The Biden administration plans to leverage the federal government’s clout as a major purchaser of health services to try to improve the quality of maternal care, with plans to create a new “Birthing-Friendly” hospital designation.
Physicians treating pregnant women/people needing emergency medical care are wrestling with how to comply with what’s been called the bedrock law of emergency medicine when facing strict, new mandates on abortion.
“Confusion among emergency room doctors remains even after the Biden administration clarified this week that federal law allowing abortions in life-or-death situations supersedes any restrictions a state may have on the procedure,” Tony Pugh wrote for Bloomberg Law on Wednesday. His article explained how conflicting federal and state laws are complicating abortion care.
Early this week, Melanie Evans of The Wall Street Journal took a close look at how physicians and hospitals are addressing the mandates of the Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 in the wake of the overturning of Roe v. Wade. That decision in Dobbs v. Jackson Women’s Health Organization stripped away an almost 50-year-old right to an abortion.
Even before the SCOTUS decision on June 24, many states had enacted laws to either restrict or prohibit abortions or expand and protect access to abortion in anticipation of the ruling to overturn Roe v. Wade, as noted in the nonprofit Kaiser Family Foundation’s tracker of these measures.
Within days of the Supreme Court ruling overturning the landmark Roe v. Wade case, information about abortion spread rampantly online.
One area of ambiguity has been the use of femtech, or technology such as period-tracking mobile apps to support women’s health. People have raised concerns about what will happen regarding computer or phone search histories for reproductive care.
“There’s a lot of information floating out there,” said Bethany Corbin, senior counsel with Nixon Gwilt Law, in an interview with AHCJ. “The main concern is that period-tracking apps or other femtech apps will serve as a way for law enforcement to get access to sensitive reproductive health data and criminalize a woman for having an abortion or even a suspected abortion. It is a legitimate concern.”
Law enforcement can access data from apps in multiple ways, Corbin said. But if women start to delete apps, there may be a longer-term negative impact on women’s health, she said, adding that some apps partner with research institutions to use data to gain valuable insights into women’s health. Removing these apps could also result in decreased access to care for some people, particularly those living in rural areas at or below the poverty line who otherwise may not have access to reproductive health care.
It may take months or years before we grasp the health-related ramifications of the Supreme Court ruling that makes it legal for states to ban and restrict abortion. But the existing health equity data about key reproductive health measures — including maternal mortality, birth control use, and abortion — offer clues and raise questions about the short- and long-term effects the decision will have on the quality of health of females from the country’s largest race and ethnic groups.
With those health topics in mind, we’re offering a new tip sheet with resources about unintended pregnancy, birth control use and abortion. These materials may help explain why trends aren’t solely the result of personal choices or cultural practices but also related to lingering distrust of a medical system rife with racist policies, socioeconomic bias among medical providers, availability of medical facilities, and other social and structural determinants of wellbeing. The reports, studies, and data we’re sharing will help you add more depth to stories about the implications of the Supreme Court ruling on a procedure that is an integral part of reproductive health care.
Disparities in reproductive health measures
In the process of gathering information to explain why non-Hispanic Black and Hispanic women may be most affected by the decision, all roads lead to birth control data. The CDC authors of this 2021 report on abortion trends connect the dots between birth control use and unintended pregnancy and abortion patterns. More specifically, the report’s authors suggest that differences in quality family planning services, among other reasons, could explain why non-Hispanic Black and Hispanic women of reproductive age are more likely than their non-Hispanic white counterparts to have unintended pregnancies and abortions. (see Figure 1)
The Department of Health and Human Services (HHS) on Wednesday outlined plans to try to protect patients’ civil rights and privacy as states move to outlaw abortion, including reaffirming limits on medical professionals’ sharing of information with law enforcement officials.
HHS also offered tips for protecting health information shared with third-party apps. In these efforts, HHS highlighted the role of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule in protecting patients while also effectively showing some limits to federal protection.
The HIPAA rules, for example, generally do not protect the privacy or security of information when it is accessed through or stored on personal cell phones or tablets, with some exceptions for ones developed by organizations covered by federal privacy law, HHS said. Information collected may be sold to data brokers, often selling it for marketing or other purposes.
The HHS Office for Civil Rights (OCR) issued new guidance addressing how federal law and regulations protect individuals’ private medical information (known as protected health information or PHI) relating to abortion and other sexual and reproductive health care. In it, HHS said that law enforcement officials seeking access to medical records must have court orders or otherwise have met privacy mandates.