘It feels like a mountain you never get done climbing’: COVID isn’t over for disabled and older adults,” by Sara Luterman, The 19th 
• “California wants to pay doctors more money to see Medicaid patients,” by Adam Beam, AP News 
• “Can a ‘prescription’ for free fruits and vegetables improve health? Study after study say yes.” By Aria Bendix, NBC News 
• “Two-thirds of Chicago kids under 6 exposed to lead in water, study estimates,” by Frances Vinall, The Washington Post  
• “State Medicaid offices target dead people’s homes to recoup their health care costs,” by Amanda Seitz, AP News