Dear LA County Community,  

BARBARA FERRER PhD, MPH, MEd
DIRECTOR, LOS ANGELES COUNTY
DEPARTMENT OF PUBLIC HEALTH
JUNE 21, 2019

The world is a very different place than when Roe v. Wade was decided over 50 years ago. In the 1960s, women could not get credit cards or serve on juries in some states, and most women were not engaged in the paid workforce. ¹ Things have changed dramatically since then. For example, the percent of women in the workforce doubled between 1950 and 2000, with the greatest increase occurring among women in their prime childbearing years. ² Such changes reflect not just one court decision – but a concerted effort by advocates across the country to address profound injustices across social, economic and health policies and practices. However, Roe v Wade was clearly a factor in freeing women to engage independently in US civic and economic life, and beyond Roe v Wade, a series of advances in reproductive medicine, and a set of additional court and regulatory decisions in the 1960s and 70s, promoted access to new contraceptive options. Taken as a whole, these developments changed the lives of women and their families worldwide. In fact, women's ability to control their own reproduction is one of the most important health advances of the 20th century. Now this progress is threatened in the U.S. by a barrage of state and federal laws and regulations that compromise not just access to abortion, but access to contraceptive care. These changes will be catastrophic for women.

It's important to understand the difference between contraception and abortion. Contraceptives prevent pregnancy, while abortion terminates, or ends, a pregnancy. Both are methods of family planning that are vital to women's health and require continued public attention and investment. Every day in the United States, millions of women, alone or with their partners, make the choice to prevent pregnancy when that is not the right path for them or for their families. They do so thoughtfully and responsibly, knowing that at this time, they lack the emotional or financial resources, security, or support required for childrearing, or they choose to not have children. In the best circumstances, they make this decision upstream, before pregnancy occurs. However, for a multitude of reasons, including contraceptive failure, abortion remains an important option enabling women to control if and when they want to be pregnant, the size of their families, and the spacing of births.

RESTRICTIONS ON REPRODUCTIVE HEALTH THREATEN US ALL.
At the federal level, access is being challenged by a “gag rule” on the 3,858 clinics³ that provide federally subsidized reproductive health care for low income women nationwide. The federal Title X program funds care at clinics, some private and some public, that provide health education, cancer screening and care, contraceptive care, well-woman visits, and, in some locations, abortion care funded by non-federal sources (federal funding for abortion is banned everywhere except in cases of rape or incest, or when the life of the woman is in jeopardy). In 2019 the Trump administration tried to impose a "gag rule" on these clinics, prohibiting them from telling patients how they can safely and legally access abortion and requiring that all pregnant women be referred for prenatal care, regardless of their interest in remaining pregnant. In April 2019, a U.S. District Court Judge issued a nationwide injunction stopping these changes from taking effect. Recently, a three-judge panel granted the Department of Justice's motion to lift these preliminary injunctions. While the preliminary injunctions have been lifted, since the panel and the Department of Health and Human Services have yet to offer any instructions on how to implement the final rule, significant uncertainty remains regarding whether the gag rule is in effect.

As this national issue unfolds, we can see that women and families in California are much better off than those in most states. California policies facilitate access to reproductive healthcare without a referral from a primary care provider; assure confidential reproductive and sexual health care for adolescents; require insurance to cover 12 months of contraceptives with one prescription and, in principle, cover the full cost of all contraceptive methods approved by the Food and Drug Administration.* Furthermore, Medi-Cal, California's state version of the federal Medicaid program, provides state funding for abortion coverage. These policies likely contribute to the state's lower than average rates of infant and maternal mortality.

But even in California, we can't afford to be complacent. As the federal administration and many states draw the net tighter and tighter around reproductive care and reproductive choice for women, options will be affected here, too.

The Los Angeles County Department of Public Health strongly supports policies that ensure access to and coverage for comprehensive sexual and reproductive health care. When people cannot access their rights equally, it is an injustice. When women are denied contraceptive and abortion care, their health, and the health of their families, suffers. When reproductive health policy is grounded in ideology rather than evidence, it is an affront to public health. Policy decisions made today will affect the lives of generations of women to come. We must ensure that health care supports and empowers women to do what is best for them, for their families and their communities. The public health community must elevate the national conversation on family planning with facts grounded in science and shaped by our communities' needs for health justice. 

WANT TO TAKE ACTION? HERE'S WHAT WE CAN DO:

Barbara

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References

1. https://www.cnn.com/2014/08/07/living/sixties-women-5-things/index.html
2. https://www.bls.gov/opub/mlr/2002/05/art2full.pdf
3. https://www.hhs.gov/opa/sites/default/files/title-x-fpar-2017-national-summary.pdf
*SB 1053, the Contraceptive Coverage Equity Act, was passed and implemented in CA in 2016. Despite its requirement that health plans provide access to the full range of contraceptive methods approved by the U.S. Food and Drug Administration without cost-sharing, prior authorizations, or denials of coverage, consumers and providers continue to experience delays and denials in care. The National Health Law Program is tracking these denials through an online survey, which is available here.