Along with inflation, crime and threats to democracy, abortion rights are among the big issues on voters’ minds this Election Day.
The perennially fiery topic has heated up even more since the U.S. Supreme Court’s June decision in Dobbs v. Jackson Women’s Health Organization overturned Roe v. Wade and the subsequent Planned Parenthood v. Casey in finding the U.S. Constitution does not confer the right to abortion. Polls leading up to Election Day showed it was one of several key factors motivating Americans to vote this year.
ACPHS faculty in pharmacy, public health and bioethics have lent their expertise to the topic and continue to conduct research on the effects of the Dobbs decision on various aspects of healthcare. Dr. Katie Cardone, Dr. Barry DeCoster and Dr. Jessica Farrell are conducting research on how the Dobbs decision will restrict healthcare outside of abortion; they hope to publish their findings in coming months. And DeCoster joined Dr. Wendy Parker and ACPHS Resident Kara Olstad last month at an Albany Law School forum considering the consequences of Dobbs.
Pharmaceutical Impacts
DeCoster and Olstad discussed the bioethical impacts of the decision and the effects on medical treatment of women who are not pregnant. Their presentation focused on the use of methotextrate, a drug used in the treatment of cancer, autoimmune diseases and ectopic pregnancies, among other conditions. In that last instance, methotextrate has been used to induce abortion in women whose pregnancies occur outside the uterus, causing pain or bleeding, and without much likelihood of resulting in a live birth.
Medical practitioners have prescribed methotextrate for a variety of conditions for more than 70 years. It has been used, for instance, since the 1940s to treat cancer and since the 1980s for rheumatoid arthritis (RA), an autoimmune disorder that affects the synovium lining the joints, causing painful swelling. Olstad called methotextrate the “gold standard of treatment” for RA, helping to halt disease progression. Because it has been around a long time, methotextrate is relatively inexpensive as well as effective, with side effects that are well understood, Olstad explained.
Despite its established track record in treating RA and other diseases, however, methotextrate’s role in inducing abortions may cause some clinicians to stop prescribing it and some insurance companies to stop covering it to protect themselves in the face of the current law, DeCoster and Olstad said. It is one of a number of safe, legal and well-tested medications that may no longer be available to women or available on a more limited basis following Dobbs, DeCoster said.
“In bioethics, often a new technology that is interesting poses new problems … and then ethics and the law catch up,” said DeCoster. “Here, we have an interesting situation. We have had this standard of care for years and years, and now the law is the variable that’s really switched and thrown a bunch of questions into the mix.”
Socio-economic Impacts
Vulnerable women with less political influence and fewer resources, including women of color, will be among the most impacted by the changes in women’s health care wrought by Dobbs, DeCoster said.
Parker’s presentation at the Albany Law School event, about the public health implications of the Dobbs decision, provided further information why that would be the case. Women with incomes below the federal poverty rate are more than five times as likely to have an unintended pregnancy as women with incomes 200% or more above the poverty rate. Among those women who choose abortion, low-income women often lack the resources for adequate health insurance or birth control. Most who choose abortion are already mothers who see another child as impeding their ability to work, attend school or care for their other children, Parker said.
Parker spoke about a groundbreaking study published two years ago from the University of California San Francisco. The aptly named Turnaway Study followed 1,000 women who, between 2008 and 2010, sought abortions around the time of the gestational age limit and were denied the procedure. The study found that 10 years later, women who were denied wanted abortions endured negative impacts, including poor health, low income and living with violent partners. By comparison, women who received sought-after abortions were more financially stable, set more ambitious goals, and were more likely to have a wanted child later.
Parker concluded her talk by questioning whether the health care, child care, and adoption/foster care systems were prepared to serve an increasing number of infants born to mothers who had sought to end their pregnancies.