Q and A on Women's Health after Roe vs. Wade
Columbia Nursing’s Veronica Barcelona, PhD, and Rebekah Ruppe, DNP ’09, provide their unique perspectives on the recent Supreme Court decision overturning Roe vs. Wade and its implications for women’s health in this Q and A. Barcelona, an assistant professor, investigates inequities in reproductive health among women and families of color. Ruppe, also an assistant professor, directs Columbia Nursing’s Nurse Midwifery Program.
Q: As a researcher committed to reducing inequities in pregnancy and adverse birth outcomes, do you anticipate that the Supreme Court ruling will make these inequities worse?
Barcelona: There is no doubt that the Supreme Court ruling will lead to unnecessary morbidity and mortality for girls, women, and people with the capacity for pregnancy, widening health disparities in pregnancy and birth outcomes. This ruling infringes on the human rights of half of all Americans to make autonomous decisions regarding their own well-being and health care. The reversal of the right to safe and legal abortion also reinforces white supremacy and structural racism by disproportionately affecting Black, Latinx, Indigenous, and other people of color, as well as those who are of low socioeconomic status. In addition, children born of unwanted and unintended pregnancies disproportionately end up in foster care systems. We are increasing the likelihood of incarceration for communities that have already been burdened by systematic exclusion.
Q: What impact will the Supreme Court’s decision have on midwifery, and the field of nursing in general?
Ruppe: Abortion care is health care and has always been a part of midwifery practice. Though some individual midwives don’t choose to provide abortion care, that does not eliminate it from the scope of full spectrum reproductive health care and services that comprise our profession. Without safe and legal abortions, lives are at stake–physically, mentally, emotionally, financially. This is true for anyone who could become pregnant and for the midwives that would care for them.
Professional midwifery organizations have reaffirmed their support for abortion as health care and a part of midwifery practice. Our state organization, New York Midwives, distributed a strong statement in response to the Supreme Court decision. They outlined specific and ongoing actions the organization will take to ensure individuals will continue to have access to abortion care in New York State, which includes removal of any obstacles to midwifery-led abortion care.
In New York State, access to abortion is codified and legal. The Reproductive Health Act (2019) allows for trained licensed midwives, nurse practitioners, and physician assistants to legally provide abortion care. There are a number of current bills and initiatives in New York that will ensure a range of support for abortion care including expanding healthcare provider capacity for abortion care, supporting safety and security of service sites, providing legal protections for providers, facilitating travel to NYS for abortion care, paying for eligible travel and services, and allowing for civil actions to be brought against anyone who obstructs a person’s right to abortion care. In addition to New York, several states and the District of Columbia have protections for abortion care and some states are expanding these protections. Interested individuals can follow state policy activity through the Guttmacher Institute’s State Legislation Tracker.
Q: How can nurses and nursing students help promote access to safe health care in the wake of this decision?
Barcelona: There is a lot that nurses and nursing students can do to support the self-determination and bodily autonomy of their patients. This includes advocacy efforts such as donating to abortion funds and writing to elected representatives and legislators to protect and expand abortion access. We also must continue to provide the highest standard of evidence-based care for women presenting with reproductive health concerns including miscarriage and abortion. We can share trusted resources with patients for finding abortions and getting assistance with travel and transportation costs (i.e. abortionfinder.org and the National Abortion Federation) I also would encourage nurses and students to continue to educate themselves on the history of forced birth, sterilization, and reproductive control in the United States; the books “Medical Apartheid” and “Killing the Black Body” are excellent sources. Nurses should also be aware of and support the reproductive justice movement, defined by Sister Song as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” Get involved and support the organizations who have been doing this work for decades.
Ruppe: There are many roles that nurses and nursing students can fill—education, advocacy, and political action are key. In order to educate others, they must first educate themselves. They should learn about the Reproductive Justice Movement. They should learn the history of forced birth among enslaved women, contraceptive pill research in Puerto Rico, and forced sterilization of many marginalized people—indigenous women, those living with disabilities, in poverty or in incarceration. They can become informed about the link between reproductive justice, reproductive rights, reproductive healthcare access and broader issues of the economy, health care and employment. They can consult state abortion laws to determine whether abortion care is within the scope of practice of advanced practice providers in their state. They can attend webinars and online trainings to become more informed about early abortion procedures. Training in Early Abortion for Comprehensive Healthcare (TEACH) has an Abortion Training Curriculum for reproductive healthcare providers and an Abortion Pill continuing education program. They can share information about organizations that have been offering legal medication abortion via telehealth (Aid Access, Carafem, Hey Jane and Just the Pill to name a few). They can get involved in advocacy through groups like Nursing Students for Reproductive Health and Reproductive Health Access Project and their Beyond Roe initiative. They can connect with organizations that have been working to fill gaps in access to and coverage for abortion for decades like the National Network of Abortion Funds, a network of grassroots organizations that provide direct support to individuals seeking abortion. Their mission is to “build power with members to remove financial and logistical barriers to abortion access by centering people who have abortions and organizing at the intersections of racial, economic, and reproductive justice.” Through NNAF interested nursing students and nurses can find local abortion funds in their area to donate and sign up for action alerts.
Q: Is there anything else you would like to mention about the impact of the Supreme Court ruling for women’s health?
Ruppe: When women and pregnant people are denied abortion, they experience lasting mental, physical, and socioeconomic consequences. The Turnaway Study (Advancing New Standards in Reproductive Health, ANSIRH) examined the effects of unwanted pregnancy on the lives of women and found that those who were denied a desired abortion and had to carry a pregnancy to term experienced greater household poverty, struggled to cover basic living expenses, were more likely to remain involved with an abusive partner, had poorer bonding with children, and had higher morbidity and mortality than those who received an abortion. ANSIRH offers a lecture series on The Turnaway Study and the consequences of receiving versus being denied an abortion in the U.S.
Barcelona: Nurses should advocate for equality in the laws and systems that support motherhood. Many women will be forced to carry pregnancies to term that they did not choose, and even for those that desire their pregnancy, we can and should do better, by providing paid maternity leave, universal health care, support for breastfeeding mothers, subsidized child care, and more. Women bear the heavy burden of managing their own education and career development, childrearing, and family responsibilities, and society should share this burden. In the end, we all benefit from better conditions for pregnancy, childbirth, and childrearing for all.