Women's reproductive healthcare requires reform. Here's what that could look like.
Big Picture:
Women’s reproductive healthcare is difficult to access, overly expensive and, consequently, underutilized by women in America. Preventive and reproductive wellness care must be made readily available to those who need it.
Operative Definitions:
Title X Family Planning Program: A federal grant initiative enacted in 1970 that focuses on providing all-inclusive family planning and other preventive health services.
Reproductive Wellness Exams: Exams centered around examining a woman's reproductive health. Consultations range from pelvic exams to resolving irregular periods.
Medicaid: A federal and state program that provides healthcare cost assistance to qualified people with limited income and resources.
Postpartum: This period begins immediately after childbirth as the mother's body returns to a non-pregnant state.
Important Facts and Statistics:
Title X supported services for more than 3 million people over nearly 4.7 million visits in 2019.
On average, women pay an extra estimated $1,300 per year for essentially the same products and services that men use.
In 2019, close to 10 million women of reproductive age in the U.S. lived below the federal poverty line.
Less than 50% of high schools and about 20% of middle schools in the U.S. teach the 16 topics of sexual health education recommended by the Centers for Disease Control and Prevention (CDC).
Five-Point Plan
(1) Encourage all states to exempt female hygiene products from their respective sales taxes and encourage all 50 states to provide feminine hygiene products in public schools. Exempting female hygiene products will make these products more affordable. Providing these products at schools will increase attendance rates for impoverished students who might otherwise have to stay at home during menstruation and will provide them with a necessity that they may not have at home.
(2) Restore 10.8% of Title X clinic funding. This will restore funding to its 2010 level. By returning $33 million of funding, clinics will become a more significant resource for reproductive care.
(3) Expand Medicaid coverage of postpartum care from 60 days to one year and include mental health counseling. For many women, recovery after birth can be physically and mentally debilitating. Providing accessible physical and mental health care will reduce maternal mortality rates and post-delivery complications.
(4) Encourage the sexual education system in all public middle and high schools to meet the CDC’s 16 essential sexual health topics. Reforming the sexual education system to meet the CDC’s recommendations and including information and statistics about abortion will ensure schools cover topics including STI transmission and pregnancies, how to prevent them and options for care. Additionally, it will provide students with ways to access resources and services if needed. As a result, this could prevent unwanted pregnancies and sexually transmitted infections (STIs) in adolescents.
(5) Include adequate rape, incest and health exceptions to abortion laws. Currently, 18 states prohibit abortion if it is after 20 weeks with no adequate exceptions for cases of rape, incest or some health complication save for a demonstrable threat to the mother’s life. By encouraging these states to provide adequate exceptions, the mental and physical health of women in these scenarios will improve.
Why This Initiative is Important:
This initiative ensures availability, accessibility and quality care for every woman in America. Women who are already covered by suitable health insurance will maintain their access to care. This plan will increase care for the uninsured, which will reduce unintended pregnancies, the spread of STIs and poor delivery outcomes. We can protect the health of our adolescents through proper healthcare and education efforts.
Economic Impact (From Our Student Economist Team):
Estimated effect on the annual federal deficit: + $110 million. States and localities will incur the costs of revamping the curriculum and providing feminine hygiene products in schools. This plan will attain economic security for women and lower long-term healthcare costs.
Final Thought for Now:
“The fundamental purpose of feminism is that women should have equal opportunity and equal rights with every other citizen.”– Eleanor Roosevelt (1935)
Acknowledgments:
The following students worked on this nonpartisan proposal: Sophie Brown, Boston University; Claire Dormitzer, University of Maryland, College Park; Karen Huynh, University of California Los Angeles; Sana Imam, The George Washington University; Sophia Welsh, Mira Mesa High School
The following individuals worked with our student interns and contributed expertise, wisdom and moral support to the development of this proposal:
Lois McCloskey, DrPH: Maternal and Child Health Center for Excellence Director; Associate Professor, Boston University. Boston, MA.
Chadburn Ray, M.D.: Professor of Obstetrics and Gynecology, Augusta University Medical School; member, Georgia Department of Public Health’s Maternal Levels of Care; Member, Maternal Mortality Review. Grovetown, GA.
M. Isabelle Chaudry, J.D.: Senior Policy Manager, National Women’s Health Network. Washington, DC.
Jane Orient, M.D.: Executive Director, Association of American Physicians and Surgeons. Tucson, AZ.
Kelsey Hazzard, J.D: President, Secular Pro-Life; Board Member, Equal Rights Institute. Naples, FL.
Sarah Gehlert: Former Dean, College of Social Work, University of South Carolina; Faculty Advisory Council, Institute of Public Health; Advisory Panel Member, Inclusion Institute for Healthcare. Lexington County, CA.
Note: (This proposal is featured in ONC's first book, Let's Fix America. The opinions expressed in this proposal represent the opinions and compromises of the authors.)
Not all participants agree with every aspect of this proposal. To arrive at a proposal that takes multiple views into account requires compromise and difficult decisions.
Sources:
“An Overview of Abortion Laws” Guttmacher Institute. 9 Mar. 2016 https://www.guttmacher.org/state-policy/explore/overview-abortion-laws#
“Budget and Appropriations.” National Family Planning & Reproductive Health Association, 13 Sep. 2018, https://www.chn.org/organizations/national-family-planningreproductive-health-association-nfprha/
Daw, R. Jamie, et al. “Women in the United States Experience High Rates of Coverage ‘Churn’ In Months Before and After Childbirth.” Health Affairs, vol. 36, no.4, pp. 598-606, Apr. 2017. doi.org/10.1377/hlthaff.2016.1241.
Denford, Sarah, et al. “A comprehensive review of reviews of school-based interventions to improve sexual-health.” Health Psychology Review, vol. 11, no. 1, pp. 33-52, 2017, DOI: 10.1080/17437199.2016.1240625.
Morgan, A. Perri, et al. “Impact of Physicians, Nurse Practitioners and Physician Assistants on Utilization and Costs for Complex Patients.” Health Affairs, vol. 38, no. 6, pp.1028-1036, June 2019, DOI: 10.1377/hlthaff.2019.00014.
“NHPC Press Release: Schools Teaching Prevention” CDC. 9 Dec. 2015, https://www.cdc.gov/nchhstp/newsroom/2015/nhpc-press-release-schoolsteaching-prevention.html
Scaccia, Annamarya. “The Price Young Girls Pay When Tampons Aren’t Free.” Free The Tampons, 29 Feb. 2016. www.freethetampons.org/the-price-young-girls-paywhen-tampons-arent-free.html.
Trumble, Sarah. “What You Should Know about Abortion after 20 Weeks .” Third Way, 19 Feb. 2020, www.thirdway.org/one-pager/what-you-should-know-aboutabortion-after-20-weeks.
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