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Daily Dose

Advances in reproductive health since Roe v. Wade

Manuel Balce Ceneta/AP/File

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 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 Doctors can also be imprisoned for providing contraception to unmarried women under another state law that’s been superceded by Supreme Court rulings but remains on the books.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 many contraceptive choices, as well as 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 [effective] 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.

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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 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.

But Goldberg said 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.

Recently enacted provisions in the federal health law that require insurance companies to cover prescription contraception for free without any copayments 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 in pushing for state restrictions that make it tougher for women to get abortions, including waiting periods and mandatory ultrasounds of the fetus.

Murphy said four bills are pending in Massachusetts, including one that would require women to sign more detailed consent forms concerning the medical and psychological risks of abortions. Other bills would implement a ban on partial-birth abortions, ban abortions based on gender selection, and allow residents to direct their tax dollars away from abortion coverage.

Deborah Kotz can be reached at dkotz@globe.com.

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