No matter your political stance, there's one unifying truth for all women in America: If the Affordable Care Act (ACA) gets repealed and health centers like Planned Parenthood defunded, there will be very real repercussions on our choices, our health, and the care available to us in both the next few months as well as over the next four years. But what might happen, exactly? Since no one knows better than the men and women actually providing us these services, we asked a handful of ob-gyns to share what they think this massive change in health care could really mean for women around the country. Spoiler: They're not optimistic.
More Teens Will Probably Get Pregnant
"Thanks to improved education and better access to contraception, especially to long-acting methods like the IUD, the teen pregnancy rate is the lowest ever recorded by the CDC. While the rate still exceeds those of other industrialized countries, it has declined annually since 1991. When I think about the potential repeal of the ACA, my greatest fear is that this progress will be undone. If the repeal results in teenage girls losing access to youth-friendly clinics or their preferred choice of no- or low-cost contraception, they may use less effective methods such as condoms, or even worse, practice unsafe sex. Teenage pregnancy changes girls' lives forever, and the economic and social cost to society is enormous. We have made such strides preventing teen pregnancy, it would be tragic to see that trend reverse."
—Stacy Spiro, M.D., an ob-gyn in the Hartford, CT, area
Newborn Babies' Health May Be At Risk
"Because of the ACA, health insurance plans [adopted after 2010] must cover breast pumps, which truly is crucial in helping mothers continue breastfeeding for longer durations of time (the ideal recommendation is exclusively for six months). Most health insurance plans (albeit not all) also must provide breastfeeding support and lactation consultation coverage for the duration of breastfeeding. Our new working mothers, who are required to get back to their jobs much sooner than mothers in many other countries, may lose the breastfeeding benefits and coverage for breast pumps, which have been crucial for them to be able to continue to actively provide nutritional support via breast milk to their newborns." See also: The Benefits of Breastfeeding
—Holly R. Khachadoorian-Elia, M.D., Assistant Professor at Harvard Medical School and ob-gyn at Massachusetts General Hospital in Boston
Poor Women Could Suffer Most
"My biggest fear over the next four years is that we will start to have a two-tier system for basic reproductive and preventive services [wherein the government will provide basic care, and people will have to pay additionally for a second tier of higher-quality and more accessible care]. As a result, some women—poor women—will suffer. Women will have to pay out of pocket for basic reproductive care—or not be able to afford to pay at all. Not only will the women suffer, but our society as a whole will have increases in disease burden, like increased maternal mortality."
—Laura MacIsaac, M.D., Network Director for Family Planning Services, Education, Research, and Policy at Mount Sinai Health System in New York City
Illegal Abortions Will Increase
"My major concern is access to safe, legal abortions. I grew up in an era of illegal abortions. Back in college, one of my friends ended up with an illegal abortion, became infected, and was never able to have a child. This should never happen in the United States again. Many women suffered things even worse than infertility—they died. Unplanned pregnancies happen, and women need to have access to safe and legal abortions."
—Mary Jane Minkin, M.D., Clinical Professor of Obstetrics, Gynecology and Reproductive Sciences at Yale University
More Women Could Die from Preventable Diseases
"This is far greater than a debate over abortion rights, which is understandably difficult for both sides. Planned Parenthood offers preventative services, which should be a right for every person. Take cervical cancer: Recent research links limited access to care to increased death rates. Whole families suffer when young mothers, wives, and sisters could be cured with access to preventative health care." (Related: Death rates from cervical cancer in the U.S. are significantly higher than previously thought.)
—Lori R. Berkowitz, M.D., ob-gyn at the Massachusetts General Hospital in Boston
STIs Will Continue to Run Rampant
"Sexually transmitted infection (STI) rates are currently at an all-time high in the United States. A reduction in STI testing—one of the most common services at Planned Parenthood and other clinics—will lead to even more untreated cases of easily curable diseases. A young woman's entire reproductive future can be threatened by an undetected STI."
—Katharine O'Connell White, M.D., Assistant Professor of Obstetrics and Gynecology at Boston University
Women Rich and Poor Will Suffer
"The Affordable Care Act (ACA) benefits not only the 6 million women and girls insured through one of its plans, but also millions of women whose private insurance plan has improved because of ACA regulations. As a result of the ACA, women can no longer be denied coverage or charged more just because of their sex, young adults can stay on their parents' insurance until they turn 26 years old, and women with preexisting conditions (including pregnancy) can no longer be charged higher premiums. The ACA isn't perfect, but repealing it without a replacement that equally champions women may have a monumental effect on the health of American women. More women—including those currently fighting cancer and those with an early pregnancy—will go without health care because of lack of insurance. And women with insurance may pay more than men for plans that do not cover contraception, pregnancy services, and cancer screening. Supporting the rights and health of women benefits not only women but also their children, families, communities, and the future of our country; the stakes are very high. It is critical that any replacement of the ACA assure access to affordable, comprehensive health care for women."
—Mary Vadnais, M.D., ob-gyn at Atrius Health and Beth Israel Deaconess Medical Center in Boston
Fewer People Will Have IUDs
"The IUD is incredibly effective, but it's also expensive and many people don't have the money to pay for that up front. It's also popular for non-contraceptive reasons. Unlike other birth control options, it doesn't give off estrogen. That means it's one of the only low-risk options for women who have concerns over clotting, suffer from irregular bleeding, a thickened lining of the uterus (endometrial hyperplasia), or severe menstrual cramps. It's not for everyone, but women deserve to have it as an affordable option and the ACA offers just that."
—Virginia Hall, M.D., ob-gyn at Penn State Health Milton S. Hershey Medical Center