Dr. Amita Vyas: A Medical Professional's Perspective on the Consequences of Overturning Roe
By Olivia Eisenberg, The Fem Word Contributor
THE FOLLOWING IS A PART OF A SPECIAL TFW SERIES FOCUSING ON THE SUPREME COURT ABORTION RULING
As most people are aware, the United States Supreme Court overturned Roe v. Wade, the 1973 decision that federally protected women’s abortion rights. It is now legal for individual states to ban, criminalize and punish the act of obtaining or even seeking an abortion. This has enormous implications for women’s access to reproductive healthcare, an area of public health that has far-reaching consequences for all of us, consequences that go far beyond the realm of abortion itself. The Fem Word met with Dr. Amita Vyas to discuss this life changing ruling and to gain a better understanding of how it will affect Americans of childbearing age and countless others, who it will affect the most, and what average Americans can do about the changing reproductive landscape.
The Fem Word had the opportunity to have a conversation with Dr. Amita Vyas, an Associate Professor and the Director of Maternal and Child Health at [George Washington University] in Washington, D.C. After earning her Masters in Demography and her Doctorate in Population and Family Health Sciences at Johns Hopkins, Dr. Vyas has gone on to conduct research on issues that include teen pregnancy prevention; social media use and health; evaluation of interventions and related programs; health behaviors; and violence against women and girls. Dr. Vyas is also a producer for Girl Rising, which is a global film campaign focused on girls' education and empowerment. She is the founder of Global India Fund, a nonprofit that informs donors and supports philanthropy and service organizations on the Indian subcontinent and has presented on a variety of public health and service-related topics.
Professor Amita Vyas Speaks to Senate Democratic Caucus on Global Empowerment of Women & Girls, 2015
“I wish we didn’t have to have this conversation, it continues to be shocking and heartbreaking, what the Supreme Court did just a few weeks ago, but I am truly grateful that I have the opportunity to speak to all of you. As women in particular it impacts all of us, it impacts our daughters, our sisters, our family members and friends.”
How would you define “public health” versus. the kind of health concerns we as individual women face or engage with each day?
In terms of thinking about defining public health versus individual level health, they’re both important. When we think about the health of the individual that often falls into the field of medicine which is “let’s look at an individual, and assess the individual’s needs and come up with a treatment or solution for an individual.” In public health, we think about health at the population level, and so we think about how policies, not just affect individuals but entire communities and families. We think about how programs and interventions are not just implemented for individuals, but again at the population level. I think the other piece that’s so important in terms of what we do in public health, is we really focus on what we call social determinants of health. We're interested in how things like childcare can affect a woman’s ability to access health care services, we think about how employment affects a person’s health and the populations health, we think about how unemployment, how income levels, how transportation, a person’s lack of ability and mobility to access services, particularly healthcare services, is impacted if they don’t have transportation whether that’s public or private transportation. So we really think about all of those social determinants, and in my work in particular, I also think about gender. I think specifically about the unique challenges that women face. Not just because men and women are different, but also different because of the social context that we live in. Women as caregivers, women as the ones who can have children, women’s roles within the workforce, women’s roles in terms of how they move up the ladder in terms of their careers and jobs and employment and their access to those things, and in particular, reproductive health which is very unique to women.
Speaking about social determinants and access and transportation, Technology has to play a huge role in that, especially nowadays. What are the goods and bads of technology.there are applications like period trackers and fertility trackers , and then technology is used to purchase reproductive products and care and sign up for appointments -- it all involves very personal data. Are you and other healthcare professionals worried that technology could be used against women? As much as it’s been helpful to increase access, there’s also a fear that data could be used to prosecute women who are seeking care. Are you concerned about that, how do you see it playing out?
Up until the Supreme Court’s ruling, I would say that overall technology, when we think about reproductive health, has been life saving in so many ways. It has allowed women to access care and services, it has allowed women to become empowered to take their health into their own hands, like with the apps you mentioned. For example, I know that a lot of teenage girls, when they first get their period, they use those apps, women use those apps. It is really empowering women, and that, in my mind, is the future of not only healthcare, but women’s healthcare and reproductive health. I think that the issues surrounding data and privacy are real. I know we’re finally starting to talk about that now, given the supreme court’s ruling. People are talking about these apps, how people make healthcare appointments, how people communicate, what people are posting on social media, adn will that allow people to track who is accessing abortion -- whether that is legally or in other ways. I think we’ve got a long way to go before we know that. I do take some hope in the fact that even in some of the most staunch, anti-abortion activists and policymakers, they’ve always been really clear that even after abortion is made illegal, that the punishment not be the punishment of women, but really the punishment of providers. So even the most staunch anti-abortionists are looking to prosecute and go after providers, whether its providers [of] telehealth services, providers that are allowing patients to cross state lines and accessing abortions, providers who are prescribing mythopristol, which is the abortion medication, and allowing patients to access said [pill] through mail or other means. In general, and even if we look way back to pre-Roe when abortion was illegal, really the prosecution was not on women but it was on providers, they were the ones who people were going after, and so I don’t see that women are going to be prosecuted, at least not now. I hope not, because that’s never really been the way, and anti-abortionists have been really vocal about that, but certainly if providers are in fear of being prosecuted, they are not going to provide telehealth services, women are not going to be able to access technology in the way that they should. But one thing that I do want to mention in terms of data and privacy, is that it was pretty incredible how many business stepped forward after the ruling and said, “If any of our employees are in need of abortion services, we will help them. We will provide resources, we will pay for them and help them access those services.” That all sounds pretty wonderful, and I am a believer in wanting to see that happen, but there are significant data and privacy issues with that, and I don’t think people are paying enough attention to that. What does a woman do, call up the human resources department and say [she’s] in need of an abortion? Where is that information going? Because that [communication] is happening outside of a healthcare system. Even when we think about the times of Covid, early on in the pandemic, employers were not allowed to ask their employees whether or not they were taking leave for Covid. We protect people’s privacy around their health, and so for a corporation or business to then say that [they’re] going to provide support for women to access abortion services, there are some really complicated issues at play when it comes to the data and privacy of that [protected] health information.
In speaking about healthcare providers being the ones that are going to be targeted -- how are you doing? How are you and your community coping? Is it scary, how can we help protect our healthcare providers and make it safe for them to practice? how can everyday people support you and your work.
Amita N. Vyas, PhD, MHS, is a tenured Associate Professor at the George Washington University (GW) School of Public Health and Director for the MPH Maternal and Child Health program and the Center of Excellence in Maternal and Child Health.
Thank you for that. As we were talking about earlier, it continues to be heartbreaking and shocking. I think we all want to continue to protect one another. But just to put this into a little bit of context, when it comes to healthcare providers that are providing abortions, the fear of retaliation, the fear of prosecution has been around for a really long time. If you look at just the past decade or so, the amount of violence against providers that provide abortions has increased tremendously. When you look at the last ten years, the amount of restrictions that states have put into place has been astounding. So we’re not really going from a place of all states freely making abortion services available and women accessing those services readily. There are entire counties, many counties around the country that don’t have a single abortion provider -- and this is before the Supreme Court ruling. On average, women in this country were already traveling 50, 60, 70 miles to access an abortion. Most states is this country mandated that abortions can only be performed by licensed physicians, some states [...] had restriction in place saying [abortions] could only be performed in hospital settings. Some states vary in terms of their parental notification and parental consent law. So the level of restriction in this country was already pretty significant even before the overturning of Roe v. Wade, and so for providers, this fear, this knowing that they’re one of few, most residents that are studying to become OB/GYNs, the majority of them are not choosing to be trained in abortion services. And so the fear has been there for a really long time, certainly it’s intensifying after this ruling because legally people can come after them, states can come after [them]. We know of cases where providers were killed, they were murdered. When you think about the violence that happens outside of those healthcare centers, it’s been significant over the years. So what can we do? I think we need to continue to raise visibility about these issues. Even though everyone is cognisant of the overturning of Roe v Wade and what that may or may not mean, there are a lot of implications that affect more people than people realize. I think we need to raise all of these issues, issues surrounding healthcare providers and ensuring they’re not prosecuted, data and privacy issues, particularly with businesses and corporations that are wanting to do something good but could have negative consequences for women. So I think we have to continue to raise visibility on these issues that are consequences of the overturning of Roe.
You mentioned historically there being a lack of abortion centers, but there have always been more underground grassroots networks — like the Auntie Network — who are helping people access abortions, whether that’s a medical abortion, herbal or other types. Do you think these kinds of efforts are good, or is there too much of a potential for well-meaning but poorly informed people to do harm by this type of effort? How do you think that we can make these underground or home-grown networks more safe?
I do support many of these networks that are out there. There’s a large network [called Plan C] that is a global network that allows women to access medication abortion. They provide a telehealth service, and then the medication is coming from pharmacists from other countries such as India to the United States. I am a big believer in empowering women to take as much control of their own healthcare as possible, so I do think that there is tremendous power and good work happening with many of these networks. My fear is how that is going to change in light of the overturning of Roe v. Wade. Before, services were legal, so these networks were allowing women to access legal services. Where things can really go wrong is if women are now going to be accessing underground services that are illegal, and that there’s no regulation of that. The last thing we want to do is go back to the 1800s and early 1900s. If you look at data from around the world and even data from here in the United States from the pre-Roe era, you’ll see that when abortion is legal in countries and states, maternal death rates are at a low. As we overturn those laws, you’ll see a huge spike in maternal death.
In the United States, when Roe v. Wade became the law of the land, maternal deaths decreased significantly in this country. When you look at countries like Afghanistan and other places with the highest rates of maternal deaths, those are the same places that have the most restrictive laws on abortion. So these things go hand in hand with each other, and much of what’s driving that is that when you’re living places that restrictive abortion, women aren’t access prenatal care early enough, but it’s also, as you were talking about Olivia, these underground networks of potentially unsafe abortions. What we do know is that medication abortion is safe, so as much as we can do - and what the current administration tried to do with the most recent executive order -- is to give power to the FDA which has said “yes this is safe and effective,” the more we can get people to know about abortion medication, because there is a real lack of knowledge of abortion medication in this country, the more that we can raise visibility around that, the safer women can be. But that said, that will only take care of a small portion of the issue, given that you have to take medication abortion in the first trimester, early on in your pregnancy. That’s one piece that as young women to raise visibility to use your networks to talk about abortion medication so women are empowered to know about it and how to access it. Currently in this country, you can access it through a telehealth visit, it does not have to be an in-person visit.
There are these “crisis pregnancy centers,” there’s a huge network of centers, many funded by states in fact. I don’t know if any of you live in Virginia -- I live in Virginia -- and there are license plates that say “choose life” on them and when someone goes into the DMV and chooses to purchase that license plate, the funding for that goes to an international network that funds crisis pregnancy centers. Crisis pregnancy centers are not regulated by any system because they are not healthcare systems. They are not staffed by healthcare personnel -- not nurses, not physicians, not PAs -- no one who is licensed. But they call themselves crisis pregnancy centers, they market themselves as a place that women in need can go to if they are pregnant, and they do all sorts of things, perpetuating myths, providing misinformation, showing women ultrasounds that are not their ultrasounds and women think they are their ultrasounds. These are women in their first trimester. For those of us who have had children, we know what those ultrasounds look like -- it does not look like a fully formed child that you are about to give birth to. So they show them those ultrasounds, and because there’s no regulation around these crisis pregnancy centers, because again they are not healthcare centers, no one can shut them down. They are privately funded entities, often part of religious organizations, and there’s not a single person that works in a crisis pregnancy center that has a healthcare degree or is licensed in any way -- these are not healthcare personnel. We have to raise visibility about these issues.
Who is going to be using these centers?” It will be people who are not educated about this and are in the worst situations to begin with, and are about to be even more in trouble than they already were.
Ashley Judd & Dr. Amita N. Vyas at Global India Fund Fundraiser for Girl Rising, Washington, DC, 2013
PHOTO: Arnab Kar Photography
Right. So you think about young girls, who might not have any social or family support, no one to help them. Their marketing tactics are really focused on those most vulnerable, and to bring them in and provide support. But it is shocking, and lots of studies have been done on these crisis pregnancy centers, these sort of mystery client types of studies where researchers go in disguised as potential clients. So we know this is happening, it has been happening for a really long time, but other people don’t know about it.
You mentioned that we will start to see maternal death rates go up with these new restrictions. In an interview with FOX26, you pointed out that the US has the highest maternal death rate of all high income countries. How do you think the Dobbs ruling will further affect the United States’ global image and ranking among wealthy countries in terms of [physical] health as well as mental health?
Unfortunately, in the United States, and this is on many health indicators, we really perform the worst when compared to other industrialized or high income nations like us. We have the worst maternal death rate, we have the worst infant mortality rate, the highest teen pregnancy rate, the highest STI rate. When we look specifically here in the United States, it is really women of color that are most at risk when we think about maternal deaths. Black women are three times more likely to die during or after childbirth than white women. That is quite significant. In 2022, in a high income country like the United States, we should not have increasing maternal death rates. The only other where we see this happening is Afghanistan. Much of this is preventable. There are lots of reasons for why we see this: women not accessing prenatal care early on, women with chronic conditions pre-pregnancy. Unfortunately women often do not enter the healthcare system until they become pregnant or later in their pregnancies, and then we find out they’ve got these other chronic conditions which increase their risk. When we look specifically at women of color, and in many communities including here in Washington, DC, we know that really good healthcare services are there, but why aren’t women accessing them? That’s really the big question. So much of it is around institutional racism that we’ve seen in our healthcare system for decades and decades and decades.
Women not being heard, women not being treated well. [I’ve come across] many stories in my own research, in talking to Black women in Washington, DC about their experiences in pregnancy and postpartum and how they were treated. And so that institutional racism is really a key piece that we need to address. Secondly, when you look just at racism and discrimination that women of color face from the day that they’re born, there’s something called the weathering hypothesis. This basically states that when women face racism and discrimination for long periods of time, so think the first twenty years of your life, it literally weathers their bodies, it weathers a woman’s body. That stress and the inability to cope with that stress, the increasing cortisol levels. This has been documented in the scientific literature, and we’ve done lots of studies to show this relationship between discrimination and increased cortisol levels and this weathering. By the time women then become pregnant, their bodies can almost not handle the stress of the pregnancy because they’ve been weathered. So, as we think about so many health inequities in the United States, and the racial inequities that we’re starting to finally address and talk openly about, this is a really big one.
I truly believe that racism and discrimination has put women of color at risk during pregnancy, and is why we see such stark differences in maternal death rates between Black and white women. So we’re starting to understand that a little more, what we’re going to do about it is what we’re working on right now. My team at GW is working to think about that, specifically in DC, since we have one of the highest maternal death rates in the United States -- how do we address these issues?
Bottom line — is this [ruling] going to kill women? The answer is yes, yes it is. And we’re going to see that, and it's visceral. I don’t know if it will bring the cost home for anti-choice advocates. I don’t know if they care, or if it doesn’t matter, if it's for this greater good in their mind. I think you’ve answered this question, and I’m sad that it’s the answer that maybe many of us have to come to expect. But it will kill women.
Absolutely. Women are going to die. One last point from Olivia’s question on mental health: the mental health consequences are significant. There have been studies done that show that when women are denied access to abortion, even when it was legal, had worse mental health outcomes -- increased risk of depression, stress, anxiety -- than women who were able to access abortions. So when we think about the mental health of adolescent girls, and the lifetime consequences of being forced to carry a pregnancy to term, it’s significant, for her physical health, her mental health, but also for the economic stability of her and her family. We talk about wanting to lift people up out of poverty, and denying women abortions perpetuates poverty. There are significant consequences to everyone’s social, [physical] and economic well being.
AUTHOR’S NOTE:
Abortion is a healthcare issue. Politicians, while they may have some knowledge about reproductive health, do not have the medical background and experience to be making decisions about people’s bodies without being properly informed of the risks. Perspectives like Dr. Vyas’ are critical to this conversation, and without them, we lack the scientific facts that make clear the dangers of limited access to reproductive health. As a reader, it is your responsibility to advocate for the healthcare professionals who provide lifesaving reproductive care, and the people who are at risk of losing such lifesaving care.
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