There’s more to reproductive health care than abortion

Dear Leading Ladies,

Tonight at 7pm, Leading Ladies is hosting a Zoom panel to discuss Life After Roe v. Wade with Professor Carrie Baker, a reproductive rights expert and activist; Krisitie Monast, executive director of HealthQuarters; and Sara Stanley, executive director of HAWC (Healing Abuse, Working for Change).

If you’re interested in Life After Roe v. Wade, please register here.

We expect the discussion to be about the limitations that millions of women outside of Massachusetts now face in trying to terminate unwanted or dangerous pregnancies.

We don’t expect much talk to be about women in Massachusetts whose reproductive rights remain protected.

And yet.

Got sex ed? Nope!

Did you know that Massachusetts schools are not required to teach sex education? While the Healthy Youth Act passed the state Senate, it has been blocked from being introduced in the House. According to masslive.com, the act would require “age-appropriate and medically accurate sex education to students in public schools that offer sex-ed classes.” It still wouldn’t require all schools to provide sex ed; it would just require those that do to provide accurate information!

So, just to be clear, students in Massachusetts may not get any sex education and if they do, it is not required to include information about HIV (AIDS) or STI (sexually transmitted infections), LGBTQ+ identities, or abortion. Furthermore, it can emphasize the benefits of abstinence, does not need to cover healthy relationships or consent, and parents may opt out of their children taking the class. Oh, and by the way, teachers do not need to receive any sex education or certification to teach a sex education class.

Scarleteen

According to Planned Parenthood, masslive.com reports, “39 states and the District of Columbia require some kind of sex education and/or HIV education.” Isn’t this a club Massachusetts would like to belong to?

Of course, some schools and school districts in Massachusetts offer comprehensive and impressive sex education programs, including the Boston Public Schools. Hats off to them. But what about all the students who will be sexually active – and let’s be realistic, the CDC estimates that around 40% of teens are sexually active – and may be ignorant about birth control, reproductive biology, pregnancy options, sexually transmitted diseases, healthy versus abusive relationships, and places to explore their sexual identity?

It’s great that abortion is available in Massachusetts, but don’t we owe our young people more?

Who can get birth control?

The good news in Massachusetts is that in 2017 Governor Charlie Baker, in response to President Trump’s attempt to gut the Affordable Care Act, signed ACCESS (Advancing Contraceptive Coverage and Economic Security in our State), a law that allows eligible people to get a year's supply of contraception and emergency contraception at no cost.

All FDA-approved contraceptive drugs, devices, and products for women; female sterilization; FDA-approved emergency contraception (like Plan B) are covered under the measure. A three-month supply of contraceptives is available with a first prescription, then a 12-month supply. Other covered services include device insertion and removal; patient education and counseling on birth control use; follow-up services related to birth control use, like help managing side effects. And, by the way, children under 18 in Massachusetts can receive contraception without a parent's or guardian's permission.

However, the law doesn’t cover male condoms or FDA-approved birth control pills with no generic equivalent. Insurers aren’t required to cover brand name products when a generic is available unless a doctor says it’s medically necessary. The law also does not apply to self-insured employers.

Still, the law sounds pretty good, right? Free birth control! So what happened? Well, according to reports in multiple news outlets, not much. “No one followed up on the 12-month provision,” reported Commonwealth magazine in 2021. “There was no campaign to educate the public about it. Insurers didn’t promote the option to the 1 million women eligible to take advantage of it and even denied coverage to some who asked for it. Pharmacists claimed ignorance, and often told women the provision in the law didn’t exist. As a result, only about 300 women obtained a 12-month supply of birth control last year through the state’s largest insurers.”

Those investigating the issue point to lack of information being shared on insurance websites, with pharmacists, and a complicated system for applying, as well as a lack of education about the law from the state.

We know that contraception helps in family planning – in preventing unplanned pregnancies and providing peace of mind for both those wed and unwed. Clearly, just building a field is not enough for people to come. You need a good billboard and map, too.

Plan B & C

We’ve discussed Plan B (the morning after pill) and Plan C (pharmaceutical abortion that works through the first trimester) before, so we won’t go into them again now except to reiterate that making Plan B easily and affordably available to college students and others could prevent a lot of heartache. Plan C should remain available for Massachusetts residents as an alternative to surgical abortion, if so desired.

Care for the pregnant

In 2020, about 1 in 10 infants (9.9% of live births) was born to a woman receiving inadequate prenatal care in Massachusetts, according to the March of Dimes. Adequacy is measured using the Adequacy of Prenatal Care Utilization Index by combining information about the timing of prenatal care, the number of visits, and the infant's gestational age.

Nationally, that percentage doesn’t look too bad in comparison to states such as Alabama (18.6%), West Virginia (15.2%), Tennessee (17.3%), and Florida (20.2%), but we come up short next to our closest neighbors – Rhode Island (5.1%), Vermont (6.3%) Maine (8.5%), New Hampshire (9.8%), and Connecticut (8.7%). The numbers of Black non-Hispanic women receiving inadequate prenatal care continue to rise most, in Massachusetts and elsewhere.

The following statistics are a decade old, but still instructive. According to mass.gov, 10% of mothers said they did not receive prenatal care as early as they had wanted and listed the top four reasons as “not knowing about the pregnancy (24%); not having a MassHealth card (14%); lack of money or insurance (14%); and lack of transportation, childcare, or inability to take time off from work or school (13%).”

The purpose of prenatal care is to reduce the possibility of miscarriages, birth defects, infections, maternal death, and other preventable health issues that can come with pregnancy and delivery, according to mphonline.org (an online resource for public health students and professionals). The more prenatal care, the better the chance of a healthy pregnancy, a safe delivery, and a thriving baby. In communities where pregnant people are more likely to lack prenatal care, there will be more problematic pregnancies, births and children born with ongoing health issues. Thus, prenatal care is truly a public health issue.

Massachusetts is doing well, but there is room for improvement. More outreach to our communities of color can save lives and ensure healthier childhoods.

What can we do?

Find out what your school district is doing about sex ed. If they have a program, find out if it includes accurate — and age appropriate — information about reproduction, sexual orientation, sexually transmitted infections, and healthy relationships, as well as resources for students to seek out confidential help and support. If they don’t have a program, approach the administration and lobby for one. If the program is insufficient, provide the authorities with examples they might adopt. A good resource is here.

As for Plan B, get in touch with your alma mater and/or the colleges your children attend to voice your support for making this alternative easily available to students – with information about counseling, STIs, and contraception, on display where Plan B is available.

As for birth control and prenatal care, support the local health center in a marginalized community near you. Make sure your donation goes towards their programs for reproductive health care.

We can’t be smug in Massachusetts. Too many people who need reproductive health care are still falling through the cracks.

Be well,

Therese (she/her)
Judy (she/her)
Didi (she/her)
Mackenzie (she/her)
Leading Ladies Executive Team
Leadingladiesvote.org
ladies@leadingladiesvote.org