Protecting accessible reproductive health care for all
By Darby Kendall
Reproductive health and rights are not only important for individual health and well-being; they’re also essential for community development. When someone is empowered to make informed choices about their reproductive health, it can interrupt generational cycles of poverty and help people reach their full potential.
The OHSU Center for Women’s Health and Center for Reproductive Health Equity, directed by Maria Rodriguez, M.D., M.P.H., has a powerful mission, bridging research and health care to become a national leader for reproductive health. Rodriguez’s research focuses on the intersection of medicine, policy and economics, and she also provides OBGYN care at the Center for Women’s Health.
This is an audio story featuring highlights from a conference Rodriguez spoke at in the spring of 2024.
Transcript
The Center for Reproductive Health Equity is something we’ve been working on for the last seven years in partnership with the OHSU Foundation and generous philanthropists. And I’m so excited about the work that we get to do, because it bridges different worlds of policy, of research and of health care, and it really sets us apart nationally. OHSU is one of only three universities that’s working in this space, and it’s the only one I know of that’s really focusing on the role of the health care system in mitigating some of the disparities that are so prominent really broadly throughout women’s health, but particularly in reproductive healthcare.
Dr. Maria Rodriguez is the director for OHSU Center for Women’s Health and Center for Reproductive Health Equity. Her research focuses on the intersection of medicine, policy and economics, and she also provides OBGYN care at the Center for Women’s Health with a focus on family planning. Here are some highlights from a conference she spoke at in March 2024.
I’m really passionate about taking a holistic approach to reproductive health, and that’s for two key reasons. The first is that reproductive health and rights are fundamental to gender equality. Reproductive health and rights are important not just for our individual health and our well-being but are also essential for community development. The second thing that keeps me going and brings me to work every day is the recognition that reproductive health has multi-generational consequences. So we see this time and time again. When we can empower an individual to make informed choices about their reproductive health, this can interrupt generational cycles of poverty and lead people to really reach their full potential.
Now, another key thing to know about reproductive health, and this is going to surprise absolutely nobody in the room, is that it is the most tightly legislated area of medicine. Since the overturn of Roe v. Wade, over 3000 different bills have been introduced, all aiming to restrict some part of our reproductive health care. This is problematic for many reasons. We don’t want politicians determining our health care. We want our physicians and our care teams and our values driving how we take care of our bodies. But it’s also problematic because these laws are frequently written so vaguely that they’re really broadly impacting women’s health.
And we took care of a woman this past summer who was caught kind of up in the gray area of these laws. She came to see us from out of state because she and her partner had been trying for some time to conceive, and she was thrilled when she became pregnant. However, she had the same sort of anxiety and depression that a lot of people do, and during pregnancy, it became so much worse. It got to the point where she couldn’t go to work; she couldn’t really feel like she could leave the house. And the hardest part about all this was she could not find a provider willing to take care of her. And that is because Texas had just introduced abortion restrictions about eight months before the rest of the country, and as part of those restrictions, physicians were liable for criminal charges if they provided any care that led to an abortion. Now, criminal charges, let’s be very clear, are not covered by your medical malpractice; your license is suspended; you can’t go to work. You’ve got no support, putting your whole family kind of at risk. So understandably, doctors were terrified.
And the worry there, and the reason she couldn’t get care is, again, women’s health is under-researched. We don’t know anywhere near enough about mental illness and pregnancy, and we have even less data about effective treatments, because we don’t enroll people in clinical trials. So kind of stuck between a rock and a hard place, we do what we commonly do in obstetrics. We talk to women; we explain the risks; we talk about the benefits. We repeat the same message over and over again, that a developing baby generally does best when you take care of the person hosting the pregnancy, and that a mom’s mental health is incredibly important for her well-being and that of her child. But she didn’t get that message. She flew to us thinking her only option was to have an abortion, get the treatment she needed for her mental health, and then try to get pregnant again. So when we talked to her, of course, we realized, no, that’s not what you need. We got her plugged in with our perinatal psychiatrist. We were able to get her the help she needed, and we just heard from her last month that she and her baby are happy and healthy and doing very well.
Another factor I’d like to touch upon is just the critical importance of a trained workforce. Eighty percent of American women were living in a county without an abortion provider. This was when abortion was legal in the United States. Overnight, we all know that changed. After Dobbs v. Jackson passed, what we saw was 26 states banned it outright. So learning to provide an abortion, which are the exact same procedures whether it’s medication or a surgical procedure, is the same for miscarriage management as well as abortion care. And I know that this is a complex issue for many people, but I can tell you, as an OBGYN, that this is really common. It’s something people need, even though they don’t ever think they’re going to, and it’s basic health care. But we saw that this gap, you know, if we had 82% of OBGYN residency programs, the only residency required to learn about abortion as part of their training, not able to provide abortion training when we had Roe, what’s it going to look like now? So we worked with the Foundation, and through the generous support of philanthropists, we were able to set up a curriculum where we have residents come from restricted settings spend a month with us in Portland. They have their housing paid for and their plane paid for, because we want to make sure that this is open to all residents from different circumstances, so that money is not a barrier to their participating. We have been getting deluged in applications because we were the first university in the country to offer this. It’s been a huge success, and that’s another initiative that we want to continue to build over the years to come, because we need trained physicians, but critically, we need trained nurses; we need trained pharmacists. It’s a whole-team approach that we need to provide evidence-based care for women.
We live in interesting times, and while there’s a lot of uncertainty, I think there’s a lot of reasons to be positive as well. OHSU, with the Center for Reproductive Health Equity, is really well positioned to lead on this nationally, both because we have the opportunity to be a policy lab here, but also because of our outstanding training programs, our expertise in all types of research, from basic science to translational, clinical to population health. And we have the willingness and the collaboration across the state, partnering with the legislature, partnering with Oregon Health Authority, to really make positive change for women. This isn’t just an opportunity we have, it’s a responsibility we have.
