August 24, 2018

It has been a year since Oregon Gov. Kate Brown signed the Reproductive Health Equity Act into law, ensuring free reproductive care for low-income women, expanding reproductive care for women regardless of immigrant status, insulating trans and gender-nonconforming people from discrimination, and protecting access to abortion services for all women.

Aileen Duldulao, Ph.D., an epidemiologist on issues of maternal and child health for Multnomah County, said it’s too early to gauge the effect of Oregon's 2017 Reproductive Health Equity Act.

“It was such a powerful moment for our state,” Commissioner Sharon Meieran said Thursday at a board briefing on developments in reproductive healthcare since the law took effect. “The way to approach this is from an upstream public health standpoint, where we can have an impact on intergenerational trauma.”

Commissioners on Thursday heard from experts about ways the 2017 law will impact residents in Multnomah County. Invited guests included Multnomah County’s Maternal Child Health Program, the Oregon Health Equity Alliance, NARAL Pro-Choice Oregon, the Future Generations Collaborative, Native American Youth and Family Center, and the OHSU-PSU School of Public Health

The elements prohibiting discrimination based on gender identity went into effect immediately. They ensure, for example, that insurance covers reproductive care for anyone who was assigned female at birth but who identifies as male.

The portion of the law ensuring all women, regardless of legal immigration status, can access abortion services, began Jan. 1, 2018. All other services for undocumented residents were implemented April 1. The law also ensured all women have access to screenings for pregnancy, sexually-transmitted infections, and breast and cervical cancers. And it requires that all residents have access to contraception.

Multnomah County health programs already provided services to residents who could not afford — or did not qualify for — health insurance. The 2017 law allows health centers to recover those costs through state funding and reinvest in programs and staff.

Aileen Duldulao, Ph.D., an epidemiologist on issues of maternal and child health for Multnomah County, said it’s too early to gauge the effect of Oregon’s 2017 law on pregnancy and abortion rates, which have been trending down — especially for young women. Unplanned pregnancy rates and abortion rates in Multnomah County have both dropped by about 60 percent for women 19 and younger during the past decade.

“Research consistently shows high rates of unplanned pregnancy correlates with higher rates of abortion. As pregnancy rates drop, abortion rates also drop, in large part due to the county and its partners increasing access to contraception and access to comprehensive sex education,” she said. “These trends should continue as we further implement” the Reproductive Health Equity Act.

Kelly Gonzales, Ph.D., is an assistant professor in the OHSU-PSU School of Public Health

Kelly Gonzales, Ph.D., an assistant professor in the OHSU-PSU School of Public Health, said research conducted in the County offers glaring evidence to support providing comprehensive and culturally appropriate reproductive healthcare to women of color. A survey of 40 Native American and African American women laid bare a common theme — one of violence, historical trauma and a distrust of the healthcare system.

“Most women perceived being mistreated because of provider bias,” Gonzales told the board. Women are taught to “stand tall but not too tall,” she said. “Don’t be threatening. Be compliant. Don’t ask too many questions. Don’t act like you know more than the doctor. Just be thankful you get services at all.”

It’s no wonder most women reported their needs were left unmet.

“This is all about giving agency to people, making sure they have, not only the information, but also access — true access,” said Commissioner Jessica Vega Pederson. “We acknowledge this huge win for reproductive justice and increasing access to free reproductive health services — and that’s especially true for our most vulnerable, immigrants and our trans community, who face extreme barriers. But it’s important to acknowledge that access to reproductive care is under attack.”

As a candidate, President Donald Trump vowed to set policy and hire administrators who would curtail women’s access to abortions. The administration changed the terms of its Teen Pregnancy Prevention Program grant, adopted as an evidence-based approach to support programs proven effective in preventing teen pregnancy. Instead the new grant terms favor an abstinence-only approach.

The county filed a lawsuit in June to challenge the terms.

Then in July, the administration proposed changes to federal family planning grants that would not only forbid providers from discussing abortion as a legal option but also ban them from giving any information whatsoever, even for unrelated services, about clinics that perform abortions.  

Chair Deborah Kafoury said that, despite federal actions that seek to block comprehensive access to sexual education and reproductive healthcare, local and state action — and her own staff — leave her feeling hopeful.

“Regardless what happens at the federal level, we have a strong and powerful team here,” she said. “We have amazing staff working with clients and pushing the policy side forward and community members who are healing their own communities by working to educate the broader community. I do hope that you believe this is a safe space. We are here to listen, to help, and to follow your lead.”