Gender-Affirming Hormone Therapy in Wisconsin: Opportunity to Expand Access by Enabling Family Planning Providers to Bill Medicaid

a blue, pink, and white trans flag

There is an opportunity in Wisconsin to expand access to gender-affirming care for low-income, transgender people in our state. Rachel Dyer, a CORE researcher and a PhD student in the UW-Madison Department of Counseling Psychology, prepared a brief on this subject with support from CORE staff. In it, Dyer dives into the process and potential outcomes of updating Wisconsin’s Medicaid policy to expand specific family planning coverage.

Dyer compiles extensive research showing that gender-affirming hormone therapy, or GAHT, can improve the health and wellbeing of transgender people. GAHT is a safe and effective form of medical care that may be sought by transgender, nonbinary, two-spirit, gender nonconforming, and other gender diverse people. Like other forms of gender-affirming care, the purpose of GAHT is to support transgender people in feeling more aligned with their gender identity, namely by reducing sex characteristics that they were born with and inducing sex characteristics that align with their gender identity.

Wisconsin could efficiently expand access to GAHT by permitting family planning clinics to bill state Medicaid for GAHT services provided in their clinics. Because each state determines for itself what constitutes family planning and what services can be covered, Wisconsin has the ability to expand the interpretation of family planning to include important healthcare services that fall under the umbrella of GAHT. As a major form of regular and preventative healthcare, family planning providers have a unique capacity to provide gender-affirming services.

The reach of family planning clinics in Wisconsin also make them a useful choice for a site to provide GAHT; there are approximately 150 clinical sites in rural and urban communities across the state that already provide publicly-funded family planning services. Further, expanding Medicaid coverage to include GAHT services provided at these clinics would be of minimal cost to the state of Wisconsin.

To learn more about the importance of clinical provision of gender-affirming hormone therapy, and the opportunity to expand access via Medicaid coverage, check out our CORE Brief.

 

CORE Review Finds Close Association Between Economic and Sexual Wellbeing

cover image from The Journal of Sex Research

A new analysis led by CORE Director Jenny A. Higgins, Madison Lands, Mfonobong Ufot, and Sara McClelland reviewed 47 studies from over 22 countries, and found nearly universal associations between socioeconomic constraints and poorer sexual wellbeing.

Public health organizations such as the American Public Health Association and the World Health Organization emphasize that sexual health involves positive and pleasurable sexual experiences, not only the prevention of negative sexual outcomes. However, surprisingly little research has paid specific attention to sexual pleasure and its relationship with poverty. To address this gap, CORE researchers systematically drew from nearly studies to document relationships between socioeconomic conditions (such as financial stressors, income, and education level) with indicators of sexual wellbeing (such as sexual satisfaction, functioning, and orgasm).

The authors proposed a variety of pathways through which socioeconomic conditions may shape sexual wellbeing and flourishing. Such pathways include, but aren’t limited to:

  • financial-associated stress, which can undermine positive aspects of sexuality;
  • the psychosocial effects of having comparatively less social and political clout, which can undermine all aspects of health, including sexual health;
  • expectations for enjoyable sexual experiences, which can be undermined by poverty; 
  • inadequate housing and access to private space, which can also erode pleasurable sexual experiences.

The authors argue that true “erotic equity” can only come about after sweeping changes to educational and employment opportunities as well as access to health and social services. 

While these changes will take time, sexual health as a human right depends on them. Sexual pleasure and positive sexual experiences are a critical part of reproductive autonomy and reproductive justice.

In 94% of studies the authors reviewed, poorer socioeconomic conditions were significantly associated with poorer sexual wellbeing and flourishing. People with comparatively low levels of income reported much lower levels of sexual satisfaction compared to those living on higher incomes. The relationship between socioeconomic conditions and sexual flourishing were consistent across geographic location and gender.

The authors identified many limitations with the existing research on this topic, including narrow and one-dimensional approaches to poverty – a very complex concept and experience. The articles included in the review were primarily focused on cisgender women, and studies from the United States and Europe contained overwhelmingly white samples. Future research in this area must attend to both gender and racial diversity.

Without broader structural improvements to socioeconomic opportunities for all, poverty will continue to undermine sexual wellbeing, which is a fundamental human right.

Read the open-access article in The Journal of Sex Research here.

Sexual Health and Flourishing Negatively Impacted by Economic Constraints

photo of two people kissing in front of a blue sky. photo by Shingi Rice

New research by CORE investigators documents that poverty and other financial constraints undermine people’s ability to have positive sexual experiences.

All major public health organizations in the United States underscore that sexual health involves both the absence of negative outcomes (such as unwanted pregnancies and STIs), and the presence of sexual flourishing, including a pleasurable and satisfying sex life.

CORE researchers examined how these positive aspects of sexual health may be affected by by socioconomic conditions. Their research brief, just published online in Perspectives on Sexual and Reproductive Health, shares findings from a study of over 2,500 people of reproductive age seeking family planning services. The project was a collaboration between researchers at the University of Wisconsin-Madison’s Collaborative for Reproductive Equity (UW CORE) and the University of Utah, using data from the HER Salt Lake Initiative. 

Researchers collected information on people’s financial resources (for example, whether they had trouble paying for basic needs in the past month) as well as indicators of sexual flourishing (for example, sexual satisfaction and orgasm).

Nearly universally, those who reported experiencing more financial constraints also reported fewer signs of sexual flourishing. Results from this analysis suggest that economics are strongly associated with sexual wellbeing, with indications that financial scarcity may reduce sexual satisfaction, orgasm, and overall functioning. These results remind us that structural constraints affect sexual bodies.

A reproductive justice framework indicates that all people must have access to the social conditions needed for healthy and autonomous reproductive and sexual lives. 

To address inequities in sexual health, public health leaders and policymakers must continue to support economic reform and poverty reduction.

Read the open-access article here: https://onlinelibrary.wiley.com/doi/10.1363/psrh.12189

CORE’s Survey of Doctors Highlights Widespread Support for Abortion Access

graph showing physician support for abortion access. 78% support access, according to a core survey. Bar chart format in yellow, coral, red, marigold, and gray.

Bar chart in coral, marigold, gray, yellow, and pink. Shows that 78% of physicians surveyed support unrestricted access to abortion care.

Our recent series of studies here at UW CORE, Collaborative for Reproductive Equity, document overwhelming support of abortion services among faculty physicians at the UW School of Medicine and Public Health. More than three-quarters of doctors surveyed expressed support for abortion access, and more than nine in ten expressed concern about abortion restrictions. We are sharing these findings in the research brief “Physician Support of Unrestricted Abortion Services in Wisconsin.”

The new research is part of a larger project that assessed abortion-related attitudes, practices, and perceptions among physicians of all specialties within a Wisconsin-based teaching hospital. The researchers surveyed 913 physicians who represent more than 20 medical specialties. The survey results showed:

  • More than three-quarters of physicians surveyed reported at least some degree of support for unrestricted access to abortion (78% said they support unrestricted abortion access somewhat or a lot).
  • 99% were at least a little concerned about legislation interfering in the doctor-patient relationship, and nearly half (48%) were extremely concerned.
  • Most doctors expressed at least some level of concern that abortion laws will make it difficult for physicians to offer timely and appropriate care (93%) and for patients to receive the care they need (91%).
  • Nine in ten doctors (90%) surveyed indicated that women’s health in Wisconsin would get worse if Roe v. Wade is overturned.

These findings underscore substantial physician concern that Wisconsin abortion restrictions can negatively affect patient care, the patient–provider relationship, and patients’ health.

CORE’s research suggests that Wisconsin’s abortion restrictions, which include (but are not limited to) a mandatory 24-hour waiting period, multiple clinically unnecessary constraints on medication abortion services, and the criminalization of abortion if Roe v. Wade is overturned, are not in line with physician’s professional perspectives. While doctors’ personal beliefs vary, the majority of doctors surveyed report that current abortion restrictions worsen patient care and that women’s health will decline further if abortion becomes illegal in our state.

Read the full research brief here.

Ending Abortion Access Will Have Significant Harmful Consequences for Individual and Families, CORE Researchers and Other Social Science Experts Tell Supreme Court

Image from the Dobbs v. Jackson Women's Health Organization amicus brief submitted by Social Science Experts

The US Supreme Court has announced that it will hear the landmark abortion rights case Dobbs v. Jackson Women’s Health Organization beginning December 1, 2021, with a decision expected by June 2022. In response to the case, which could upend legal precedent that established that abortion is allowable until fetal viability at about 24 weeks, dozens of groups have filed amicus briefs for the nation’s high court to consider.

What is an amicus brief? An amicus brief is a legal term for written testimony provided by a ‘friend of the court,’ called an amicus curiae. These ‘friends’ can offer evidence or insight that will be important to consider in a legal case. Amicus briefs can be submitted by concerned individuals, scholars, states, medical professional associations, religious organizations, non-profits, and other groups. Briefs can be submitted in support of either the petitioners (in this case Thomas Dobbs, the State Health Officer of the Mississippi Department of Health) or in support of the respondents (in this case Jackson Women’s Health Organization—the last remaining reproductive health clinic that provides abortions in the state of Mississippi).

CORE Scholars and over one hundred other social science experts submitted an amicus brief to the Supreme Court in support of the respondents. The social scientists’ brief includes signers who have collectively spent decades conducting and publishing peer-reviewed research about the safety, incidence, social, psychological, and health impacts of unintended pregnancy and abortion in the United States. Their research has been published in hundreds of scientific articles which have appeared in leading medical and social science journals. Having extensively studied the effects of state restrictions on people seeking abortions, the researchers write that overturning the legal precedent that protects the Constitutional right to abortion will have harmful and significant consequences for individuals and families.

As the authors of significant studies on unwanted pregnancy and abortion in Mississippi and other restrictive settings, these scholars are deeply familiar with the consequences for families and individuals if abortion is no longer available. They have researched the impact of abortion restrictions and bans on healthcare delivery and find that many restrictions have far-reaching consequences. One highly-cited publication that was included in the brief was the CORE research article “Undue Burden Beyond Texas: An Analysis of Abortion Clinic Closures, Births, and Abortions in Wisconsin” by Dr. Joanna Venator and Dr. Jason Fletcher that found that closure of abortion clinics led to increased drives of over 100 miles to access abortion in some Wisconsin counties, in turn leading to lower abortion rates and higher birth rates. This limited access could constitute an undue burden, and violate the precedents set by Roe v. Wade (1973) and Casey v. Planned Parenthood (1992). The social science experts state that banning abortions after 15 weeks, as proposed by Dobbs and the state of Mississippi, will force people to travel out-of-state, increase costs, and prevent some from accessing abortion at all.

CORE faculty who signed the letter include Dr. Jenny A. Higgins, Dr. Nicholas Schmuhl, Dr. Jane Seymour, Dr. Daniela Mansbach, and Dr. Jason Fletcher.

The authors note that research has shown that pre-viability abortion bans harm, rather than improve, people’s health. In addition, social science research demonstrates that eliminating access to abortion has long-term negative socioeconomic consequences for women. Women who are denied an abortion are more likely to live below the poverty level and be unemployed years after being denied the abortion than people who receive their wanted abortion.

Read the full brief the social scientists submitted to the Supreme Court here.

Ending Abortion Access Will Have Significant Harmful Consequences for Individual and Families, CORE Researchers and Other Social Science Experts Tell Supreme Court

CORE Researchers and other social science experts provided information to the Supreme Court indicating their concerns about the consequences of ending abortion access.

Image from the Dobbs v. Jackson Women's Health Organization amicus brief submitted by Social Science Experts

Image from the Dobbs v. Jackson Women's Health Organization amicus brief submitted by Social Science Experts

The US Supreme Court has announced that it will hear the landmark abortion rights case Dobbs v. Jackson Women’s Health Organization beginning December 1, 2021, with a decision expected by June 2022. In response to the case, which could upend legal precedent that established that abortion is allowable until fetal viability at about 24 weeks, dozens of groups have filed amicus briefs for the nation’s high court to consider.

What is an amicus brief? An amicus brief is a legal term for written testimony provided by a ‘friend of the court,’ called an amicus curiae. These ‘friends’ can offer evidence or insight that will be important to consider in a legal case. Amicus briefs can be submitted by concerned individuals, scholars, states, medical professional associations, religious organizations, non-profits, and other groups. Briefs can be submitted in support of either the petitioners (in this case Thomas Dobbs, the State Health Officer of the Mississippi Department of Health) or in support of the respondents (in this case Jackson Women’s Health Organization—the last remaining reproductive health clinic that provides abortions in the state of Mississippi).

CORE Scholars and over one hundred other social science experts submitted an amicus brief to the Supreme Court in support of the respondents. The social scientists’ brief includes signers who have collectively spent decades conducting and publishing peer-reviewed research about the safety, incidence, social, psychological, and health impacts of unintended pregnancy and abortion in the United States. Their research has been published in hundreds of scientific articles which have appeared in leading medical and social science journals. Having extensively studied the effects of state restrictions on people seeking abortions, the researchers write that overturning the legal precedent that protects the Constitutional right to abortion will have harmful and significant consequences for individuals and families.

As the authors of significant studies on unwanted pregnancy and abortion in Mississippi and other restrictive settings, these scholars are deeply familiar with the consequences for families and individuals if abortion is no longer available. They have researched the impact of abortion restrictions and bans on healthcare delivery and find that many restrictions have far-reaching consequences. One highly-cited publication that was included in the brief was the CORE research article “Undue Burden Beyond Texas: An Analysis of Abortion Clinic Closures, Births, and Abortions in Wisconsin” by Dr. Joanna Venator and Dr. Jason Fletcher that found that closure of abortion clinics led to increased drives of over 100 miles to access abortion in some Wisconsin counties, in turn leading to lower abortion rates and higher birth rates. This limited access could constitute an undue burden, and violate the precedents set by Roe v. Wade (1973) and Casey v. Planned Parenthood (1992). The social science experts state that banning abortions after 15 weeks, as proposed by Dobbs and the state of Mississippi, will force people to travel out-of-state, increase costs, and prevent some from accessing abortion at all.

CORE faculty who signed the letter include Dr. Jenny A. Higgins, Dr. Nicholas Schmuhl, Dr. Jane Seymour, Dr. Daniela Mansbach, and Dr. Jason Fletcher.

The authors note that research has shown that pre-viability abortion bans harm, rather than improve, people’s health. In addition, social science research demonstrates that eliminating access to abortion has long-term negative socioeconomic consequences for women. Women who are denied an abortion are more likely to live below the poverty level and be unemployed years after being denied the abortion than people who receive their wanted abortion.

Other amicus briefs submitted regarding this case include:

Read the full brief the social scientists submitted to the Supreme Court here.