Q&A with the Physician Leader of Planned Parenthood League of Massachusetts
The availability of family planning services is narrowing as a result of actions and decisions by the federal government and the Supreme Court, including anticipated changes that would reduce patients’ access to a broad range of health care services and limit physicians’ ability to provide evidence-based medical care. Vital Signs asked Jennifer Childs-Roshak, MD, MBA, president and CEO of Planned Parenthood League of Massachusetts (PPLM), a leading provider of reproductive health care and evidence-based sex education, what the recent decisions and proposed changes mean for patients and physicians in Massachusetts and the country.
Jennifer Childs-Roshak
How are politically driven policies on women’s reproductive health care affecting patients across the country?
Politicians across the country have not been shy about trying to make abortion inaccessible. Political attacks also extend to preventive reproductive health care. When politicians rally around “defunding” Planned Parenthood, they are championing an effort that will prevent millions of women, men, and young people from accessing the preventive care they need.
[PPLM health centers] often serve as a gateway to the larger health care landscape, and the people most harmed by these attacks are those who already face significant barriers to care: people with low incomes, people who live in rural areas, people of color, and the LGBTQ community.
So far, we’ve been able to defeat “defunding” efforts on the federal level, but many states are pursuing similar tactics that would keep their residents from accessing preventive care. If anyone questions the impact of these defunding schemes, I tell them to look at Indiana, whose former governor, Vice President Pence, issued budget cuts that led to the closure of a Planned Parenthood health center. That county was left without any HIV-testing provider, and, subsequently, an outbreak of HIV occurred. In the first quarter of 2018, 37 states introduced 308 new abortion restrictions and we know that the more abortion restrictions a state imposes, the worse women and children’s health outcomes are.
Every year, PPLM provides health care to over 30,000 patients across Massachusetts. Its services include routine exams and screenings, birth control, testing and treatment for infections, HPV vaccination, gynecologic care, pregnancy testing and counseling, abortion, and gender affirming hormone therapy. PPLM’s sexual health education programs reach over 12,000 people a year.
Dr. Childs-Roshak, a family physician, is the first physician to lead PPLM and Planned Parenthood Advocacy Fund of Massachusetts. She serves on the Board of Directors of Physician Health Services, Inc., an organization founded by the Massachusetts Medical Society.
Are physicians in Massachusetts protected from political restrictions to their patient care?
The overwhelming majority of Massachusetts voters and lawmakers support reproductive rights and health care, but we are not immune to politically motivated efforts to restrict access to care.
Every year, a small but vocal minority of activists and politicians introduces various bills that would wedge the state in between physicians and their patients. These bills would require physicians to provide state-scripted counseling, arbitrarily ban certain medical procedures, and require abortion providers to meet medically unnecessary requirements. These same groups work against nearly every effort to proactively improve access to reproductive health care and sex education, making it that much harder to close gaps in care and address disparities.
The Supreme Judicial Court has ruled the Massachusetts Constitution protects the right to safe, legal abortion, regardless of the status of Roe, and efforts to roll back reproductive rights have never succeeded in Massachusetts. Still, the current national political environment has emboldened politicians in state houses across the country, making it incumbent on all of us to stay vigilant in defending our rights and the rights of our patients.
What will proposed changes to the federal Title X program, which funds family planning services for low-income women, mean?
Access to affordable contraception, particularly long-acting reversible contraception, has had a profound public health impact. The US is experiencing a 30-year low for unintended pregnancies and unintended pregnancy among teens, and a record low in abortion rates. [The proposed Title X grant funding changes] would prioritize providers who push women toward abstinence or to use fertility awareness methods such as the “rhythm method” instead of providing women with the more effective forms of birth control they are seeking. This could have devastating consequences for patients’ ability to access high-quality reproductive health care.
[In addition, the proposed] gag rule, barring any practice, hospital, or community health center that receives Title X funding from providing or even referring their patients for abortion, [violates] basic medical ethics by forcing providers to withhold health care information from patients. It harms patient health and destroys the trust patients have in their providers.
In Massachusetts, five Title X grantees care for 67,000 patients at 82 locations. [These changes] will leave many women, men, and young people with nowhere to turn for care, and will disproportionately hurt women of color.
If [the proponents of these changes] truly cared about reducing rates of unintended pregnancy and abortion, they would work with reproductive health care providers to improve access to effective contraception and evidence-based sex education.
TITLE X
Title X is the sole federal program dedicated to family planning services. According to the Office of Population Affairs, the Title X program supports about 4,000 safety-net family planning sites that collectively served four million women, men, and adolescents in 2016.
Grant Changes
In February, the administration released its Title X Funding Opportunity Announcement, which included a significant number of changes from previous years. Among the changes, the new criteria eliminate HHS/CDC’s evidence-based clinical Quality Family Planning Guidelines and focus on abstinence and fertility awareness methods such as the “rhythm method,” as an approach to birth control.
Proposed “Gag Rule” (MMS Acts against Gagging Physicians on Reproductive Health Care)
In June, the administration issued a proposed rule that would bar clinicians from specifically referring pregnant patients to abortion service providers, when explicitly requested. Clinics that receive Title X funds that cannot or do not comply with the new rules would lose Title X funding.
How concerned are you about the potential for Roe v. Wade to be overturned?
The significance of Justice Kennedy’s retirement cannot be overstated: the right to access safe, legal abortion in this country is now on the line. [In] at least 20 states, [the right to abortion is at high risk] if Roe v. Wade is overturned. Not only that, this open seat is an invitation for hostile states to pursue additional restrictions and bans.
Roe v. Wade has kept abortion legal in the US even as state and federal policies imposed increasing burdens on people’s ability to access reproductive health care and physicians’ ability to provide care. A woman who seeks an abortion but is denied is more likely to fall into poverty than a woman who can receive abortion care, according to a study by researchers at the University of California.
As we saw in Texas when the state severely restricted abortion, women may take matters into their own hands and attempt self-managed abortion if they cannot access professional care.
When safe, legal abortion is inaccessible, women suffer. In 1965 — eight years before Roe v. Wade — 17 percent of all deaths due to pregnancy and childbirth were the result of illegal abortion. Without Roe, the doctor-patient relationship is undermined by the state and a physician’s medical opinion of what is best for his or her patient would be replaced by the state’s.
What are the health and equality implications of the politicization of women’s health?
The end goal of politicizing women’s health seems to be to control women’s bodies and, in turn, their lives. When women have full reproductive freedom and are able to choose if, when, how, and how many children they have, they are better able to plan for their futures and obtain their educational and professional goals. In fact, contraception has contributed to wage gains made by women since the 1960s and has helped shrink the gender pay gap.
Access to contraception played a critical role in increasing the number of women in professions, like medicine, that have been historically male-dominated. I never would have been able to finish college, no less medical school and a residency, without access to reliable birth control. A woman’s ability to time and space births as she sees fit also improves her health and well-being — and her family’s. It’s no surprise that [family planning] was named one the greatest public health achievements of the 20th century [by the CDC].
Decisions about contraception and pregnancy must be left to a woman in consultation with her physician. Under the guise of religious freedom, every employer [can now] deny their employees insurance coverage for contraception, for religious or undefined “moral” objections. Given the wide-ranging benefits of contraception use for women, men, and families, efforts to politicize this basic, preventive care harm everyone.
How does pressure around reproductive health care affect physicians and their practice?
Whether it’s our administrative workload, patient volume, or other duties, we as physicians already have so much on our plates. The government shouldn’t be making it harder for us to care for our patients. In addition, reproductive health care providers face intimidation tactics against them, their staff, and their patients.
In 2017, the National Abortion Federation, an organization that tracks violence against abortion providers, counted the highest number ever of trespassing and picketing incidents at reproductive health centers since it started tracking in the 1970s. While our security staff and clinic escorts do a wonderful job creating a safe, welcoming environment, no one should have to worry about facing harassment or intimidation in order to simply do their job.
Women demonstrating support for access to reproductive health care at a Supreme Court rally.
