“My research centers on examining the intersection of policy, health and economics. In no other area of medicine is policy as critical to health as ob/gyn. It is essential to understand how policy can promote health, or perpetuate reproductive health disparities,” said principal investigator Maria Rodriguez, MD, MPH, an associate professor of ob/gyn in the Section of Family Planning at Oregon Health & Science University in Portland.
During the first 2 years of Oregon’s Reproductive Health Equity Act (RHEA), immigrant women across the state used the expanded coverage to access abortion, indicating that the policy was fully enacted in metropolitan and nonmetropolitan areas alike, according to a research letter in JAMA Health Forum.
Oregon’s RHEA, which took effect January 1, 2018, ensures coverage for family planning, including abortion and contraception, through state funds for all low-income state residents, regardless of citizenship status.
“Oregon leads the nation in innovative and progressive reproductive health policy.” said principal investigator Maria Rodriguez, MD, MPH, an associate professor of ob/gyn in the Section of Family Planning at Oregon Health & Science University in Portland. “My research centers on examining the intersection of policy, health and economics. In no other area of medicine is policy as critical to health as ob/gyn. It is essential to understand how policy can promote health, or perpetuate reproductive health disparities.”
The cross-sectional study of abortion services reimbursed under Oregon’s RHEA in 2018 and 2019 encompassed 11 standalone clinics statewide and one hospital-based clinic.
Oregon’s RHEA allowed for 625 abortions during the 2 years.
Nearly half (48.3%) of the abortions were for women aged 25 to 34 years (range, 15 to 46 years).
The vast majority of abortions (79.7%) were for women who resided in metropolitan zip codes.
Mirroring national trends, nearly all abortions (93.9%) occurred during the first trimester, and slightly more than half (57.3%) were surgical abortions.
But there was no difference in rates of second trimester abortion by residence: 5.6% metropolitan vs 6.3% nonmetropolitan (P =.94).
Additionally, a vast majority of abortions (80%) were for women who had previously given birth.
The primary outcome of the study was the distance traveled to receive an abortion, which was a median distance of 8.73 miles, ranging from 0.42 miles to 124.44 miles.
Nearly a third of the women (30.2%) traveled less than 5 miles to receive abortion care, while 5.1% traveled 50 miles or more.
“Reproductive health is fundamental, to not just an individual’s health and rights, but also to the well-being of our communities,” Rodriguez told Contemporary OB/GYN®. “However, unintended pregnancy is becoming increasingly concentrated among people who are low-income or of color.”
Restricting access to essential health care services, such as abortion, may perpetuate multigenerational cycles of poor health and inequity, according to Rodriguez. “It is important that Oregon implemented this equitably in rural and urban areas because all individuals need access to quality abortion care,” she said. “While the population of women who need the newly covered services is small, meeting the needs of this unique subpopulation is important for both the health of our community and achieving reproductive justice.”
Several other states also are intent on passing policies to promote reproductive health equity, including Virginia and New York.
“For ob/gyns and other providers focused on women’s or public health, the clinical and justice repercussions of restricting access to preventative and reproductive health care for low-income individuals on the basis of citizenship has always been clear: it is a lose-lose scenario,” Rodriguez said.
This picture perpetuates disparities in reproductive health care and has far-reaching consequences for communities, according to Rodriguez.
“The same is true from a policy perspective,” she said. “Limiting access to reproductive health care based on citizenship alone worsens health outcomes and increases system costs.”
Rodriguez said the challenge lies at the political level. “Also, the need for us as a society to recognize the benefit we all receive by providing essential health care services to all individuals who need it but cannot afford it,” she said.
Rodriguez reports no relevant financial disclosures.
Rodriguez MI, Skye M, Shokat M, et al. Women’s access to abortion care under Oregon’s Reproductive Health Equity Act. JAMA Health Forum. Published online May 21, 2021. doi:10.1001/jamahealthforum.2021.0402