Advertisement

Threats to reproductive health care: time for obstetrician-gynecologists to get involved

Published:November 03, 2016DOI:https://doi.org/10.1016/j.ajog.2016.10.037
      To be healthy, support their families, and be productive members of their communities, women must have access to comprehensive reproductive health services including treatment of miscarriage and ectopic pregnancy and access to abortion, sterilization, and other contraceptive methods. However, in the United States, hospitals and legislative bodies are erecting barriers and limiting access to these basic health care services. These barriers are caused by factors such as hospital mergers (specifically those that are religiously affiliated); federal, state, and local legislation; hospital policies; and business-related decisions are threatening reproductive health care. Such barriers, of which women are often not even aware, put women at real risk of harm. This commentary provides clinical examples of these harms and recommends ways that obstetrician-gynecologists can get involved to publicize the consequences of these barriers and, hopefully, prevent them from occurring or break them down to promote women’s health.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Uttley L.
        • Reynertson S.
        • Kenny L.
        • et al.
        Miscarriage of medicine: the growth of Catholic hospitals and the threat to reproductive health care.
        1st ed. American Civil Liberties Union and MergerWatch, New York2013 (Available at:) (Accessed July 12, 2016)
      1. American Civil Liberties Union of Washington. Overview: restrictions on health care at religiously affiliated medical facilities. American Civil Liberties Union of Washington; 2016. Available at: https://aclu-wa.org/overview-restrictions-health-care-religiously-affiliated-medical-facilities. Accessed July 12, 2016.

      2. Eckholm E. Virginia abortion clinic rules get final approval. The New York Times (2013). Available at: http://www.nytimes.com/2013/04/13/us/virginia-abortion-clinic-rules-get-final-approval.html. Accessed July 12, 2016.

      3. Center for Reproductive Rights. Virginia Board of Health votes to amend regulations designed to shutter abortion clinics; 2015. Available at: http://www.reproductiverights.org/press-room/virginia-board-of-health-votes-to amendregulations-designed-to-shutter-abortion-clinics. Accessed July 12, 2016.

      4. Scotus. Whole Woman’s Health et al v Hellerstedt, Commissioner, Texas Department of State Health Services, et al (2016).

        • American College of Obstetricians and Gynecologists
        Premature rupture of membranes. ACOG Practice bulletin no. 160.
        Obstet Gynecol. 2016; 127: e39-e51
        • Eschenbach D.
        Treating spontaneous and induced septic abortions.
        Obstet Gynecol. 2015; 125: 1042-1048
        • Freedman L.
        • Landy U.
        • Steinauer J.
        When there’s a heartbeat: miscarriage management in Catholic-owned hospitals.
        Am J Public Health. 2008; 98: 1774-1778
      5. American Civil Liberties Union. Tamesha Means v United States Conference of Catholic Bishops. American Civil Liberties Union (2015). Available at: https://www.aclu.org/cases/tamesha-means-v-united-statesconference-catholic-bishops. Accessed July 12, 2016.

        • Freedman L.
        • Stulberg D.
        Conflicts in care for obstetric complications in Catholic hospitals.
        AJOB Prim Res. 2013; 4: 1-10
        • Anderson F.
        • Hogan J.
        • Ansbacher R.
        Sudden death: ectopic pregnancy mortality.
        Obstet Gynecol. 2004; 103: 1218-1223
        • Farquhar C.
        Ectopic pregnancy.
        Lancet. 2005; 366: 583-591
      6. Stationery Office. Why women die: report on confidential enquiries into maternal deaths in the United Kingdom, 1994–1996. Norwich (United Kingdom): Stationery Office; 1998.

        • Berke Fogel S.
        Health care refusals: undermining quality care for women.
        National Health Law Program, Washington (DC)2009 (Available at:) (Accessed July 12, 2016)
        • Dickens B.
        • Faúndes A.
        • Cook R.
        Ectopic pregnancy and emergency care: ethical and legal issues.
        Int J Gynecol Obstet. 2003; 82: 121-126
      7. The American College of Obstetricians and Gynecologists. Facts are important: abortion is health care. 2015. Available at: http://www.acog.org/-/media/Departments/Government-Relations-and-Outreach/FactsAreImportantABisHC.pdf. Accessed July 12, 2016.

        • American College of Obstetricians and Gynecologists
        Increasing access to abortion. ACOG Committee opinion no. 613.
        Obstet Gynecol. 2014; 124: 1060-1065
        • Gabbe S.
        Obstetrics.
        Elsevier/Saunders, Philadelphia2012
        • American College of Obstetricians and Gynecologists
        Prenatal diagnostic testing for genetic disorders. ACOG Practice bulletin no. 162.
        Obstet Gynecol. 2016; 127: e108-e122
        • Tauer C.A.
        Obstetrics and pediatrics: an ethical view.
        Health Prog. 2005; 86: 13-18
        • Finer L.
        • Zolna M.
        Declines in unintended pregnancy in the United States, 2008–2011.
        N Engl J Med. 2016; 374: 843-852
      8. National Survey of Family Growth. NSFG listing E: key statistics from the National Survey of Family Growth. 2016. Available at: http://www.cdc.gov/nchs/nsfg/key_statistics/e.htm. Accessed Oct. 18, 2016.

        • American College of Obstetricians and Gynecologists
        Sexual assault. ACOG Committee opinion no. 592.
        Obstet Gynecol. 2014; 123: 905-909
      9. The Henry J. Kaiser Family Foundation. Medicaid and family planning: background and implications of the ACA. 2016. Available at: http://kff.org/report-section/medicaid-and-family-planning-future-challenges/. Accessed July 12, 2016.

        • American College of Obstetricians and Gynecologists
        Abortion training and education. ACOG Committee opinion no. 612.
        Obstet Gynecol. 2014; 124: 1055-1059
        • MacKay H.
        • MacKay A.
        Abortion training in obstetrics and gynecology residency programs in the United States, 1991–1992.
        Fam Plann Perspect. 1995; 27: 112
        • Turk J.
        • Preskill F.
        • Landy U.
        • Rocca C.
        • Steinauer J.
        Availability and characteristics of abortion training in US ob-gyn residency programs: a national survey.
        Contraception. 2014; 89: 271-277
      10. The American College of Obstetricians and Gynecologists. Restrictions to comprehensive reproductive health care—ACOG. 2016. Available at: http://www.acog.org/Resources-And-Publications/Position-Statements/Restrictions-to-Comprehensive-Reproductive-Health-Care. Accessed July 12, 2016.

        • Institute of Medicine, Committee on Quality Health Care in America
        Crossing the quality chasm: a new health system for the 21st century.
        National Academies Press, Washington (DC)2001 (Available at:) (Accessed July 12, 2016)
        • Sloboda M.
        The high cost of merging with a religiously-controlled hospital.
        Berkeley Womens Law J. 2001; 16: 140-156