Access to Emergency Contraceptives in Light of the Turnover of Roe V. Wade

Following the overturn of Roe V. Wade, CVS stores across the United States placed a purchasing cap on “Morning After Pills,” more commonly known as “Plan B,” in hopes of ensuring equitable access to all who wanted to purchase. Though no purchasing cap was placed on Plan B in Walgreens stores, representatives claimed that they may enforce a limit if they see an influx of purchasing. Many fear that with the overturn of Roe V. Wade, bulk-purchasing of Plan B could cause shortages, greatly impacting those who need it most.

Without an ID or prescription, emergency contraceptive pills can be purchased over-the-counter, whereas abortion medications require a prescription and strict pill regimen. Commonly used after unprotected sex, Plan B and similar contraceptives can prevent the release of an egg from the ovary. Plan B is not accessible to all, however. With an average price of around $50, these tiny pills could be too expensive for those who need it, placing it out of reach for some consumers.

However, in the beginning of 2022, CVS decided to reverse their purchasing cap on Plan B as sales returned to normal levels. Yet with the overturn of Roe V. Wade, we can’t help but wonder what the future looks like for access to contraceptives like Plan B. According to the Plan B label, the contraceptive claims to “prevent a fertilized egg from attaching to the womb.” Though the statement is not backed by scientific evidence, the statement was approved to be included on the box to get Plan B passed as an over-the-counter contraceptive. Some anti-abortionists argue that interference with the egg in any way is still considered abortion. This has sparked confusion over the language on the packaging and could cause further controversy over whether contraceptives like Plan B will still be made available.

The US Food and Drug Administration states that Plan B does not prevent the fertilized egg from implanting in the womb and therefore does not cause abortion. In addition, if a fertilized egg is implanted in the womb before Plan B is taken, the contraceptive will not be effective. Therefore, Plan B has decided to update its packing to reflect more accurate information regarding the drug.

Though knowledge of Plan B is widespread - around 93% of adults have heard of Plan B - 73% of US adults are not entirely sure of how the pill works. 32% are unsure if Plan B is legal in their state, and 5% incorrectly believe that Plan B is illegal in their state.

Some states, including Idaho and Louisiana, have begun discussing future restrictions for emergency contraceptives and possibly IUDs in light of the overturn of Roe v. Wade. While no states have officially banned Plan B, there is uncertainty and confusion regarding the future of contraceptives. Missouri’s “trigger law” would impact Plan B access but would not ban emergency contraceptives. Therefore, even if Plan B and other contraceptives are still made available, their access might be limited.

Edited by: Heiley Tai

Graphic Designed by: Makayla Gorski

References

1. https://www.cnbc.com/2022/06/27/cvs-capping-purchases-of-plan-b-pills-to-ensure-consistent-supply.html

2. https://www.cnbc.com/2022/09/09/plan-b-and-other-contraception-may-be-at-risk-following-abortion-ban.html

3. https://www.cnn.com/2022/12/23/health/fda-plan-b-label-abortion/index.html

4. https://www.kff.org/womens-health-policy/press-release/the-public-including-women-of-childbearing-age-are-largely-confused-about-the-legality-of-medication-abortion-and-emergency-contraceptives-in-their-states/

Genetic Testing Through the Lens of Reproductive Health

In the realm of reproductive health and genetics, much attention has been given to the possibility of new advances that would allow for editing of the germline to create what has become known as “designer babies”. What has garnered less attention is a practice that is currently undertaken in every US state: newborn screening for genetic disorders. While these newborn screening programs are not new, there are advances on the horizon that warrant consideration, such as a shift from targeted testing centered around specific genes to genome wide testing. Even within the current programs that screen for a limited number of conditions, there exist ongoing ethical considerations that must be addressed.

The purpose of newborn genetic screening is two-fold and is intended to provide benefits on both an individual and population level. On an individual level, these screenings increase reproductive autonomy, allowing parents to “pursue assisted reproductive technology in order to avoid conception of an affected child, to consider termination of a pregnancy, or to prepare for the birth of a chronically ill child” (1). On a population level, newborn screening can help decrease the incidence of certain genetic conditions (2). However, these potential benefits can also become problematic, increasing stigma around non-fatal genetic conditions and implying that those conditions must be eradicated for the good of society.

In addition to concerns around the stigmatization of genetic conditions, there are many other ethical considerations that come with prenatal genetic screening, especially when envisioning genome wide screening becoming standard practice. Many of these concerns center around the quality and validity of the results these tests may produce, which is of the utmost importance in this context where life and death decisions may be made based on this information. As the scope of screening increases, so does the amount of information gleaned, making it more difficult to decide which results are clinically useful and the extent to which they can be used to make sound medical decisions (3). In addition, there is a distinction between diagnostic and predictive power in the results of genetic testing, which must remain clear in the minds of healthcare providers and explicitly explained to patients (3). Also relating to the communication of results, sensitive information may be gleaned from prenatal genetic testing, leading to questions around what information should be returned and to whom. For example, results from genetic screening could potentially have relevance to the health status of parents and/or other family members, and the question of whether to return this information and in what form becomes a challenge (2). In addition, issues arise relating to the autonomy of the unborn child, as results may appear suggesting susceptibility to conditions that would not manifest until later on in life. Questions arise around whether that information should be returned to the child, and if so, when and how it should be done (1). In addition, genetic results can often have serious consequences, especially with respect to employment and insurance discrimination, leading to the question of whether gleaning genetic information from an unborn child violates their right to control how their genetic information is used (1).

As genetic and genomic advances are made, ethical considerations arise that must be thoroughly addressed before new practices are put into place. In the realm of reproductive health, unique challenges are faced that warrant additional consideration given the vulnerable nature of the unborn child. While genetic screening has the potential to alleviate suffering and provide benefits to parents, progress must proceed carefully to ensure that unintentional consequences do not arise along the way.

Edited by: Laila Khan-Farooqi

Graphics Designed by: Kidest Wolde

References

1. Ethical issues in genetic testing. ACOG Committee Opinion No. 410. American College of Obstetricians and Gynecologists. Obstet Gynecol 2008;111:1495–502.

2. Dive, L., & Newson, A. J. (2021). Ethical issues in reproductive genetic carrier screening. The Medical journal of Australia, 214(4), 165–167.e1. https://doi.org/10.5694/mja2.50789

3. Royal College of Physicians, Royal College of Pathologists and British Society for Genetic Medicine. Ethical issues in prenatal genetic diagnosis. Guidance for clinical practice. Report of the Joint Committee on Genomics in Medicine. London: RCP, RCPath and BSGM, 2022.

Effects of Maternal Mental Health on Both Mother and Child

Maternal mental health is a critical aspect of pregnancy and birth that can often be overlooked. While the birth of a child is a momentous occasion, it can also be a challenging time for many mothers. In fact, the World Health Organization estimates that approximately 10% of pregnant women and 13% of women post-birth experience a mental disorder. These disorders can have a significant impact on a mother's well-being, as well as the development and health of her child8.

There are two significant periods where maternity is categorized: prenatal and postnatal. Prenatal period refers to the period before birth (during pregnancy), whereas postnatal refers to the period post birth (after pregnancy). Lastly, perinatal refers to the short period of time, usually weeks, before and after birth. It is important to distinguish these periods pre and post birth because they generate disparate effects for the mother—and for the child, as well6.

The article “Prenatal mental health and the effects of stress on the fetus and the child. Should psychiatrists look beyond mental disorders?” by Vivette Glover discusses the impact of prenatal stress on the neurodevelopment of the child and the potential role of mental health professionals in addressing this issue. Glover highlights various types of prenatal stress, including the mother's exposure to natural or man-made disasters, emotional cruelty, and domestic abuse by her partner, among others2.

Recent data suggests external and internal stressors can increase the risk of emotional, behavioral, and cognitive problems in the child. Early childhood maltreatment of the mother has been found to be associated with altered brain structure in the newborn, with reduced cortical gray matter2. This association was independent of the mother's prenatal mood, and of other potential confounding variables. This suggests that such early trauma may affect the mother's biology in a way that in turn alters the development of the brain of her fetus and may indicate vulnerability to later depression and other problems for the child. Even more, research has consistently shown that postpartum depression can have negative effects on child development. For example, a systematic review of 28 studies found that children of mothers with postpartum depression were at higher risk of cognitive and behavioral problems3. Another study conducted in the US found that maternal depression in the postpartum period was associated with lower cognitive and language scores in children at age three8. A longitudinal study conducted in the UK found that maternal depression in the postpartum period was associated with lower academic achievement in children at age 16 7.

Maternal mental health postnatal has become a priority for hospitals and health systems in the United States. One in five women experience maternal mental health conditions, such as perinatal and postpartum depression, birth-related PTSD, and anxiety, yet 75% go untreated, with suicide and substance abuse being the leading causes of maternal deaths in the first year after childbirth 7. Women of color are more likely to experience these conditions but are less likely to seek help. The recent partnership between the American Hospital Association (AHA) and the national non-profit organization 2020 Mom aims to improve maternal mental health care by producing tools and resources specifically for hospitals and health systems.

Hospitals are the hub for 98% of births in the country and are therefore critical in improving maternal mental health outcomes. Efforts to improve maternal mental health vary depending on the patients and communities served . For example, Common Spirit Health engaged obstetrics providers, perinatal nursing staff, and social workers in a screening program to identify the mental health conditions of pregnant and postpartum women 4. Providers receive mental health training, and patients with identified risk of depression and anxiety relate to a social worker to assess their condition. Similarly, the integrated maternal mental health initiative at SCL Health administers a universal mental health screening, connects patients with mental health resources, and provides mental health training to obstetrics providers and staff.

Furthermore, it is important to identify and treat postpartum depression. A systematic review of 19 studies found that depression screening during pregnancy and the postpartum period was associated with increased rates of treatment and improved maternal and child outcomes5. Similarly, a study conducted in the US found that maternal depression screening and referral to mental health services was associated with lower rates of depression and improved maternal and child outcomes 3. As highlighted in various studies, maternal mental health issues can have long-lasting effects on the child's development and health, and therefore, addressing this prevalent issue in society should be a top priority. By providing access to mental health resources, promoting strategies that support maternal mental health, and engaging healthcare providers in screening programs, we can improve outcomes for both the mother and the child and create a healthier and happier society.

It is crucial to recognize and address maternal mental health concerns to ensure the best possible outcomes for both mother and child. In this context, it is important to explore and understand the various factors that contribute to maternal mental health and promote strategies that can support and improve it.

Edited by: Deven Gupta

Graphic Designed by: Eugene Cho

References

1) American Hospital Association. “AHA, 2020 Mom Partner to Improve Maternal Mental Health.” AHA News, 27 Apr. 2020, www.aha.org/news/headline/2020-04-27-aha-2020-mom-partner-improve-maternal-mental-health.

2) Glover, Vivette. “Prenatal mental health and the effects of stress on the fetus and the child. Should psychiatrists look beyond mental disorders?” British Journal of Psychiatry, vol. 208, no. 5, May 2016, pp. 399-400. doi: 10.1192/bjp.bp.115.172057.

3) Goodman, Sherryl H. “Depression in Mothers.” Annual Review of Clinical Psychology, vol. 9, no. 1, 2013, pp. 379-407, doi:10.1146/annurev-clinpsy-050212-185612.

4) “Improving Maternal Mental Health.” CommonSpirit Health, www.commonspirit.org/stories/improving-maternal-mental-health. Accessed 28 Mar. 2023.

5) “Maternal Mental Health Initiative.” SCL Health,

www.sclhealth.org/campaigns/mom/better-mental-health. Accessed 28 Mar. 2023.

6) Natalist. "The Importance of Prenatal and Postnatal Care." Natalist, Natalist, 16 Oct. 2020, https://natalist.com/blogs/learn/the-importance-of-prenatal-and-postnatal-care.

7) Sabo, T., Brown, A., Eckenrode, J., & Zimmerman, M. (2005). Gender differences in perceived social support and stress at entry into substance abuse treatment. Evaluation and program planning, 28(4), 391-398.

8) World Health Organization. (2013). Mental health action plan 2013–2020. World Health Organization.https://apps.who.int/iris/bitstream/handle/10665/89966/9789241506021_en. g.pdf;jessionid=9B9B101E0C324F2713F3E67A91F841D2?sequence=1