Tubal Sterilization Rates by State Abortion Laws After the Dobbs Decision

Xu, X., Chen, L.,  et al. (2024).

JAMA.

https://doi.org/10.1001/jama.2024.16862

Abstract

The June 2022 US Supreme Court decision Dobbs v Jackson Women’s Health Organization overturned the federal constitutional right to abortion. Consequently, legality of abortion is now regulated by individual states, and multiple states have banned or restricted abortion. Because women may turn to sterilization if abortion is more difficult to obtain, we examined whether the use of sterilization procedures changed after the Dobbs ruling by restrictiveness of state abortion laws.

Here are some thoughts:

The study revealed a significant increase in tubal sterilization rates among women in the United States following the Dobbs v. Jackson Women's Health Organization ruling. This decision overturned Roe v Wade, leading to stricter abortion laws in many states. The researchers found that the increase in tubal sterilizations was particularly pronounced in states with strict abortion bans, suggesting a direct correlation between limited abortion access and women seeking permanent contraception. The study emphasizes the importance of considering the permanent nature of tubal sterilization when making decisions about contraception, highlighting the potential unintended consequences of abortion restrictions on reproductive health and access to healthcare.

Biden just signed the largest executive order focused on women’s health

Jennifer Gerson

GovExec.com

Originally posted 19 March 24

President Joe Biden on Monday signed an executive order directing the most comprehensive set of actions ever taken by the president’s office to expand and improve research on women’s health. In a statement, the president and First Lady Jill Biden also announced more than 20 new actions and commitments by a wide range of federal agencies for research on issues that emerge across a woman’s lifespan, from maternal health outcomes and mental health challenges to autoimmune diseases and menopause. 

The announcement follows the November creation of the White House Initiative on Women’s Health Research, led by Jill Biden and the White House Gender Policy Council. Currently, the National Institutes of Health (NIH) spends only 10.8% of its overall funding on women’s health research, a figure that includes conditions specific to women and those that predominantly affect women. 

Congress first ordered the NIH to include women in clinical trials in 1993; in 2016, the NIH strengthened its own standards so that its grantees must justify if women are not included in any specific clinical trial and explain how any effects on women will be studied and analyzed. Monday’s announcement seeks to ensure that this same kind of accountability is applied to every federal research program. 

Jennifer Klein, director of the White House Gender Policy Council, told The 19th that with Monday’s announcement, the Biden administration is seeking to close existing research gaps when it comes to women’s health so that women’s experiences with the health care system can be changed for the better. 

The info is here.

Here is my summary:

President Joe Biden recently signed a significant executive order focused on women's health, marking a historic move towards advancing women's healthcare research. The order includes over 20 new actions and commitments across various federal agencies, aiming to address research gaps in women's health. Key components of the order involve prioritizing women's health research, strengthening data standards, focusing on midlife health issues like heart attacks and Alzheimer's disease, and enhancing accountability in federal research programs. This initiative also emphasizes the importance of understanding conditions that uniquely affect women, such as endometriosis and menopause. Additionally, the order directs efforts towards addressing tribal beliefs related to menopause, improving mental health services for women, and conducting new research on nutritional needs. Biden's executive order underscores a comprehensive approach to women's health beyond reproductive care, highlighting the need for increased funding and research in areas where women have been historically underrepresented.

Living in an abortion ban state is bad for mental health

Keren Landman

vox.com

Originally posted 20 Feb 24

Here is an excerpt:

What they found was, frankly, predictable: Before the Court’s decision, anxiety and depression scores were already higher in trigger states — a population-wide average of 3.5 compared with 3.3 in non-trigger states. After the decision, that difference widened significantly, largely due to changes in the mental health of women 18 to 45, what the authors defined as childbearing age. Among this subgroup, anxiety and depression scores subtly ticked up in those living in trigger states (from 4.62 to 4.76) — and dropped in those living in non-trigger states (from 4.57 to 4.49). There was no similar effect in older women, nor in men.

These differences were small but statistically meaningful, especially since they sampled the entire population, not just women considering an abortion. Moreover, they were consistent across trigger states, whether their policies and political battles around abortion had been high- or low-profile. Even when the researchers omitted data from states with particularly severe restrictions on women’s reproductive health (looking at you, Texas), the results held up.

It’s notable that the different levels of mental distress across states after Roe was overturned weren’t just a consequence of worsened anxiety and depression in states with trigger bans. Also contributing: an improvement in these symptoms in states without these bans. We can’t tell from the study exactly why that is, but it seems plausible that women living in states that protect their right to access necessary health care simply feel some relief.

The research is here.

Here is the citation to the study:

Thornburg B, Kennedy-Hendricks A, Rosen JD, Eisenberg MD. Anxiety and Depression Symptoms After the Dobbs Abortion Decision. JAMA. 2024;331(4):294–301. doi:10.1001/jama.2023.25599

Conclusions and Relevance  In this study of US survey data from December 2021 to January 2023, residence in states with abortion trigger laws compared with residence in states without such laws was associated with a small but significantly greater increase in anxiety and depression symptoms after the Dobbs decision.

‘A lottery ticket, not a guarantee’: fertility experts on the rise of egg freezing

Hannah Devlin

The Guardian

Originally posted 11 NOV 22

Here is an excerpt:

This means that a woman who freezes eggs at the age of 30 boosts her chances of successful IVF at 40 years. But, according to Dr Zeynep Gurtin, a lecturer in women’s health at UCL, this concept has led to a false narrative that if you freeze your eggs “you’ll be fine”. “A lot of people who freeze their eggs don’t get pregnant,” Gurtin said.

First, only a fraction opt to use the eggs down the line – some get pregnant without IVF, others decide not to for a range of reasons. For those who go ahead, HFEA figures show that, as an average across all age groups, just 2% of all thawed eggs ended up as pregnancies and 0.7% resulted in live births in 2018. For each IVF cycle, this gives a 27% chance on average of a birth for those who froze their eggs before the age of 35 and a 13% for those who froze their eggs after this age. The most common age for egg freezing in the UK is 38 years old.

A recent analysis by the Nuffield Council on Bioethics found women often felt frustrated at having received insufficient information on success rates, but also reported feeling relief and a sense of empowerment.

Egg freezing, Gurtin suggested, should be viewed as “having a lottery ticket rather than having an insurance policy”.

“An insurance policy suggests you’ll definitely get a payout,” she said. “You’re just increasing your chances.”

As lottery tickets go, it is an expensive one. The average cost of having eggs collected and frozen is £3,350, with additional £500-£1,500 costs for medication and an ongoing expense of £125-£350 a year for storage. And clinics are not always upfront about the full extent of costs.

“In many cases, you’re going to spend a third more than the advertised price – and you’re spending that money for something that’s not an immediate benefit to you,” said Gurtin. “It’s a big gamble.”

“When people talk about egg freezing revolutionising women’s lives, you have to ask: how many can afford it?” she added.

Travelling abroad, where treatments may be cheaper, is an option but can be logistically problematic. “When it comes to repatriating eggs, sperm and embryos, it is possible, but it’s not always that straightforward,” said Sarris. “You need to follow a process, you don’t just send them with DHL.”

The info is here.

Why So Many Middle-Aged Women Are on Antidepressants—Scientists are gaining a better understanding of women’s midlife depression

Andrea Petersen

The Wall Street Journal

Originally posted 2 APR 22

For years, middle-aged women have had some of the country’s highest rates of antidepressant use. Now, scientists are starting to better understand why—and to develop more targeted treatments for women’s midlife depression.

About one in five women ages 40 to 59 and nearly one in four women ages 60 and over used antidepressants in the last 30 days during 2015 to 2018, according to the latest data from the National Center for Health Statistics. 

Among women ages 18 to 39, the figure was about one in 10. 

Among men, 8.4% of those ages 40 to 59 and 12.8% of those 60 and older used antidepressants in the last 30 days, according to the NCHS data.

The figures are drawing increasing attention from scientists and doctors. Many are alarmed at how high depression rates were among midlife women even before the pandemic, now that the past two years have exacerbated mental-health issues for many Americans. 

(cut)

Researchers at NIMH who have been following 90 women since 1988 have found that the incidence of women’s midlife depression is concentrated in the two years before and after the last menstrual period, says Dr. Schmidt. 

The quality of women’s midlife depression is distinct, too, Dr. Schmidt says, in that it often involves intense anxiety, irritability and sleep problems along with the more typical sadness and loss of pleasure in once-enjoyed activities.

Doctors speculate that antidepressant use among middle-aged women is being driven in part by the reluctance of women—and many of their physicians—in recent decades to use hormone-replacement therapy for menopausal symptoms. In 2002, a large study, the Women’s Health Initiative, was stopped after women taking hormone therapy had an increased risk of breast cancer, heart attacks and strokes. 

Later analyses found that the risks were largely concentrated among women who were older when they started hormone therapy. For women in their 50s, hormone therapy actually reduced the risk of heart disease and death from any cause. 

Hormone therapy, either estrogen alone or combined with a progestogen, is the most effective treatment for hot flashes and night sweats, according to the North American Menopause Society and the American College of Obstetricians and Gynecologists. 

Some research has found that it can also improve mood.

The info is here, behind a paywall.