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Health & wellness

Roe v. Wade 40 years later: Advances in women’s reproductive health

Tuesday will mark the 40th anniversary of the Supreme Court’s ruling on Roe v. Wade that struck down many state and federal restrictions on abortions, and it’s a perfect time to reflect on how much (and also how little) women’s reproductive health issues have changed since then.

Abortion remains a highly charged political issue -- leading Congress to continue to ban federal funding for abortion procedures. And women in most states are finding it harder lately to get one with the recent passage of more restrictions, like waiting periods.

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“We’ve been fortunate in the state of Massachusetts with policies supporting the availability and accessibility of abortion,” said Dr. Paula Johnson, chief of the Division of Women’s Health at Brigham and Women’s Hospital. “Our state health law is not restrictive and doesn’t limit coverage or payment for abortion services.”

Oddly, the state still has an antiquated law that makes it a crime for a doctor to perform an abortion, punishable by up to seven years in prison -- though it’s been invalidated by Roe v. Wade. Some state lawmakers are trying to repeal it since the law would stand if Roe v. Wade were ever overturned. Doctors can also be imprisoned for providing contraception to unmarried women under another state law that’s been superceded by Supreme Court rulings but remains on the books.

Abortion opponents will be marking the 40 years with their annual march on Washington to protest the Supreme Court decision. “It’s a sad anniversary,” said Eva Murphy, legislative director of Massachusetts Citizens for Life. “The decision has resulted in 55 million-plus deaths since 1973. We’re very aware of the toll this has taken.”

Women now have a plethora of contraceptive choices at their disposal, as well as access to the morning-after pill to prevent pregnancy -- if a condom breaks or they weren’t using contraception -- and prescription medications that can abort a pregnancy before the first eight weeks.

“In the early 70s, all women had for contraception was the pill, which was only available in high doses, the Dalkon Shield, an IUD that was associated with many infections, and sterilization,” said Dr. Alisa Goldberg, a obstetrician-gynecologist at the Brigham and director of clinical research and training at the Planned Parenthood League of Massachusetts. “Over the past 40 years, we have seen the doses in combined oral contraceptive pills drop significantly,” as well as safer IUDs and hormonal contraceptives in the form of a skin patch, vaginal ring, injection, and under-the-skin implant.

Have all these advances reduced the rate of unplanned pregnancies and abortion rates?

That’s likely the case, since both have fallen through the years.

Massachusetts has seen a steady decline in its abortion rates over the past few decades that continued even after more women gained access to health coverage with the 2006 state health law. The state abortion rate dropped from 3.8 per 1,000 women in 2006 down to 3.1 per 1,000 women in 2011.

“Personally, I think this is because of expanded access to long-acting reversible methods of contraception,” Goldberg said.

Nationally, abortion rates have decreased steadily since the mid-1980s. The rate of unplanned pregnancies also fell for awhile but hasn’t budged much in the past 20 years. Half of all American women of reproductive age today will have an unintended pregnancy by age 45, about the same rate as in 1994, according to the Guttmacher Institute, a nonprofit research organization based in New York City.

But Goldberg pointed out that the flattening in the unintended-pregnancy rate doesn’t tell the whole story: higher-income women have seen a continuous decline in unintended pregnancies while low-income women have seen a rise.

Between 1994 and 2006, she said, women with incomes below the federal poverty level experienced a 50 percent increase in unintended pregnancies, while women who had family incomes at least double the poverty level -- more than $22,000 a year for an individual -- had a 29 percent decrease in unplanned pregnancies.

Nearly 70 percent of women in this country who have abortions have family incomes that are less than double the poverty level.

Recently enacted provisions in the federal health law that require insurance companies to cover prescription contraception for free without any co-payments could lead to a dramatic reduction in both unplanned pregnancies and abortions, but it’s too early to know for certain.

Abortion opponents have succeeded, however, in pushing for state restrictions that make it tougher for women to get abortions. Since the Supreme Court upheld a ban on partial birth abortions in 2007 which are performed more than halfway through a pregnancy, more than 30 states have adopted some form of abortion restriction, including bans on abortions at 20 weeks, mandatory ultrasound tests to view the fetus, and 24- to 72-hour waiting periods.

Some states even require doctors to inform women about suicide risks if they seek an abortion, a requirement based on questionable research studies.

“These restrictions, which do nothing to improve the quality of care,” Goldberg said, make it increasingly difficult for women to get abortions.

Murphy said Massachusetts has four bills being considered by its state legislature including one that would require women to sign more detailed consent forms concerning the medical, emotional, and psychological risks of abortions. It’s named for Laura Hope Smith, a 22-year-old who died in 2007 after an abortion in a Hyannis clinic.

Other bills would implement a state ban on partial birth abortions, ban abortions based on gender selection, and allow residents to check a box on their state tax form directing their tax dollars away from abortion coverage.

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.
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