May 2020

As the Covid-19 pandemic grips the nation, health care providers continue to deliver excellent services to patients, many at substantial risk to their own well-being and well-ordered lives. Even outside the direct-care services for patients infected with the virus, providers face varying degrees of risk of contagion, and they carry on. These are the bright, dedicated, and courageous faces in the pandemic.

The shadowy face, however, is evident in structural fault lines in the health care infrastructure: the crises due to health-care-resource shortfalls and systemic inequities giving rise to health disparities. These are not new problems, just ones that have become more apparent under pressure. These problems are ones with which professionals working in reproductive health care are all too familiar—poor access, poor to no insurance coverage, lack of affordability, and barriers everywhere.

Stark recognition and acknowledgement of these problems offer the opportunity to do something about them. We can each contribute a voice to their importance and perhaps to their solutions, or at least amelioration. And it is even more crucial that those of us working in reproductive health care make our voices heard, because forces are at work to throw up more barriers in our field, even as the Covid-19 pandemic grips the nation and an ensuing recession threatens to exacerbate inequities.^[1]

The urgent pressures brought to bear by the Covid-19 pandemic may be providing cover to steadily ongoing efforts to undermine reproductive health care. Once again, dissenters will be presenting arguments to the U.S. Supreme Court to restrict contraceptive coverage through the Affordable Care Act.^[2] Anti-contraceptive policy makers and employers want sweeping new regulations allowing wide-ranging exceptions for businesses, schools, and insurers who hold objections to the ACA contraceptive provisions. Appeals courts had blocked the new regulations, so the argument advances to the U.S. Supreme Court. We have yet to learn the impact from the changing tenor of the Court, whose justices will need to examine whether their legal decisions are influenced by personal beliefs about the value of women’s access to medical drugs and devices that allow them to determine their family needs and desires.

Additionally, according to the ACLU, the distraction of the Covid-19 pandemic is exactly the cover to accomplish a long-held policy objective of lawmakers opposed to reproductive rights—eliminating access to abortion care.^[3] While most states have allowed  medical professionals to determine what is essential or non-essential for patients’ health, several states prohibited time-sensitive abortion services. The prohibition included not only surgical procedures, but it also specifically banned medication abortion.  As these states are beginning to lift restrictions, the threat to abortion services will remain. Even before the pandemic, in 2019 alone, states passed 59 new restrictions on access.

These are tough times, and with the current challenges imposed by the Covid-19 pandemic and by those who choose to use it as an excuse to promote an outside agenda, it may be feel hard to be hopeful or to feel that what you do is appreciated.

For many areas in clinical medicine, the value of their services is not questioned or impugned. Over the years, the authors of Contraceptive Technology have drawn upon the insights of our long-time colleague, Felicia Stewart, whom we continue to miss dearly.^[4] We share here some of her inspirational words:^[5]

“Becoming an expert on heart disease management has self-evident value, and is not controversial. The value of work as a heart disease clinician is not likely to be attacked as immoral, and heart problems are not likely to be cared out for special scrutiny as expenditures by public health services. The local town council or school board is not likely to ask the local heart specialist to testify about proposed local policies. Unfortunately, this is not true for clinicians working in the field of family planning services and reproductive health.

“When we talk with patients about their sexual and reproductive health, counsel patients about their contraceptive options, provide abortion care to patients who have decided to terminate an unintended pregnancy, work to shape public policy, or contribute to reproductive health research, we are engaged in a critically important and deeply moral undertaking.

“Reproductive health care reflects a deep commitment to the moral importance of parenthood and children. Our work helps ensure that every pregnancy is [wanted] and as safe as possible, and that children are born when their parents are best able to provide the love and support they need to thrive. In sum, reproductive health care makes an essential contribution to the human infrastructure we count on for our society’s wellbeing, opportunity, security, freedom.

“As scientists, clinicians, and educators, we may not be accustomed to talking about values and the spiritual aspects of what we do. But despite our shyness, we need to do a better job of explaining our own moral values as we work with colleagues and patients—we need to teach the why as well as the what, when, how, and science of reproductive health. Otherwise, it is easy to understand how the moral high ground has increasingly seemed to belong to those who oppose efforts to provide reproductive health care. For many of us, the moral importance of our work is its most compelling appeal, and it helps sustain us in the face of political and economic challenges.”

To all, be safe; be well. Thank you for all you do.

^[1] https://nwlc-ciw49tixgw5lbab.stackpathdns.com/wp-content/uploads/2020/03/NWLC_FactSheet_COVIDxRepro.pdf

^[2] https://www.guttmacher.org/article/2020/01/acas-birth-control-benefit-back-supreme-court

^[3] https://www.aclu.org/news/reproductive-freedom/the-battle-for-abortion-access-is-in-the-states

^[4] Felicia Hance Stewart, 1943-2006. Formerly: co-director, UCSF Center for Reproductive health research & policy; director of reproductive health programs, Henry J Kaiser Family Foundation; deputy assistant secretary of population affairs, U.S. Public Health Service.

^[5] Stewart FH. Preface. In: Hatcher RA, Trussell J, Stewart FH, et al. Contraceptive technology. 18th revised edition. New York: Ardent Media, Inc., 2004.