Latest Thoughts
Pregnancy Equity Insurance Act
Published in the Colorado Springs Gazette and Denver Gazette 12/3/2023
Achieving equity can be a laudable goal. However, the means utilized to achieve equity can be as crucial as the equity goal itself.
One of the areas where equity has been historically most neglected is women’s rights. For generations women were relegated to a secondary status relative to men. This has markedly improved over the last 60 years. However, as a society we are bedeviled by the reality that women bear a disproportionate burden in human reproduction.
One way to ameliorate that innate biological difference is to render women less susceptible to the consequences of consensual sex by promoting abortion. Our state of Colorado has taken this tack to an extreme and enacted the Reproductive Health Equity Act in 2022 which established a right to abortion for any reason at any time during pregnancy. Most recently, the Colorado Assembly passed laws to ensure ready access to abortion and to eliminate all insurance cost sharing for abortion services.
There is no doubt that these legislative efforts are having an effect, but is this really what Coloradans want? Whether you are prolife or prochoice, you should be alarmed at the rapidly rising abortion rate in Colorado. In the last two years alone, the Colorado Department of Public Health and Environment has reported a 19% increase in abortions performed on Colorado women. There is evidence that 2/3 of women feel their abortion was unwanted, coerced, or otherwise inconsistent with their values and preferences. This means that while we may be streamlining abortion access in our state, we are doing nothing to address the social and financial factors that are driving the abortion decision. A “choice” is only a choice if women feel they have more than one option.
There are other compelling public health reasons that should prompt Colorado legislators to address the rising abortion rate. Even though abortion in the first trimester is relatively safe compared to other out-patient procedures, the risk of dying from an abortion increases 38% for every additional week of gestation after 8 weeks. And in Colorado, we have a disproportionate number of late abortions – 10.5% after the first trimester and 3.4% (487) after 21 weeks which is the limit of fetal viability. This poses a very high risk to the health and life of women. Even if you discount the risk of dying from an abortion, research suggests that there is an approximately 10% complication rate from second trimester abortions and a 1.7% risk for serious, life threatening, complications. And in case you are wondering, the risks of abortion late in pregnancy are likely significantly higher than the risks of natural childbirth, contrary to what you may have heard.
Aside from the acute complications, there is growing evidence that the abortion decision has an adverse effect on women’s long term mental health. There is also research showing that surgical abortions increase preterm birth and low birth weight in subsequent pregnancies, especially for later abortions. The reason this is relevant is that preterm births and low birth weight infants are one of the drivers of maternal and infant mortality. This is a national scourge which disproportionately impacts communities of color.
The fact that hundreds of healthy Colorado women choose every year to have post-viability abortions on their healthy fetuses is an indictment of our current safety-net and healthcare systems. Pregnancy resource centers can provide important support to these abortion vulnerable women, but public policy and programs should better reflect our values. Women should never feel forced to pursue an abortion because of financial and social challenges.
Fortunately, there is an alternative, life-affirming, approach to achieve gender-based equity which Coloradans should consider. Rather than try to dismiss the biological differences in human reproductive roles, we can honor those differences. We can make conscious efforts to minimize the impact those differences have on the physical health and educational/career aspirations of women. In 2020, Colorado voters endorsed Prop 118 which established paid family and medical leave. This is a prototypical example of this alternative approach. But there is much more that can be done.
The physical, social, and financial costs of pregnancy can be ameliorated in many ways to advance the cause of reproductive justice/equity. One initiative that Democrats for Life has promoted is making “birth free”. While this is an ambitious plan, smaller steps are politically and financially feasible in Colorado. Eliminating cost-sharing for prenatal/postpartum care, rather than just for an abortion, is a great place to start.
Infant and maternal mortality have increased in recent years, disproportionately affecting communities of color. Prenatal care has been demonstrated to improve neonatal and maternal outcomes. Postpartum care is important for recognizing rare complications of pregnancy contributing to increasing maternal mortality, including cardiomyopathy. It is also critical to ensure appropriate counseling regarding interpregnancy intervals, screening for postpartum depression, addressing chronic health conditions and encouraging continuation of breast feeding.
Copays and coinsurance can decrease utilization of medical services, including critical preventative services such as prenatal and postpartum care.
The United States Preventative Task Force has made grade A & B clinical recommendations that are proven to reduce morbidity and mortality in women and their offspring. These are predicated on access to quality prenatal and postpartum care and include:
1) Screening for pre-eclampsia in pregnant persons with blood pressure measurements throughout pregnancy.
2) Aspirin use to prevent preeclampsia and related morbidity in pregnant persons who are at high risk for preeclampsia after 12 weeks of gestation.
3) Screening for asymptomatic bacteriuria using urine culture in pregnant persons.
4) Providing intervention during pregnancy and after birth to support breastfeeding.
5) Screening for herpes, chlamydia, gonorrhea, syphilis, and HIV in all pregnant persons.
6) Screening for depression and anxiety in pregnant and postpartum women and provide women at increased risk, counseling and interventions.
7) Daily dietary supplement containing folic acid in all persons planning to or who could become pregnant.
8) Screening for gestational diabetes in asymptomatic pregnant persons at 24 weeks of gestation or after.
9) Offering pregnant persons effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excess weight gain in pregnancy.
10) Screen for intimate partner violence.
11) Rh(D) blood typing and antibody testing for all pregnant persons during their first visit for pregnancy related care.
12) Asking pregnant persons about alcohol and tobacco use and providing behavioral interventions to promote abstinence.
There are wide gaps in free prenatal/postpartum care coverage in Colorado despite Colorado’s Medicaid program, Health First Colorado, and the Affordable Care Act program, Connect for Health Colorado. This places an unnecessary and costly burden on women in Colorado. Decreased access to quality prenatal/postpartum can translate into measurable increases in maternal/infant morbidity and mortality and long-term Colorado healthcare costs. It blatantly violates the principle of pregnancy equity.
There is an opportunity for Colorado legislators to make a difference. Democrats for Life of Colorado has reached out to both Democrats and Republicans seeking sponsors for what we have called the “Pregnancy Equity Insurance Act” in the 2024 General Assembly. The bill would eliminate insurance cost sharing including copays and coinsurance for all prenatal/postpartum services. Thus far, while some legislators have expressed an interest, nobody has stepped up to sponsor the legislation.
Prochoice advocates often level criticism at the prolife movement for inattention to the needs of women and their children with limited means. This proposal belies that characterization and would make alternatives to abortion more sustainable for more women. It is a natural area in which we should be able to find common ground.
If you agree that we need to provide improved access to all pregnancy choices and decrease the obstacles to continuing a pregnancy for the families of Colorado, the Pregnancy Equity Insurance Act could be a valuable tool. It has the potential to improve gender/pregnancy equity while simultaneously improving healthcare outcomes. Please contact your state representative/senator to request that they champion this important effort and start systematically removing all the other barriers to pregnancy healthcare.
Kathleen Houston
Thomas J. Perille MD
Democrats for Life of Colorado
