What Would Happen In Wisconsin If Roe v. Wade Falls?
WHAT WOULD HAPPEN IN WISCONSIN IF ROE V. WADE FALLS?
Consequences of the Upcoming Dobbs v. Jackson Women’s Health Organization Supreme Court Decision
May 3, 2022
Research
Contraceptives’ Effects on Sexual Experiences Play a Huge Role in Satisfaction, Study Finds
Sexual acceptability – how birth control methods affect users’ sexual well-being – is likely an important component of contraceptive satisfaction, but hasn’t been systematically examined until now. Dissatisfaction with a contraceptive method leads many people to stop using contraception. If people want to use contraception, they should be able to find a method that works for them – and new CORE research indicates that how a method affects a user’s sexual experiences is a key factor in determining whether they will continue using this health product over time.
Renee D. Kramer, Jenny A. Higgins, and colleagues at the University of Utah examined contraceptive satisfaction among contraceptive users who were starting a new method. They wanted to find out if sexual acceptability measures could be used to predict contraceptive satisfaction after three months of use. Their study was recently published by the American Journal of Obstetrics & Gynecology, also known as “the Gray Journal.”
Among about 2,000 users, over half were completely satisfied with their contraceptive method after 3 months. Patients who said their contraceptive method improved their sex life were upwards of 8x as likely to be satisfied with their method.
Contraceptive care providers may wish to underscore that sexual experiences of birth control methods matter and encourage patients to find a contraceptive method that works for them sexually.
CORE Review Finds Close Association Between Economic and Sexual Wellbeing
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
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
Study Finds Over Half of Physicians Who Are Willing to Refer for Abortion Care Don’t Know How to Do So
A new study by CORE researchers shows that physicians want to refer patients for abortion services, but many lack the knowledge on how to do so. Published in in Social Science and Medicine – Population Health, the paper shares findings from a survey of over 800 physicians across specialties at the University of Wisconsin School of Medicine and Public Health, the state’s largest and only public medical school.
Elizabeth Anderson, Sarah K. Cowan, Jenny A. Higgins of CORE, Nicholas B. Schmuhl, and Cynthie K. Wautlet teamed up to learn more about how referral knowledge may serve as a barrier to abortion access.
Their survey results indicate that the overwhelming majority (over 80%) of physicians were willing to consult on abortion-related patient cases. However, only half (53%) of physicians who were willing to refer a patient for abortion care knew how to do so. Physicians who had not received abortion-related information in medical school, as well as more junior physicians, were especially lacking in abortion referral knowledge.
These findings illustrate another obstacle for those seeking abortion: healthcare providers who are “willing but unable” to direct patients to abortion services if needed.
Clear and robust referral systems could aid physicians in helping their patients get the reproductive healthcare they need.
Read the open-access article here, titled “Willing but unable: Physicians’ referral knowledge as barriers to abortion care.”
CORE’s Survey of Doctors Highlights Widespread Support for Abortion Access
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.
Press Release: UW CORE Study Highlights Physicians’ Attitudes Toward Abortion; Research Brief Reveals Majority Support for Abortion Access
New press release shares information from a CORE research brief. The study surveyed over 900 physicians, and found that many are concerned about abortion policies interfering in healthcare.
FOR IMMEDIATE RELEASE: November 17, 2021
CORE: The Collaborative for Reproductive Equity
University of Wisconsin-Madison
Contact: Samantha Herndon
smherndon@wisc.edu
608-285-2364
UW CORE Study Highlights Physicians’ Attitudes Toward Abortion: Research Brief Reveals Majority Support for Abortion Access
A new study by UW-Madison researchers documents overwhelming support of abortion services among faculty physicians at the UW School of Medicine and Public Health, with more than three-quarters of doctors expressing support for abortion access and more than nine in ten expressing concern about abortion restrictions. CORE, the UW Collaborative for Reproductive Equity, shares 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.
UW CORE is an initiative within the School of Medicine and Public Health at the University of Wisconsin-Madison. CORE investigators conduct rigorous, interdisciplinary research focused on reproductive health, equity, and autonomy in Wisconsin, and beyond.
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New Brief: Wisconsin’s Proposed Changes to Reproductive Health Funding
NEW CORE BRIEF: What would happen if reproductive healthcare providers were unable to participate in the Wisconsin Medicaid program?
Members of the Wisconsin state legislature recently passed new legislation that would prohibit healthcare organizations that perform abortions from being certified under the state’s Medical Assistance program. This prohibition would mean that these clinics could not be reimbursed for other healthcare services provided to Wisconsinites as part of the state’s Medicaid program. Evidence suggests that this policy would have a negative impact on thousands of residents.
The bill is currently on the Governor’s desk.
What is the policy?
Existing Wisconsin state law already prohibits the use of any state, local, or federal funding to cover abortion care services except in limited circumstances. The proposed bill would add a major new level of restriction: it would prevent any healthcare organization that performs abortions from participating in the Medicaid program altogether. Most centrally, this ban would impact family planning clinics that provide abortion care, preventing them from seeking reimbursement from the Medicaid program for any of the reproductive health services they provide, not only abortion. Such vital services include contraception, sexually transmitted infection testing and treatment, and breast and cervical cancer screening.
Implications for Wisconsin
Research indicates that if Wisconsin state law were to prohibit healthcare providers that perform abortions from participating in the state Medicaid program, tens of thousands of Wisconsinites would lose access to essential reproductive healthcare services.
Read the full brief here, and check out our visual explainer on Instagram or Twitter.
Ending Abortion Access Will Have Significant Harmful Consequences for Individual and Families, CORE Researchers and Other Social Science Experts Tell Supreme Court
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.
New CORE study documents serious financial barriers to abortion care
CORE researchers published an innovative new paper that finds that cost is of the largest obstacles to abortion care in the U.S. The new study was published in the International Journal of Environmental Research and Public Health. The researchers studied the barriers to accessing abortion care for pregnant people through a novel method: by analyzing posts on the social media platform Reddit, which is used by over one-quarter of young adults in the U.S.
Findings from CORE’s new study underscore how overlapping barriers from funding to transportation and time off work create challenges for people who want or need abortion care. The obstacle of how to pay for an abortion and related costs is especially large in states such as Wisconsin—we are one of 33 states where Medicaid cannot be used to pay for abortion care, even though Medicaid does cover prenatal and birthing care costs.
The research team, which includes Jenny Higgins, MPH, PhD; Madison Lands, MSW, MPH; Taryn Valley, MS; Emma Carpenter, MSW, PhD; and Laura Jacques, MD, analyzed the 250 most recent Reddit posts that mentioned abortion. By studying what people posted to Reddit anonymously, instead of asking survey or interview questions, the researchers had a unique opportunity to learn about the questions and concerns that people face when considering an abortion before ever setting foot in a healthcare clinic.
CORE researchers identified four key themes of cost-related barriers to abortion:
- Inability to secure funds for abortion services and transportation
- Insufficient funds to select desired aspects of abortion services
- Insurance and administrative hurdles create unique barriers
- Relying on self-managed abortion options due to cost barriers
The following anonymous quote from the study illustrates Theme 4:
“I used Aid Access [an international mail-order service for medication abortion pills] to terminate my pregnancy because I couldn’t afford $500+ for the abortion counseling appointment and medical abortion. I didn’t qualify for aid because my finances look good on paper. But they don’t take into account your rent, health insurance, car payment, student loans, etc.”
Many other personal quotes in the study (see image below) illustrate the challenges that cost, long travel distances to clinics, abortion stigma, and other barriers create for people who need abortion services.
While some self-managed abortion methods, such as the medications mifepristone and misoprostol, are considered safe and effective, other methods may be harmful. The study’s results indicated that cost barriers lead some people to consider such illegal and potentially detrimental methods because they cannot afford medication or procedural abortion with a healthcare provider, due to lack of private or public insurance coverage for abortion services.
Results from this study contribute to growing evidence of the harmful effects of restrictions such as the Hyde Amendment, especially for people living on low incomes.
→ Read the full Cost-Related Barriers study here, and check out our research poster by CORE Research Manager Madison Lands below.
