29 June 2022 Blog Post: On SCOTUS an the Dismantling of Women’s Health

29 June 2022 Blog Post: On SCOTUS an the Dismantling of Women's Health

While last week’s decision to roll back the constitutional protections afforded to women by Roe v. Wade was traumatic, it was not the first first salvo in the assault on women’s health in the United States. Efforts to undermine the health and well being of women convincingly began during the Trump Administration as evidenced by the rise maternal mortality rates for both 2019 and 2020 (Figure 1 below; “1” superscript designates statistically significant increases).

Unsurprisingly, the United States lags far behind its peers in maternal mortality rates – which makes the comments by world leaders regarding the SCOTUS decision all the more prescient. Figure 2 below shows how the US stacks up against other countries (2018 are the latest data in this figure, the current situation in the US is even worse with 23.8 deaths per 100,000 live births).  Note that a pregnant woman in New Zealand has a 14 fold reduced risk of dying as compared to an American woman. A pregnant African-American woman is 32 times more likely to die as compared to her New Zealand counterpart. Putting that in perspective, smoking cigarettes increases your risk of lung cancer by 25 fold.

There are only two factors that significantly modify the risk of maternal mortality: first, access to contraception, and second, access to safe abortion. This makes it straightforward in one sense but, in another, makes it incredibly easy to dismantle health safeguards.

How do we know this?  Countries with better training of and access to abortion providers have lower maternal mortality rates (Darney et al. Obstet Gynecol. 2020;135(6):1362). This relationship is also true in the United States; states that have restricted abortion access have increasing maternal mortality while it is declining in states with improved access to abortion services (Addante et al. Contraception. 2021;104(5):496. Epub 2021 Mar 26).

Governors in three western states (California, Washington and Oregon) have committed to making pregnancy termination services accessible to all. A number of companies have already stated that they will provide transportation services for employees to states that have such services. 

Those that would wish harm on women are not going to stop here. With only two factors modifying maternal health, the next logical point of attack will be on contraception availability.

Safeguarding maternal health is simply not within the purview of the 9 lawyers of SCOTUS; it is a public health issue. Their reckless disregard for the limits of their knowledge will have one simple downstream effect – it will kill women. 

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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24 June 2022 Blog Post: Overturning Roe v. Wade

24 June 2022 Blog Post: Overturning Roe v. Wade

On May 3rd I wrote a blog about the, then, leaked Supreme Court majority opinion on overturning Roe v. Wade which has now become reality (link: https://www.cnn.com/politics/live-news/roe-wade-abortion-supreme-court-ruling/h_9a4458b69569b8f7ff46c76cb2238577). Even more disturbing (if such a thing is even possible) is that the ruling further opens the door to the reconsideration of same-sex marriage and contraception. As the dissenting opinion points out:

“The right Roe and Casey recognized does not stand alone,” they wrote. “To the contrary, the Court has linked it for decades to other settled freedoms involving bodily integrity, familial relationships, and procreation. Most obviously, the right to terminate a pregnancy arose straight out of the right to purchase and use contraception. In turn, those rights led, more recently, to rights of same-sex intimacy and marriage.” 

Stated simply woman’s right to access competent and safe pregnancy termination care is, quite simply, a public health issue and those that voted in an administration permitting this travesty, have mixed politics and health.

As it stands, maternal mortality in the United States has already increased in every ethnic group (Figure below) since 2018 with statistically significant rises in the aggregate for both 2019 and 2020. For all US women, a total of 23.8 women die per 100,000 live births. 

Countries with better training of and access to abortion providers have lower maternal mortality rates. We suffer (as with most healthcare outcomes) disastrously by comparison (Figure 2 below; 2018 data).

Access to safe abortion care is an essential component of health care, not politics. As it stands, hundreds of pregnant American women die unnecessarily each year and that will only get worse. The Supreme Court can frame their opinion as constitutional law, but in reality, they have strayed far out of their lane. Evidence-based health policies and good reproductive health care from well trained professionals is needed – not a dangerous majority opinion from political appointees.

What’s worse, is that their overreach has only just begun.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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22 June 2022 Blog: On COVID in Europe

22 June 2022 Blog: On COVID in Europe

Media outlets, like CNN and The Guardian, are reporting on a rising wave of cases in Europe as the traditionally busy summer travel season on the continent begins.

Link: https://www.cnn.com/2022/06/22/world/coronavirus-newsletter-intl-06-22-22/index.html

Link: https://www.theguardian.com/world/2022/jun/21/covid-surges-europe-ba4-ba5-cases

As an interesting aside, note that the CNN article references raw numbers while the Guardian article speaks (more appropriately and accurately) in terms of case rates. Prior blog posts here have discussed the importance of rates over raw numbers to ensure accurate comparison of data.

Portugal and France have had the most dramatic surge with Germany also experiencing a rapid rise in case rates (Figure below). Summarized neatly by the Guardian:

“Multiple European countries are experiencing a significant surge in new Covid-19 infections, as experts warn that with almost all restrictions lifted and booster take-up often low, cases could soar throughout the summer leading to more deaths.”

These figures fit with our anecdotal reports from patients who are currently in Europe or have recently returned. Firstly, there are no masks to be seen – from Italy, to Portugal, France and Germany. Significant summer heat has been an additional barrier to mask wearing. Crowded tourist spots, restaurants and the lifting of restrictions of mask wearing in airports and airplanes gives ample and redundant opportunities to be exposed to the Omicron subvariants now circulating. Multiple patients in our practice have fallen ill and tested positive for COVID-19 while traveling in Europe.

Complicating the situation in Europe is the lack of Paxlovid availability. Although there is no evidence that Paxlovid is effective in prevention after a close exposure and has limited (if any) utility among those at low risk, it does seem to have some efficacy among those individuals that are older, at high risk of progression or are unvaccinated.

It is a reasonable question at this point as to whether or not COVID-19 infection is simply inevitable. While I don’t believe that we are doomed, it does seem that any activity that is outside of the sphere we have established over the past two years leaves one at considerable risk, augmented by a higher prevalence of infection, abandoned mitigation practices and more transmissible variants. That is not to say that one should not attend a wedding, travel to Europe or have that 40 person family reunion. But do so with the expectation that time, proximity and widening your social circle will, in all likelihood, leave you at risk of acquiring COVID-19.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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