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Author: Maisie Talbot

  • Abortion History and Access in the US

    Abortion History and Access in the US

    This brief was originally published by Maisie Talbot on February 10, 2022. It was updated and republished by Zachariah Seecoomer on July 4, 2022.

    Abortion is a procedure to end a pregnancy, which can be carried out via two different methods: medication abortion and in-clinic abortion. Medication abortion consists of two different types of medication: mifepristone and misoprostol. The effectiveness of this method ranges from 94% – 98%, while the effectivesness of in-clinic abortion is 99% . After the 12th week of pregnancy, it becomes more difficult to find a provider who will provide both procedures; however, this ultimately depends on which US state the patient is in.

    Pre-Roe v. Wade Supreme Court Decision

    Illegal abortions were common before the judical decision handed down by Roe v. Wade, but they were not widely available to everyone. During the mid 1800’s, many states enacted laws restricting abortions. By 1900, abortion was illegal in all states, with the exception of circumstances where the mother’s life was in danger. At the time, the procedure elicited a high death toll due to unsafe methods, and the lack of antibiotics posed a risk of infection. By 1930, one fifth of the maternal mortality rate was due to unsafe abortions. During the 1950s to the 1960s, the rate of illegal abortions ranged from 200,000 to 1.2 million per year. 

    Access to safe abortion was not an easy task at this time, especially for low-income women. The high cost of having an abortion from a safe provider, the cost of the review process prior to the procedure (to acertain if the mother’s life was in danger), and the costs of travel increased the rates of self-induced abortion. This procedure presented health-related risks like sepsis, internal injuries, and mortality due to a lack of both medical skills and standards necessary for positive health outcomes.

    Roe v. Wade

    Jane Roe, a fictional name to protect the plaintiff’s identity, was an unmarried pregnant woman who filed a lawsuit against Henry Wade, the district attorney of Dallas County, Texas in 1970. Roe fought against the state law that outlawed abortion except for when the mother’s life was in danger if the pregnancy continued. Roe claimed that it infringed upon the right to ‘personal privacy’, and went against the 1st, 4th, 5th, 9th, and 14th amendments. Roe won by a 7-2 majority in the Supreme Court in 1973, thus protecting a woman’s right to have an abortion without “extreme” government restrictions throughout the United States. There are certain specifications relating to the three trimesters of pregnancy within the Roe v. Wade decision:

    1. In the first trimester, the state may not regulate the woman’s choice to have an abortion; it is between the mother and the physician.
    2. During the second trimester, the state may place regulations on the procedure that are ‘reasonably related to maternal health’.
    3. At the third trimester, the state may regulate or exclude abortions entirely, but not if the mother’s life in in danger.

    Without Roe v. Wade, states could enact laws that further restrict the ability to receive a legal abortion. Currently, 22 states have laws restricting the ability to obtain an abortion, and on the alternate side, 15 states, along with D.C., have laws that protect legal abortion access. To check which states have restrictions, and to what extent, click here. 

    Health Implications

    According to the World Health Organization, unsafe abortions still pose a significant risk for maternal health across the world, with 7 million women admitted to the hospital every year as a result. The major long-term physical health impacts of unsafe abortion range from infection, haemorrhage, and injury to the genital tract and internal organs. 

    The American Psychological Association notes that having an abortion within the first trimester poses no more mental health risks than carrying a pregnancy to term. Women who are unable to access abortion are seen to experience higher levels of “anxiety, lower life satisfaction and lower self-esteem,” compared to women who were able to access one.

    Women of lower socioeconomic status (SES) and women of color have the highest rates of abortion in the US, compared to women of higher socioeconomic status and white women. Unintended pregnancy rates among African Americans and Hispanic Americans with a low SES are high. 70% of all pregnancies among Black women are unintended, and 57% for Hispanic women, compared to 42% for White women. These statistics are mostly due to various social and cultural factors, and access to contraceptives if a major factor in unintended pregnancy.

    Current Events

    Restrictive Legislation

    The Texas Heartbeat Act was signed into law on May 19th, 2021 and enforced on September 1st, 2021. This law restricts abortion access after 6 weeks within the state of Texas. This law also allows private citizens to sue individuals who receive, provide, or otherwise abet an abortion past the 6 week mark for up to $10,000 in damages. The United States Department of Justice has sued the state of Texas for the Heartbeat Act, claiming it is invalid under the 14th Amendment, meaning no state can enforce a law that deprives an individual of privilege and immunity; the 14th amendment also prevents the state from depriving life, liberty, and property without due process. However, the Supreme Court rejected the case.

    A draft of a Supreme Court opinion, which is a legal decision, that would overturn Roe v. Wade was leaked on May 2nd, 2022. This verdict would greatly restrict abortion access on the grounds that abortion is not historically a Constitutional right. This would result in 13 states immediately banning abortion in the first and second trimesters of pregnancy (week 1 through week 26) given these states have trigger laws in place. Abortion trigger laws automatically ban or restrict abortion access if Roe v. Wade is revoked.

    Florida Govern Ron DeSantis further restricted abortion access through new legislation which takes effect July 1, 2022; abortion will now be banned after 15-week of pregnancy. Similar 15-week abortion bans were recently passed in Kentucky and Arizona as well.  

    In February and March of 2022, multiple restrictions on abortion medication or pills have been enacted in Kentucky, Wyoming, and South Dakota. These FDA-approved abortion medications are the most widely used form of abortion in the U.S, being responsible for an estimated 54% of abortions. According to the FDA, they are safe to use within the first 10 weeks of pregnancy. The recent restrictions include prohibiting the use of abortion pills, the mailing of these medications, and physicians’ ability to prescribe the medications to these states. 

    Protective Legislature 

    In January 2022, the New Jersey state lawmakers introduced statuary protections in relation to abortion. Abortion statuary protections in New Jersey are state laws that guarantee a woman’s right to terminate the pregnancy, authorize healthcare professionals to prescribe abortion medication, and ensure insurance coverage for pregnancy terminating services. Similar legislation was passed in Colorado and Connecticut in April and May of 2022. In March 2022, a new law was passed in California increasing the economic accessibility of abortions. The law prohibits cost-sharing charges for abortion services by insurance companies. This means that abortion services are included in monthly insurance costs with no additional fees, such as copays. In addition, Oregon lawmakers have passed the Reproductive Health Equity Fund, allocating $15 million to organizations that provide abortions and to individuals in need of abortion services.

  • Health Literacy and Impact on the ‘Infodemic’

    Health Literacy and Impact on the ‘Infodemic’

    Health literacy is an individual’s ability to find, understand, and use information and services in order to make well-informed health-related decisions for themselves or others. Only about 12% of Americans are considered health literate. When health organizations provide patients health information that is difficult for the patient to understand, or has unfamiliar and confusing steps, we create a health literacy problem. Low health literacy is common among Americans who have limited education, are older, have lower socio-economic statuses, are non-native English speakers, and those with chronic medical conditions. Misinformation, which is false or inaccurate information that can deceive or misinform others, can create confusion, fear, and anxiety among those with low health literacy. It can even impact those who have high health literacy and their ability to understand medical information. Misinformation has arguably spread just as fast, or faster, than COVID-19 itself. 

    Health Literacy’s Importance During a Pandemic

    Having a high rate of health literacy can help prevent the onset of illness and disease, reduce national disease averages, and improve population health. A current and persistent threat to global health is the COVID-19 virus, which has caused mass casualties and long-lasting negative health outcomes to the affected global population. There are currently 11 variants of COVID-19, with the Delta variant being of particular interest. Due to an increase in strains and total cases, a rapid transmission of accurate and reliable health information is crucial in preventing the virus from spreading further. Patients who don’t have access to accurate and reliable health information have higher hospitalization rates and develop more chronic diseases, on average. Similarly, Pfizer states that low health literacy is associated with many adverse health outcomes, such as: 

    1. Lower reported health status
    2. Greater mortality rates
    3. Less-specific disease knowledge and ability to recognize common signs and symptoms of illness.
    4. Greater utilization of hospital services, and less confidence and skills needed for self-care and chronic disease management. 

    The Lancet notes that health literacy also involves taking social responsibility, as thinking beyond personal choices and self-interest can make an impact on reducing the rapid transmission of COVID-19 and increase vaccination rates. Health literacy provides the tools needed to prevent and combat these negative health outcomes, and allows patients to make educated decisions about their health. 

    Impact on Vaccine Development

    The current goal is to get 75% of the world population vaccinated with one of the approved vaccines available; Pfizer-BioNTech, Moderna, and Johnson and Johnson/Janssen. Achieving this goal of 75% would mean that herd immunity could take effect, where enough people are protected from COVID-19 to effectively control its spread, thus reducing associated transmission and mortality rates. Currently, about 46.8% of the world has received at least one dose of the three vaccines listed. As of late September of 2021, Africa had the lowest vaccination rate, and Europe had the highest, with North America following closely behind. 79% of shots administered are in high or upper-middle-income countries, and 0.5% of doses were administered in low income countries. Low health literacy and misinformation have targeted individuals through social media, news outlets, word of mouth, etc. Some common misconceptions include:

    1. The COVID-19 vaccine contains a microchip.
    2. The vaccine can make an individual magnetic.
    3. The vaccine can make an individual ‘shed’ vaccine components outside of the body.
    4. The vaccine alters a human body’s DNA.
    5. The vaccine alters a woman’s fertility.

    The CDC notes that most of the misinformation and disinformation has been centered around vaccine development, safety and effectiveness, and COVID-19 denialism. In addition, the WHO calls the spread of misleading COVID-19 and vaccine information an infodemic, that furthers, “skepticism and distrust, which is the perfect environment for fear, anxiety, finger-pointing, stigma, violent aggression and dismissal of proven public health measures – which can lead to loss of life.” This scepticism and distrust has cost the United States over $5 billion from June-August of 2021 from preventable COVID-19 hospitalizations, and caused over 280,000 preventable cases among the unvaccinated during the same time period. Since the onset of the virus, nearly 4.8 million have lost their lives worldwide. 

    How to Monitor Misinformation

    In order to make well-informed decisions about one’s health, access to reliable and factual health information is essential. Monitoring misinformation and disinformation during a global pandemic can be challenging, but there are strategies available to assist with this goal. The International Federation of Library Associations and Institutions (IFLA) recommends these 8 strategies to help spot misinformation:

    1. Consider the source: identify the author (if possible) and investigate other publications the author has made. Is the author relevant and trustworthy?
    2. Read beyond the story or publication, or compare other articles to it in order to increase validity.
    3. Make sure the supporting sources are credible, and support the publication.
    4. Identify if others agree: is it peer-reviewed, or trustworthy among others?
    5. Try to identify if it is a joke/satire.
    6. Check your biases, and consider your own beliefs as they could affect judgement.
    7. Ask the experts: consult credible, trustworthy sources like the WHO, CDC, etc. 
    8. Read the article or story before you click share.

    If one comes across a source that is spreading false information, there are ways to report it here, which provides instructions to report misinformation/disinformation among various social media outlets, like Facebook, Instagram, Twitter, YouTube, TikTok, etc.

  • Maisie Talbot, University of Vermont

    Maisie Talbot, University of Vermont

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    I am a Junior at the University of Vermont studying Health Sciences, and a minor in Behavioral Change Health Studies, and hope to continue my journey in the public health field post-grad.