Bubbling Up

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When Governor Mike Parson signed House Bill 126 into law on May 24th, he stated this action signaled that Missouri stands for protecting women’s health. This law is just the latest action that flies in the face of a preponderance of evidence, conflicts with widespread consensus among health professionals, and will, in fact, be harmful, not helpful to women’s health overall.

Evidence of progress over the past several decades is nicely highlighted by the national Office on Women’s Health in its “30 Achievements in Women’s Health in 30 Years.” These include decreases in breast cancer and HIV/AIDS deaths, decrease in teen pregnancy, cervical cancer prevention, making birth control better, safer and more accessible, and approval of emergency contraception. Scientific evidence and professional guidance have been important tools in these advances. Work at the National Institutes of Health, the Food and Drug Administration, and other federal agencies is increasingly focused on strengthening research on diseases and conditions that affect women. Building on the need to focus specifically on women’s health, in April the Journal of the American Medical Association launched a new series of articles entitled “JAMA Clinical Insights: Women’s Health.” Science continues on a path to more robust and systematic efforts to equitably investigate women’s health issues.

Access to the full range of reproductive health services has been a primary component in these advances. The Centers for Disease Control named family planning one of the 10 greatest public health achievements of the 20th century. Benefits include preventing unintended pregnancies, reduction of maternal deaths, reduction of infant deaths, and increase in healthy pregnancies. Benefits extend well beyond direct health indicators to a variety of improvements in various social determinants of health, including higher earnings, increase in labor market mobility, and greater access to non-wage health benefits.

And the evidence shows when access to reproductive health services is limited through laws, regulations, and bureaucratic requirements, women suffer. When one country outlawed abortion, maternal mortality rates more than doubled. When access to abortion was reinstated, the maternal mortality rate dropped back down within a single year. In one rural Indiana county, within two years of the only HIV-testing site shuttering its doors due to technicalities similar to Missouri’s new law, cases of HIV skyrocketed to epidemic levels.

Unfortunately, the health of Missouri women lags women’s health nationally. In 2018, Missouri ranked 50th in Health Outcomes for women, down from 43rd in 2016. Women’s outcomes in Missouri are getting worse, not better, so it isn’t just that other states are having better outcomes more quickly – we’re actually moving the wrong way. Also in 2018, Missouri ranked 42nd in maternal mortality with a mortality rate of 32.6 per 100,000 (up 14 percent since 2016) compared to a national average of 20.2. Black women in Missouri fare even worse, with a maternal mortality rate of 65 compared to a white rate of 28.2.

If we’re truly interested in improving women’s health, there are several models we could quickly implement. Here in St. Louis, the Contraceptive Choice Project demonstrated that investments in contraception produced positive outcomes for women. Similar projects in Colorado and Delaware have had major impact in a short period of time. Recognizing good outcomes when we see them, Missouri Foundation for Health launched The Right Time a few months ago, and we look forward to achieving comparable results for women across Missouri.

Women’s health in Missouri will improve when public officials make decisions and administer public programs through actions that are consistent with scientific evidence and with the judgement of professionals who specialize in caring for women. The American College of Obstetricians and Gynecologists, the leading group of physicians providing health care for women, recently published their statement on Missouri. The statement affirms the need for Missouri to re-focus on helping women. It concludes:

“A right without access is no right at all. The women of Missouri – and across the United States – must have access to the full range of reproductive health care, of which abortion is a component. It is time for politicians to recognize the integrity of the medical profession, and to afford women the respect and autonomy that they deserve.”

Women of color, low-income, and rural women face the greatest barriers in accessing reproductive health care, and health care overall. Recent decisions by Missouri officials, including the adoption of a law that does irreparable harm to women’s access to care, increase those barriers and harm women’s health. Is this the direction we want for a state whose motto is: “Let the welfare of the people be the supreme law?”