The MMS Advocates for Women’s Reproductive Health

BY LEDA ANDERSON, ESQ., LEGISLATIVE COUNSEL, ADVOCACY AND GOVERNMENT RELATIONS

Over the past year, the Medical Society has played a meaningful role in advancing several key initiatives to support and advance women’s health in the Commonwealth and beyond. From abortion access to combating racial inequities in maternal health, the MMS has had a seat at the table and helped to shape policies that will profoundly impact equitable access to reproductive health care.

Enforcing Access to No-Copay Contraceptives

In 2017, as contraceptive access was being clawed back in states across the country and Congress attempted to dismantle the Affordable Care Act (ACA), the Medical Society was part of a coalition of organizations that fought to codify federal no-copay contraceptive provisions from the ACA into Massachusetts law. The effort succeeded. With the passage of the Contraceptive ACCESS law in November 2017, the Commonwealth protected access to no-copay birth control, expanded access to emergency contraceptives, and authorized 12-month prescriptions in a single dispensing. Several years later, the law’s intent has been hampered by patchwork implementation, with the requirements of the law poorly understood by health plans and pharmacies and underutilized by physicians prescribing contraceptives.

Research indicates easy access to birth control improves family planning and reduces chances of unintended pregnancies, and a 12-month supply can limit gaps in usage and reduce dispensing costs. During COVID, 12-month dispensing of oral contraceptives has emerged as a  clinical best practice  for reproductive health providers because it decreases the number of in-person visits required to obtain refills and can enable longer-term access for individuals who are at risk of income or health coverage loss. Ensuring robust implementation and compliance of the ACCESS law is key. That is why the Medical Society partnered with state regulators at the Division of Insurance to host an educational webinar for physicians about this important law and share the DOI Bulletin 2020-26, which details the law’s basic parameters.

Addressing Racial Inequities in Maternal Health

Racial inequities in maternal mortality are staggering, with Black women experiencing mortality rates more than three times that of White women, according to the Centers for Disease Control and Prevention. In Massachusetts, Black women are twice as likely to die from pregnancy or childbirth-related complications. Severe maternal morbidity (SMM), which includes unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health, impacts approximately 50,000 women each year nationally and disproportionately impacts women of color. African American women are twice as likely to experience SMM compared with non-Hispanic White women.

To address these inequities, the result of systemic racism in health care, the Medical Society joined a coalition that pushed to establish a legislative commission to study and make recommendations to address racial disparities in maternal health. The legislature responded, establishing this commission, which offers a long overdue opportunity to begin righting this wrong. With the MMS represented on this commission through the accomplished Dr. Charles L. Anderson, president and CEO of the Dimock Center, the Medical Society hopes to recommend policy to be codified into law that will meaningfully improve equitable health outcomes for people of color in Massachusetts.

Supporting the ROE Act to Protect and Expand Access to Abortion

The Medical Society believes that abortion is an essential medical component in the continuum of reproductive health care and should be safely accessible in a collaborative, team-based model of care. The MMS also supports policies that enhance and protect the patient-physician relationship and preserve physicians’ ability to make clinical decisions for the benefit of patients.

For these reasons and more, the MMS advocated for the passage of the so-called ROE Act, most provisions of which became law in December 2020. It created an affirmative right to abortion in the state, expanded abortion access after 24 weeks in instances of lethal fetal anomalies, and removed a parental consent requirement for 16- and 17-year-olds.

By supporting the ROE Act, the MMS advocated to protect people’s right to make deeply personal and complex decisions with the support and trusted guidance of their physician, without inequity and absent undue barriers or stigma.

Promoting Evidence-Based Regulation of Reproductive Care Treatment Options

Mifepristone is a drug commonly used in combination with misoprostol to end pregnancy within the first 70 days of gestation and is also critical in managing early pregnancy loss. Though mifepristone is safe and effective and has been FDA-approved for more than 20 years, it has long been subject to outdated, medically unnecessary restrictions known as a Risk Evaluation and Mitigation Strategy (REMS), which were intended for the most dangerous drugs with known or suspected complications or contraindications. Under the current REMS, these restrictions to mifepristone harm patients by hindering access to essential, time-sensitive health care and deepening health inequities for those who already face the most severe barriers to care — particularly people of color, people with low incomes, and those in rural communities.

The Medical Society agrees with other major professional medical organizations that the REMS classification on mifepristone is not evidence-based and has advocated to the FDA to re-evaluate the current REMS classification on mifepristone to reduce barriers and improve access to reproductive health care. In May 2021, the FDA announced it would review longstanding restrictions on mifepristone. The announcement came as part of a joint legal filing in the ACLU lawsuit Cheslius v. Becerra, challenging the constitutionality of the restrictions.