Women’s Health at a Crossroads: Shaping Policy and the 2024 Election

After covering the background of women’s health and the space’s market trends, it’s only fitting to discuss women’s health policy, which has shaped the current landscape.

What’s particularly important about women’s health policy now is the direction it may take depending on the outcome of the 2024 election in a couple of months.

In this article, I’ll cover the policy behind reproductive health, highlight key maternal health initiatives, dive into women’s health research, and briefly discuss my thoughts on the upcoming election regarding women’s health.

The Past, Present, and Future State of Reproductive Health

It’s been two years since the Supreme Court’s majority decision in the Dobbs v. Jackson’s Women Health Organization case, effectively overturning Roe v. Wade. I’ve written a timeline below of the events leading up to the decision:

The Dobbs ruling has had a ripple effect across the nation, with many states immediately adding strict abortion laws or removing abortion rights. The Guttmacher Institute has kept track of such laws. You can see the most up-to-date abortion policies map below:

Despite states enacting such restrictive policies, abortion rates increased by 11% between 2020 and 2023 (likely an underestimate, too). While we saw an 11% increase in abortions nationwide, states without total abortion bans saw a 26% increase in 2023 compared to 2020. Further, states bordering neighboring states with strict abortion bans experienced a ~40% increase in abortions during the same time period.

There are likely three reasons to explain this paradoxical increase in abortions despite restrictive measures by states.

1. Telehealth for medication abortion increased significantly after the FDA lifted in-person dispensing requirements for mifepristone during the pandemic, benefiting many, especially in rural areas.

2. Increased financial support post-Dobbs, primarily from abortion funds, has helped many in states without bans, though its sustainability is uncertain as donations have slowed.

3. State policies, including "shield laws" in 22 states and Washington, DC, have protected healthcare providers and patients from legal consequences, expanded data privacy, and increased funds for clinic security.

So, the abortion rate increased despite strict abortion laws. We’re good!

Not exactly.

Abortion access is not easy: over 170,000 traveled out of state in 2023, overcoming substantial economic and logistic challenges. Communities of color, LGBTQ+ individuals, young people, immigrants, and those with low incomes or disabilities are especially harmed by strict abortion policies. Such policies may further exacerbate inequities already seen in maternal mortality, which disproportionately affects people of color.

Lastly, there’s been a worrying trend from restricting abortion to targeting contraception and IVF. The Kaiser Family Foundation provides a great overview of how state and federal actions are shaping access to contraception, with many states adding protective policies to safeguard contraception rights. Luckily, the mifepristone case before the Supreme Court was shot down for lack of standing, but it could have impacted how the FDA approves all drugs. More troubling, though, are the pending bills in 13 states threatening IVF by considering embryos as people, posing significant risks to reproductive healthcare access.

Key Maternal Health Initiatives

Maternal health disparities in the U.S. are stark, with Black women facing a maternal mortality rate over 2.5 times higher than white women and American Indian and Alaska Native women experiencing rates twice as high. Geographic disparities also exacerbate the issue. Rural areas are seeing a decline in hospitals offering obstetric services, increasing the risk of complications and highlighting the urgent need for better access to maternal care.

So, what’s being done about maternal health?

The Biden-Harris Administration introduced the Maternal Health BluePrint earlier in his term. This comprehensive plan outlines actions to improve maternal health outcomes, reduce disparities, and enhance the overall experience of pregnancy and postpartum. Outside of Biden’s Maternal Health BluePrint, several other pieces of legislation and key initiatives were enacted or are pending enactment. Below I’ve organized key policy highlights.

Medicaid Expansion

Biden’s Blueprint aimed to permanently extend Medicaid postpartum coverage from 60 days to 12 months. During the pandemic, states could implement this extension through the American Rescue Plan Act, which provided increased Medicaid funding. However, this funding was set to expire in 2027, creating a potential postpartum insurance cliff. Thankfully, the Consolidated Appropriations Act of 2023 made this extension permanent, and nearly all states have implemented or plan to implement it. This extension is crucial as half of pregnancy-related deaths occur between one week and one year postpartum, with over 80% being preventable. Additionally, Medicaid finances around 2 out of 5 births.

Other Legislation

Black Maternal Health Momnibus Act

The Black Maternal Health Momnibus Act (great name) is a set of 13 bills aimed at tackling the maternal health crisis, particularly among Black women. Here are highlights of the act: 

• Investment in addressing social factors affecting health

• Support of community-based organizations

• Improved care for veterans

• Diversification of maternal health workforce

• Enhanced data collection

• Support for maternal mental health and substance use. 

Mamas First Act

The Mamas First Act aims to address the maternal health crisis by expanding Medicaid to cover doula and midwifery care. This legislation seeks to improve access to culturally competent, patient-centered care, reducing maternal mortality and disparities, especially for underserved communities.

Keep Obstetrics Local Act

The Keep Obstetrics Local Act is draft legislation that would address the closure of maternity units in rural and underserved areas by doing the following:

• Increasing Medicaid payment rates for labor and delivery services.

• Providing standby payments to low-volume hospitals.

• Creating payment adjustments for low birth volume hospitals.

If you recall from my prior article, 267 rural hospitals shut down their obstetrics services from 2011 to 2021, and 63 rural hospitals shuttered their obstetric services during the pandemic alone.

Maternal Mental Health

Transforming Maternal Health Model

CMS’s Transforming Maternal Health Model helps Medicaid programs develop a holistic approach to pregnancy, childbirth, and postpartum care. The model focuses on improving access to care and delivering personalized, whole-person care to address the physical, mental, and social needs of pregnant and postpartum individuals.

HHS Maternal Mental Health Task Force

The Maternal Mental Health Task Force published their National Strategy to Improve Maternal Mental Health Care. It focuses on building a robust healthcare infrastructure prioritizing perinatal mental. Key initiatives include integrating mental health into perinatal care, expanding workforce training, and enhancing support for substance use disorders during and after pregnancy.

The Substance Abuse and Mental Health Services Administration

SAMHSA is investing $27.5 million to improve behavioral health services for women. The funds will expand access to services and improve the capacity of providers to identify and address mental health conditions, substance use and gender-based violence.

Clinical Research

Women represent more than half the population, but only ~11% of the NIH’s budget is allocated to women’s health research. This shouldn’t surprise you if you read Part 2 of this women’s health series on investment and market trends.

Sure, you may point out that the government increased NIH funding for endometriosis research in 2022 to $16 million (0.04% of the NIH budget), equating to $2 per person with endometriosis per year. Crohn’s disease, on the other hand, received $90 million in the same year, equating to $130 per person with Crohn’s per year. Around 1 million Americans have Crohn’s disease, while 6 million American women have endometriosis. So, there is 6x more funding for the disease that has 6x fewer people affected. Quite the disparity!

Big picture, though, Biden signed an executive order in March, increasing women’s health research funding via the Fund for Women’s Health Research at the National Institutes of Health (NIH). The executive order will set aside $200 million in 2025 to fund new, interdisciplinary women’s health research. In the long term, President Biden urges Congress to invest $12 billion in this fund. Some areas of research that will be funded include endometriosis, menopause, the impacts of COVID-19 on women’s health, health disparities among women of color, and women’s mental health.

Women’s Health research will receive more funding through other initiatives below:

• The Novo Nordisk Foundation, Wellcome, and the Bill & Melinda Gates Foundation have already committed $300 million over three years to advance global health equity.

• The Advanced Research Projects Agency for Health (ARPA-H) Sprint for Women's Health committed $100 million to transformative research and development in women's health.

• The Menopause Research and Equity Act (House), if passed, would require the NIH to invest in menopause research, mid-life women’s health research, and finding new treatments for the symptoms of menopause.

• Advancing Menopause Care and Mid-Life Women's Health Act (Senate), if passed, would fund $25 million annually from 2025 through 2029 for research and public health activities, and $10 million annually for the same period for public health promotion, education, training programs, and awareness efforts related to menopause and mid-life women’s health.

Dashevsky’s Dissection

I’d be remiss to talk all about women’s health policy and ignore the upcoming election. So I must ask:

Is the future of women’s health hinging on the outcome of the 2024 election?

Depending on the outcome, the future of women’s health could (will) take two drastically different paths.

The Biden-Harris administration has made significant strides in expanding access to reproductive and maternal health services, emphasizing research on female-specific conditions, and ensuring equitable healthcare for women. The White House Initiative on Women’s Health Research and other progressive policies could continue to foster advancements and provide support for women’s health issues if Vice President Harris is elected.

Conversely, Trump’s previous tenure was marked by more restrictive policies on reproductive rights, which could significantly roll back the gains made in women’s health. A return to such policies might limit access to essential health services and reduce funding for important research, negatively impacting the healthcare landscape for women.

Objectively, the stakes are high, and the election outcome will profoundly influence women’s health policy.

In summary, women's health policy is at a pivotal juncture, influenced by recent Supreme Court decisions and poised for significant change depending on the 2024 election outcome. The direction of women's health policy could drastically affect access to care and research funding, making the upcoming election a critical determinant for the future of women's health in America.

This article was part one of three in a series on Women’s Health. The full whitepaper is below, click the button.

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