Family Planning services include the dispensary of contraceptives, pregnancy testing, STIs testing with treatment. It does not just include sexual health care but also primary care, cancer screening and preconception and prenatal care.[1] Roe v. Wade, is a Supreme Court decision that established a woman’s legal right to an abortion, it was protected by the privacy rights get off the 14^th amendment in the constitution. It was a legal precedent for Griswold, it established the right to privacy involving medical procedures. Abortion was not just a criminal offense but considered immoral too.[2] Over the past decade there has been a decline in accessible abortions and family planning. Abortions are a very common gynecological procedures in the world, with a worldwide rate of 28 out of 100 women, meanwhile in the United States the abortion rate was 16 per 1000 women. Although these statistics are based on safely induced abortions, unsafe abortions due occur and are a danger to women. It is estimated that 98% unsafe abortions occur in the developing world,[3] and causes approximately 13% of all maternal deaths worldwide, high rates in areas where abortion access is restricted.[4] Denying reproductive health care or making it difficult to access these services are causes in these rates.

The factors that deny the accessibility to reproductive health care as mentioned before are also affected from institutional barriers to state and federal restrictions. For instance, in 2017, although abortion was legalized, 19 states adopted 63 new restrictions on patient’s access, abortion rights, and service provision.[5] This could cause a delay or prevent women from obtaining desired health care, increase cost of care, increase the risk of women remaining in poverty. There’s unacceptable health inequities among low-income women, women of color, and young people.

In the united states there has been a decline of 6.8% of facilities providing abortions. In specific states there has been a more drastic drop (for instance Texas), at least 25% in 10 states over a 7-year period (2008-2014).[6] In some counties, abortions are illegal or inaccessible, but the number of abortions does not decline. Meaning that women would commit to an unsafe and illegal abortion as a last resort, which would cause them to experience complications and even death.[7] Unsafe abortions results in maternal morbidity and mortality, deaths from unsafe illegal unsafe abortions make up a big percentage of all maternal deaths worldwide. Hemorrhage is a common complication of an unsafe abortion which can lead to a hypovolemic shock, coagulopathy and death. The world Organization (WHO), has estimated that, as many as one-quarter to one-third of pregnancy-related deaths is due to complications of unsafe abortion procedures.[8] They also define an unsafe abortion as an abortion that is carried out by people that lack the necessary skills to perform them or use hazardous techniques in an environment that is unsafe and does not meet the medical standards that are required to perform such procedure.

Besides barriers that prevent the access of reproductive health care there are other factors that influence the accessibility of them. Distance is a major factor in the accessibility of reproductive health care. In 2015, the population’s lack of access to an abortion clinic due to the no clinic within 25 miles (0.37%, percentage is the mean of the number of clinics in 25mi.) With the same population in 2015, the distance was increased to 50 miles and the mean of clinics in that area was 0.24%, for 100 miles the mean drastically decreased to 0.12%.[9] Meaning that the population’s access to an abortion clinic was prevented due to distance. Some states have poor public transportations, or people may not have cars making it difficult to have access to these clinics. Besides distance being an issue some states, part of their adapting rules, have restricted operating hours, meaning that these clinics can operate as little as 4 hours a day, and possibly be open 4 days a week as well. This can mean, if you can’t make it in those hours and it’s your closest clinic you would have to go to another clinic with maybe a better working schedule but a greater distance.

Recently there has been an issue in the funding of planned parenthood, the government wants to suspend it funding, the Federal government approximately gives $500 million dollars to Planned Parenthood as funding. In Texas there was a budget cut to TDSHS, Texas Department of State Health Services, it was receiving $111 million to $37.9 million in a time span of one year (2012-2013), that was a 67% budget cut.[10] This would impact everyone, if there’s no funding from the government planned parenthood would have to resort to donations, and even with that it wouldn’t be enough to keep planned parenthood running. This would just make it even more difficult than it is already for those women who need these services.

Most people believe that having an abortion is to have the embryo removed from the womb in a clinic, this is part of the misunderstanding of what abortion is and highlights the importance of teaching programs that need to be established. You can also have an abortion with the help of medication, meaning that there would be no need to go to a clinic and have the procedure done, but instead just take the medication. These medications are mifepristone followed by misoprostol, are medications for abortions, it terminates pregnancies up to 10 weeks of gestation. They’re approved by the United States Food and Drug Administration (FDA). Mifepristone, leads a breakdown of the uterus lining, cervical softening, and increase prostaglandin (group of fatty acids) sensitivity. Meanwhile misoprostol causes cervical dilation and softening and uterine contractions to promote pregnancy expulsion. These medications are 93% to 99% efficient and can be used up to 70 days of the woman’s last menstrual period. The efficiency of these medications can prevent the woman’s need to require a vacuum aspiration procedure to complete the abortion (1% to 7%).[11] But before a woman who wishes to terminate her pregnancy can use these medications, she has to undergo standard counseling in which helps to ensure that she or they (partner as well) are certain of their decision and the best type of abortion for them; whether being medication abortion or a vacuum aspiration procedure. They then have to get screened by a clinician for medical eligibility for the medication. The death rate between women who use misoprostol and mifepristone to women who have a live birth less. Out of the 3 million American users there has only been 19 deaths that is a mortality rate of 0.0006% (ever since they’ve been approved by the FDA in 2000), while women who have live birth mortality rate is 14 times greater at 0.009%. Mifeprex® Risk Evaluation and Mitigation Strategy (REMS) program states that misoprostol and mifepristone may be dispensed in clinics, medical offices and hospitals only. Meaning it cannot be dispensed in pharmacy’s regardless having a prescription. It also requires prescribers to complete a Prescriber Agreement Form and register with the medication’s manufacturer, and on top of that sign an FDA-approved Patient Agreement Form, which summarizes the medications instructions and potential risks.[12] For low-income women, being able to afford insurance or even a single consult with a doctor can be difficult, if a woman is able to get cleared in the screening and is given a prescription she cannot be able to get it a pharmacy, and instead would have to go to her doctor and fill the required paperwork to have hold of the abortion medication regimens. If a woman had an easier way to get ahold of these medications at a lower cost, it would be beneficial for her and her health. Most U. S pharmacies are not involved in abortion care, it can mean that they are unfamiliar with abortion medication regimens, follow up protocols, and the management of complications. This could be solved by integrating trainings into the pharmacist’s education. Pharmacists, have the right to decline or object to dispensing abortion medication for personal and/or ethical reasonings. Not only would this affect the accessibility of misoprostol and mifepristone, but it can cause delays in the treatment. But it can be solved if there is some sort of public education and community organizing, training for pharmacists and outreach, and working with state pharmacy boards to change policies and allowing an easier access for abortion medication.

Such factors can influence the inaccessibility of safe abortions to women, pharmacists denying access to abortion medication, issues with funding the clinics. Safe abortions are so low risk, a woman needs one should have easy access to these services, which can make the rate of unsafe abortion death drop dramatically. There are many ways that can make access to reproductive health care easier. To start with there could be better government funding, a change in pharmaceutical laws meaning a patient can still be able to get their medication regardless of the pharmacist beliefs, better provision of contraception (increase use in developing countries, already cut maternal deaths by 40%), there should also be learning programs to teach others about abortion or other contraceptives. Not only do abortions prevents morbidity and mortality but empowers women and adolescents to make the correct reproductive decisions for themselves and their futures. There already some organizations that try to make reproductive health care more accessible. The American Society for Reproductive Medicine (ASRM), dedicates its focus on advancing the science and practice of reproductive care, which only be achieved if patients have access to a full range of reproductive medical services.  It is also committed to reduce the economic, educational, and political barrier that prevent patients from receiving reproductive care. Society for Family Planning (SFP) is another organization that aids in the accessibility of family planning care, which includes abortions and contraceptive care.[13] With organizations like these it is possible to prevent any abortion-related deaths. There has been a decrease occurring in the U.S from 40 per million births to 8 per millions birth a time period of 6 years due to the increased availability of legal abortion.[14] If we make it easier with help of these organizations we could be able to modest changes to the way reproductive health care is accessible at the moment.

Therefore, when having easy access to reproductive health care can prevent morbidity and mortality (or at least decrease the rates) but empowers women and adolescents to make the correct reproductive decisions for themselves and their futures. And if there teaching programs are implied in schools or doctor offices, anywhere suitable, it would not just inform people but would help make a change in how people think, and help planned parenthood.

 

 

 

 

WORK CITED

1. History.com Editors, “Title Roe v. Wade.”  A&E Television Networks, (2009) https://www.history.com/this-day-in-history/roe-v-wade
2. 2.     Lim, Li Min., Singh, Kuldip. “Termination of pregnancy and unsafe abortion.” Best Practice and Research Clinical Obstetrics and Gynecology 28, no. 6 (2014). 859-869. [https://www-sciencedirect-com.ccny-proxy1.libr.ccny.cuny.edu/science/article/pii/S1521693414001059#tbl4]
3. 3.     Espey MD, Eve., Dennis PhD, Amanda., Landy PhD, Uta., “The importance of access to comprehensive reproductive health care, including abortions: a statement from women’s health professional organizations.” American Journal of Obstetrics and Gynecology, (2018). [https://www-sciencedirect-com.ccny-proxy1.libr.ccny.cuny.edu/science/article/pii/S0002937818307567]
4. 4.     Fischer, Stefanie., Royer, Heather., White, Corey. “The impacts of reduced access to abortion and family planning services on abortions, births, and contraceptive purchases.” Journal of Public Economics 167, (2018). 43-68. [https://www-sciencedirect-com.ccny-proxy1.libr.ccny.cuny.edu/science/article/pii/S0047272718301531#s0040]
5. 5.     Raifman, Sarah., Orlando, Megan., Rafie, Sally., Grossman, Sally. “Medication abortion: Potential for improved patient access through pharmacies.” Journal of the American Pharmacists Association 58, no. 4, (2018), 377-381. [https://www-sciencedirect-com.ccny-proxy1.libr.ccny.cuny.edu/science/article/pii/S1544319118301821#sec1]
6. 6.Mark, Alice G., Wolf, Merrill., Edelman, Alison., Castlemen, Laura., “What can obstetrician/ gynecologists do to support abortion access?” International Journal of Gynecology and Obstetrics 131, no. 1, (2015), S53-S55. [https://www-sciencedirect-com.ccny-proxy1.libr.ccny.cuny.edu/science/article/pii/S0020729215000909]

 

[1] Fischer, Stefanie., Royer, Heather., White, Corey. “The impacts of reduced access to abortion and family planning services on abortions, births, and contraceptive purchases.” Journal of Public Economics 167, (2018). 43-68.

[2] History.com Editors, “Title Roe v. Wade.”  A&E Television Networks, (2009)

[3] Espey MD, Eve., Dennis PhD, Amanda., Landy PhD, Uta., “The importance of access to comprehensive reproductive health care, including abortions: a statement from women’s health professional organizations.” American Journal of Obstetrics and Gynecology, (2018).

[4] Mark, Alice G., Wolf, Merrill., Edelman, Alison., Castlemen, Laura., “What can obstetrician/ gynecologists do to support abortion access?” International Journal of Gynecology and Obstetrics 131, no. 1, (2015), S53-S55.

[5] Espey MD, Eve., Dennis PhD, Amanda., Landy PhD, Uta., “The importance of access to comprehensive reproductive health care, including abortions: a statement from women’s health professional organizations.” American Journal of Obstetrics and Gynecology, (2018).

[6] Fischer, Stefanie., Royer, Heather., White, Corey. “The impacts of reduced access to abortion and family planning services on abortions, births, and contraceptive purchases.” Journal of Public Economics 167, (2018). 43-68.

[7] Espey MD, Eve., Dennis PhD, Amanda., Landy PhD, Uta., “The importance of access to comprehensive reproductive health care, including abortions: a statement from women’s health professional organizations.” American Journal of Obstetrics and Gynecology, (2018).

[8] Lim, Li Min., Singh, Kuldip. “Termination of pregnancy and unsafe abortion.” Best Practice and Research Clinical Obstetrics and Gynecology 28, no. 6 (2014). 859-869.

[9] Fischer, Stefanie., Royer, Heather., White, Corey. “The impacts of reduced access to abortion and family planning services on abortions, births, and contraceptive purchases.” Journal of Public Economics 167, (2018). 43-68.

[10] Fischer, Stefanie., Royer, Heather., White, Corey. “The impacts of reduced access to abortion and family planning services on abortions, births, and contraceptive purchases.” Journal of Public Economics 167, (2018). 43-68.

[11] Raifman, Sarah., Orlando, Megan., Rafie, Sally., Grossman, Sally. “Medication abortion: Potential for improved patient access through pharmacies.” Journal of the American Pharmacists Association 58, no. 4, (2018), 377-381.

[12] Raifman, Sarah., Orlando, Megan., Rafie, Sally., Grossman, Sally. “Medication abortion: Potential for improved patient access through pharmacies.” Journal of the American Pharmacists Association 58, no. 4, (2018), 377-381.

[13] Espey MD, Eve., Dennis PhD, Amanda., Landy PhD, Uta., “The importance of access to comprehensive reproductive health care, including abortions: a statement from women’s health professional organizations.” American Journal of Obstetrics and Gynecology, (2018).

[14] Lim, Li Min., Singh, Kuldip. “Termination of pregnancy and unsafe abortion.” Best Practice and Research Clinical Obstetrics and Gynecology 28, no. 6 (2014). 859-869.