Today marks the 40th the anniversary of Roe v. Wade, the Supreme Court’s landmark ruling that legalized abortion nationwide. As I reflect on what that means for me personally and for women across the country, I am struck that even in a state like Massachusetts, where we tout ourselves as national leaders in health care access, there is still much work to be done.
But first, to highlight some of the positive — we are unquestionably fortunate that when compared to other states, Massachusetts policies in large part support the availability and accessibility of abortion services. For example, Massachusetts does not fall under the category of states increasingly hostile to abortion rights, where women may find it more difficult to access abortion services due to recent passage of more restrictions, such as mandatory waiting periods and ultrasounds of the fetus. Massachusetts further doesn’t restrict coverage of abortion in private or public insurance plans. And in a recent victory, a federal appeals court upheld the state’s buffer zone law, which creates a 35-foot fixed buffer zone around the driveways and entrances of Massachusetts abortion clinics.
Despite these protections, abortion remains a highly charged political issue, both nationwide and in our state; and access to abortion, as well as family planning and comprehensive evidence-based sexuality education, is far from a reality for many Massachusetts residents.
According to a report from NARAL Pro-Choice Massachusetts, Massachusetts has experienced an overall decline in abortion providers in both clinics and hospitals in recent years, while regional disparities in access to abortion care are growing with the majority of providers concentrated in the metro Boston area. Beyond the numbers and geographic distribution, factors such as age, income level, stage of the pregnancy, and availability of culturally and linguistically competent care create obstacles to obtaining abortion care.
I was also shocked to learn recently that Massachusetts still has antiquated laws on the books which ban all abortions without exception; require that abortions after the twelfth week of pregnancy be performed in hospital as opposed to other clinical setting; and outlaw birth control for unmarried couples. While these laws are superseded by Roe v. Wade and other Supreme Court rulings, if these rulings were ever overturned, women in Massachusetts could face serious barriers to safe, legal abortion care and family planning. That’s some pretty scary stuff. There is pending legislation to repeal these three provisions.
Moreover, as Massachusetts shifts its health care policy agenda from access to issues of quality and cost, the conversation around reproductive health care will need to continue in a different arena. Under Chapter 224, the new state law to promote health care quality and curb rising health care costs, provider organizations are encouraged to become certified as Accountable Care Organizations (ACOs). Standards for ACOs may include ensuring patient access to health care services across the care continuum. While ACOs have the potential to improve access to care, enhance coordination and integration of care, and improve quality and outcomes, ACOs may also restrict patient choice of providers through limited networks. We will have to watch closely to ensure that patients who receive care from ACOs are able to access the full range of reproductive and sexual health services, including comprehensive family planning services, sexually transmitted infection diagnosis, treatment and counseling, and abortion services, including non-hospital based care.
So back to what the 40th anniversary of Roe v. Wade means to me. I am disheartened that even after 40 years, the topic of abortion continues to be a highly politically charged and divisive part of public policy debates on the state and national levels. I feel fortunate to live in a state like Massachusetts which has been consistently supportive of abortion rights, particularly in light of increasing restrictions in other states over recent years. Yet I know that even in our state, the work to ensure that all health care policies reflect women’s self-determination and full control over our reproductive health is far from finished.
-Alyssa R. Vangeli