Women’s Health
Revisited-Reproductive Health and Violence Towards Women
State healthcare laws impact women and should be considered
by anyone thinking of relocating within the USA. Primary measures of women’s
health and well-being include: access to reproductive services, availability of
birth control options, maternal death rates, proportion of women covered by
medical insurance, and violence against women. In order to keep this a
blog-sized article, this analysis reviews; reproductive services, sex education
mandates, and reported rates of rape, murder, and aggravated assault, which
includes domestic violence. A subsequent issue will explore other components of
women’s health.
Access to Abortion
Roe-v-Wade, the Supreme Court ruling which made abortions
legal in the United States was enacted in 1973. The majority of the national population
felt that abortion should be legally available to women then and still do
today. A 1979 study conducted by the
Gallup Organization found 80% of the population believed abortion should be
legal and 70% thought it should be available to women on Medicaid. (Public
Perception on Abortion) It should be noted, the survey was
commissioned by Redbook Magazine, which would have targeted a largely female
population, so this acceptance of abortion rights may reflect the feminine
viewpoint. A Harris Group poll at the time found 60% of Americans thought
abortion should be legal in all cases. Fast forward to 2018 and Pew Research
found that 58% of Americans still think abortion should be legal and only 15%
were willing to say that abortion should be illegal in all cases, including
rape, incest, and when the woman’s life is endangered. (Public
Opinion on Abortion, 2019) The latter must view
women as a host body rather than as emancipated individuals.
Table of Abortion Laws
Most Restrictive
|
Moderately Restrictive
|
Least Restrictive
|
Bans at 0-12 weeks
gestation, which is during the first trimester of pregnancy
|
Allows abortion during the
second trimester of pregnancy; 12-24 weeks gestation
|
States which permit
abortion to-24-weeks and into the third trimester; depending on the circumstances
|
6 weeks-Louisiana* Senate
Bill 184 proposes banning abortion at fetal heartbeat detection, which is
during the embryonic stage
|
Louisiana current law
permits abortion to 15 weeks, which is 2 weeks past the 1st
trimester
|
States permitting abortion
to 24 weeks; CA, CT, DE, HI, ID, IL, MD, ME, MI, MN, MO, MT, NY, TN, WY
|
6 weeks fetal heartbeat law
was voted unconstitutional by the North Dakota Supreme Court in 2016. ND has since
voted to outlaw dilation and evacuation procedures, criminalizing doctors who
perform them
|
North Dakota current law
permits abortion to 22 weeks
|
Massachusetts law allows
abortion up to 27 weeks past the last period
|
18 weeks-Arkansas abortion ban
was signed by Governor Hutchinson in March 2019.
|
Arkansas current law allows
abortion within the 2nd trimester
|
Virginia permits abortion
at 25 weeks
|
6 weeks-Mississippi Governor
Bryant signed a bill in March 2019 banning abortion at fetal heartbeat or 6
weeks past-last-period
|
Mississippi- current law permits
abortion to 20 weeks, but restriction to 15 weeks is under litigation
|
These states permit
abortion for lethal fetal anomaly: MS, GA, LA, SC, TX, DE, MD
|
6 weeks-Florida has a bill
pending to restrict abortion once there is a fetal heartbeat, which is during
the embryonic stage, so 6 weeks or less of pregnancy; and to make doctors
performing abortions felons
|
Current Florida law permits
abortion to 24 weeks
|
These states permit
abortion to viability w/o restriction, leaving the decision to the clinician and patient: AK, CO,DC, NH, NJ, NM, OR, VT
Bans partial birth abortion; NH |
House Bill 28 would outlaw
abortion after 13 weeks in North Carolina
|
North Carolina- current law
allows abortion to 20 weeks
|
Michigan permits post
viability abortion if a woman’s health is endangered
|
Senate Bill 1867 was signed
by Arizona Governor Ducey, would require doctors to give life-saving
treatment to aborted fetuses
|
Arizona-has passed a law
mandating a rollback to 20 weeks which is under litigation
|
Arizona currently allows
abortion to 25 weeks
|
Ohio’s fetal heartbeat bill
passed the legislature but was vetoed by Governor Kasich
|
Ohio current law allows
abortion to 22 weeks
|
Permits abortion to viability for rape and incest: MI
|
Similar efforts to restrict
abortion to 6 weeks also include: Kentucky, South Carolina,Tennessee, and Texas. A Texas bill failed in April 2019 and would have included the death penalty for women who have abortions for any reason and for clinicians who perform them.
|
AL, AR, GA, ID, IND, IO,
KS, KT, LA, NB, OK, SC, SD, TX, WV, WI all permit abortion up to 22 weeks
|
States permitting abortion to viability if woman's life is endangered: RI, MI
States permitting abortion to viability for fetal abnormality: MD, DE |
Utah has an 18 week ban on
abortion in their 2019 legislative agenda
|
FL, MA, RI, NV, and PA
permit abortion to 24 weeks
|
Utah permits abortion to
viability for-rape, incest, and lethal fetal anomaly
|
Notes-
*All first trimester bans are under review by the courts and
are not currently allowed. The now conservative US Supreme Court is expected to
hear some of these cases this year. Several states are trying to limit abortion
from the point of fertilization or at the embryonic stage, which occurs within
two weeks of the sperm penetrating the egg during intercourse, and before a
woman would know she is pregnant. These folks must have skipped biology class
as a fertilized egg is not a baby.
Availability of Contraceptive
Services
Catholic hospitals have repeatedly been found not to comply
with state laws regarding the availability of emergency contraception for women
whom have been sexually assaulted. A California study found only 66% compliance
among Catholic hospitals. (National Women's Law Center, 2019)
Criteria
|
Most Restrictive for Sexual Activity
|
Least Restrictive for Sexual Activity
|
Access to Abortion Clinics
|
States with the fewest
number of abortion clinics for the eligible population of females, each with
only 1 clinic: MS, MO, KT, ND, SD, WV
Other states with a dearth
of facilities: AL, SC, LA, WI, UT, TX
These states may have
adequate abortion facilities, based on population but they are not geographically
dispersed: MN, IA, ID, WY, NE, KS, OK, AR, TN, DE, RI, HI
|
States considered to have
acceptable access to abortion clinics: CA, OR, WA, CO, MT, GA, AK, NC, VI,
MD, NJ, PA, NY, NH, VT, ME, CT
|
Availability of Morning After Pill
This is commonly known as
Plan B was approved by the FDA in 2011
|
States which do not mandate
information on emergency contraception even in the event of rape: MS, MO, GA,
NC, LA, ND, SD
|
States permitting
pharmacists to prescribe emergency contraception to women of any age: AK, WA,
CA, HI, NH, NM, VT, ME, MA
States with reporting
mechanisms for hospitals that do not comply with emergency contraception
notification for rape victims: HI, MN, NJ, NM, IL OR, UT, WA, and WI
|
Birth control RX is mandated coverage for private
insurance; although self-insured
plans under ERISA are exempt as are religious entities
|
No mandate to cover RX
contraceptives on government plans in: TX, TN, VI, OH
|
All other states mandate RX
contraceptive coverage on private insurance plans
|
Birth control RX is mandated coverage for state
agencies
Abortion covered by insurance
|
No mandate to cover RX
contraceptives on government plans in: TX, TN, VI, OH
States with limited
insurance mandates to cover abortion: AZ, ID, IN, KS, KY, MI, MO, NE, ND, OK,
UT
|
These states will not allow
any exemptions for state or private agencies: CO, GA, IA, MT, NH, NV, VT, WA,
WI
Medically necessary
abortions must be covered by insurance: WA, OR, NJ, NM, NY, IL, HI, CT, CA,
AZ, AK
|
Mandated sex education in public schools
|
These states have no
mandate for sex education in public schools: AZ, CO, FL ID, MA, VI, TX, LA,
|
States requiring sex
education to be medically accurate and also provide education on sexually
transmitted diseases: CA, DE, DOC, GA, HI, IA, KT, MN, MD, MS, MT, NV, NJ,
NM, NC, ND, RI, SC, TN, UT, VT, WI
|
Nonprescription birth control measures (condoms) widely available at retail outlets
|
Some states like TX, AR,
and DE have laws requiring condoms to be distributed by MD’s or
Pharmacists-These laws are typically not enforced.
|
Metropolitan areas
throughout the US have condoms in grocery, drug, and convenience stores.
Individuals can have condoms delivered to their home from Amazon or the Condom
Super Store.com
|
Adequate supply of OBGYN and primary care providers
|
Inadequate supply of primary
care for women in: ND, SD, MO, IO, IND, WI, KT, WV, UT, MS, TX, GA, LA
|
Adequate supply of primary
care for women: WA, OR, CA, NY, MA, MI, IL, PA, NJ, NC, VI, MD, FL
|
Assault and
Violence-A Statewide Analysis
Using the Federal Bureau of Investigation Crime Statistics
for 2017 I analyzed rape, murder, and aggravated assault, which includes
domestic violence statewide. The tables below show the safest and most
dangerous states for women to live. Scores compare the variance between the
national average and each state’s metrics including the Washington DC area. A negative
score means these states had fewer incidents than the national average and
conversely a positive score means the state had greater incidents of violence.
These data are combined male and female rates, but 79% of all violent crimes were
committed by men and women were victims 48% of the time. However, 93% of
rapists were male and 89% of their victims were female. Likewise, for murder,78%
were men and 24% of the victims were women. (Federal Bureau of Investigation, 2019)
Safest Places
The safest places to live in the USA are the northeastern
states of Maine or Vermont or the eastern seaboard states of Connecticut or
Virginia. These states all tend to have good education systems and fairly high
taxation. If you are a woman living in Maine you are 3 times less likely to be
raped, nearly 5 times less likely to be murdered and 3 times less likely to be
assaulted than for a woman in Alaska.
Health Metrics
|
For Violence
|
Statewide
|
|||
Measures based on 2017 FBI
data
|
National Incidence Rate per
100,000 people
|
Maine
|
Connecticut
|
Vermont
|
Virginia
|
Rape
|
41.7
|
35.4
|
23.3
|
35
|
33.8
|
Score
|
-6.3
|
-18
|
-6.7
|
-7.9
|
|
Murder
|
5.3
|
17.
|
2.8
|
2.2
|
5.3
|
Score
|
-3.6
|
-2.5
|
-3.1
|
0
|
|
Aggravated Assault
|
284.9
|
65.3
|
123
|
114
|
118
|
Score
|
-220
|
-162
|
-171
|
-167
|
|
Combined Score
|
-230
|
-182
|
-181
|
-175
|
In terms of this ranking methodology, the goal is to have
fewer events than the national average for acts of violence but as you can see,
these states have high rates of aggravated assault, rape, and murder, compared
to the national incidence rate. It is difficult to draw conclusions from this
grouping as they are so varied. Most worrisome is the rape statistic for Alaska,
which I triple checked and represents 32 out of 39 agencies reporting their
data for 2017. Alaskans have 386 more
incidents of these violent crimes per 100,000 people than the national average,
due largely to the rape metric. However,
the assault rate was high in Alaska as well. The highest murder rate in the nation was in
Washington DC, with more than twice as many murders than the national average
for 2017. The rate of assaults in DC is similar to Alaska. About the only things that Alaska and New Mexico have in common are large tribal populations, which may explain some of the violence. But
Montana also has significant tribal populations and their violence metric was much lower as was North Dakota's, where the Pine Ridge Reservation is
located.
Health Metrics
|
For Violence
|
Statewide
|
|||
Measures based on 2017 FBI
data
|
National Incidence Rate per
100,000 people
|
Alaska
|
Washington, District of
Columbia
|
New Mexico
|
Tennessee
|
Rape
|
41.7
|
116.7
|
64
|
60.3
|
43.7
|
Score
|
75
|
22.3
|
18.6
|
2
|
|
Murder
|
5.3
|
8.4
|
16.7
|
7.1
|
7.8
|
Score
|
3.1
|
11.4
|
1.8
|
2.5
|
|
Aggravated Assault
|
284.9
|
575.4
|
546.3
|
537.8
|
483
|
Score
|
290.5
|
261.4
|
252.9
|
198.1
|
|
Combined Score
|
386.6
|
295.1
|
273.3
|
202.6
|
In my 15 hours of research for this article, I decided the
issue of female autonomy and reproductive rights is too complicated for one
article. This analysis has attempted to show the level of vitriol lobbed
against women’s constitutional rights at this moment, during the Trump
Administration. Though the anti-abortionists have been relentless in their assaults
on state laws governing women’s health and the clinicians whom provide these services,
they have only managed to change public perception by 2%. According to a recent
Pew Research poll only 2% fewer Americans believe abortion should be
outlawed. All of the harassment,
personal injury, and even deaths caused by the irrational cabal of personhood-fetus-promoters
has barely managed to move the dial. One can only hope that doctor patient
privilege and privacy will be protected by the courts. But with the statewide
and more recent federal court appointments hueing conservative, we can
anticipate an increase in the rate of incarceration for women whom are merely
trying to make informed decisions for their lives. At the Supreme Court we can
count on newly minted Justice Kavanaugh, who doesn’t hate all women, just the
ones who disagree with him, to vote against women’s autonomy at every turn. (Congressional
Record, 2018) (AP, CNN,
2018)
And this is the healthpolicymaven signing off encouraging
you not to sign blanket releases when entering an inpatient facility. Do
stipulate that for which you agree and for which you decline.
This article was written by Roberta E. Winter, MHA, MPA a
freelance journalist and is not subject to approval of any corporate or
government agency. Winter is the author of Unraveling US Healthcare-A Personal
Guide, published by Rowman and Littlefield in 2013. Research for this article
will inform an update to her healthcare guide. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972
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