MetroWest Daily News | Mass. reproductive justice advocates are calling for comprehensive maternal care

By Cici Yu
Story Originally Appeared in MetroWest Daily

BOSTON — Reproductive justice advocates are calling on lawmakers to pass legislation that ensures all individuals have access to comprehensive reproductive care after the tragedy of a Duxbury mother charged with strangling her three children at home last month.

“That is a horrible tragedy, and really does underscore the lack of maternal health care in our state,” state Rep. Lindsay Sabadosa, D-Northampton, said in an interview. “We need to do more to de-stigmatize and to also talk about postpartum depression and postpartum psychosis.”

According to the Massachusetts Department of Public Health, approximately one in seven women in the state suffers from postpartum depression or other pregnancy-related mood disorders.

State Sen. Becca Rausch, D-Needham, filed a bill requiring full insurance coverage for all post-pregnancy mental health care, regardless of whether individuals are on MassHealth or a private insurance company.

“We are rapidly seeing the profound hurt and harm that stems from the lack of robust post-pregnancy mental health care,” Rausch said, adding that it's alos important for legislators to ensure people have the mental health support they need following the end of a pregnancy.

In response to the Supreme Court's 5-4 ruling last June to overturn Roe v. Wade, which had guaranteed a right to an abortion, then-Gov. Charlie Baker signed legislation to protect reproductive and gender-affirming care in Massachusetts, broadening access to abortion and shielding providers from out-of-state prosecution.

“Massachusetts is an incredibly important state in the abortion access puzzle,” said Rebecca Hart Holder, president of Reproductive Equity Now. “We have an opportunity to set the pace for the nation and I think we have an obligation to advance access to care not just for residents of Massachusetts but people across the country.” 

That would include a public education campaign last November targeting so-called crisis pregnancy centers, which reproductive rights advocates say seek to manipulate and dissuade people from getting abortion care. However, Baker vetoed a $1 million fund for that effort last fall.

“Now that we have a pro-choice governor (Democrat Maura Healey) in the office, we are again urging the Legislature to really make this important step of investing in a public education campaign,” said Claire Teylouni, director of goverrnment affairs for Reproductive Equity Now, adding that it’s crucial to make sure people can identify and access legitimate, unbiased and medically accurate care. 

Karissa Hand, spokesperson for Healey, said the governor supports efforts to “continually expand access to reproductive care, including emergency contraception, medication abortion, full-spectrum pregnancy and birthing care and postpartum mental health care.”

Some in Mass. still face barriers

Margaret Batten, a member of the board of directors for the Eastern Massachusetts Abortion Fund, said although Medicaid covers abortion costs, those with federal insurance, teens, those in abusive relationships and those who are underinsured still face barriers. 

“Abortion care is health care and it's a fundamental human right to have access to reproductive health care, including abortion care," Batten said. "So that's why abortion funds exist to make sure that health care is accessible to as many people as possible."

She said her organization funds people who have received abortion care in eastern Massachusetts, regardless of the patient's identity or documentation. It also assists those who need to travel out of state for abortion care.

Batten said she has seen an increase in people coming from Texas after that state banned almost all abortions after six weeks of pregnancy, even in cases of rape, sexual abuse and incest.

“We're ready, willing and able to help anyone coming to Massachusetts now. It's not a sprint, it's a marathon with Roe v. Wade no longer the law of the land,” Batten said. “We need to make sure we have funds, not just this year —when everyone is all hyped up about the Dobbs decision — but we need funds next year and the year after that.”

Teylouni said there should be more effort to address existing disparities in maternal health outcomes and in realizing true reproductive equity in the commonwealth.

REN is prioritizing this session a bill by Sabadosa and state Rep. Ruth Balser, D-Newton. 

“This bill aims to eliminate out-of-pocket spending for the full spectrum of pregnancy care by mandating insurance coverage for all of those types of care without any cost-sharing imposed on consumers,” said Teylouni, adding that insurers would be required to cover the entire cost of that care without subjecting individuals to any copays or deductibles if it becomes law.

High-deductible plans

According to a 2019 report from the Massachusetts Health Policy Commission, about 1.5 million people in Massachusetts were enrolled in high-deductible health plans, which require individuals to pay significant out-of-pocket costs before their health insurance kicks in. 

“This bill is really about breaking down financial barriers to accessing reproductive health care and it's about reinvention, envisioning our health care spending in a way that centers its patients and in a way that supports pregnant people,” Teylouni said.

Sabadosa said she refiled the bill in this session because part of it — mandating insurance coverage without any cost sharing for abortion and abortion-related care — went into effect last summer, but not all of it. More than 20 lawmakers co-signed the bill to support more comprehensive reproductive care. 

“We understand that those costs are high, but a lot of people are leaving the hospital after having given birth and going into medical debt because they can't afford the cost or they have a really high deductible,” Sabadosa said. 

Sabadosa noted another important bill that she filed with state Rep. Natalie Higgins, D-Leominster, that focuses on closing a loophole around coercive practices in Massachusetts; removing a 30-day waiting period for patients on Medicaid who want permanent contraception; and improving informed consent so that everyone has fair access to the procedure.

“The United States has a terrible history of forcing patients to have sterilization when they don't want it or telling them that it's not permanent, or just doing it without saying a word,” Sabadosa said. “It really becomes an economic and a social justice barrier that gets thrown up.”

Lack of knowledge about abortion

Gabrielle Galusha, a second-year master's candidate at Boston University's School of Public Health, said there is a lack of knowledge about abortion care in public, specifically access to medication abortion, which uses two pills, mifepristone and misoprostol, to expel the pregnancy.

“By giving people the tools and knowledge that they deserve about their reproductive health, it would make a huge difference,” Galusha said. She believes medication abortion will give people the option to avoid traveling to visit a care provider and to remain in the comfort of their homes, which helps address “abortion deserts.”

Taylor Germain, communications director for REN, said in an interview that the state defines abortion deserts as a 50-mile radius without in-person abortion clinics.

“One big step that we took in the bill that we passed in July was to require Massachusetts public colleges and universities to provide access to or referrals for medication abortion on campus,” she said. “We want to make sure that folks have both access to medication abortion and in-clinic care if they so choose.”

However, a lawsuit filed by anti-abortion physicians in Texas against the U.S. Food and Drug Administration challenging their authority to have approved mifepristone could have major implications for medication abortion access in all 50 states, including Massachusetts.

Teylouni said a bill filed by Sabadosa and state Sen. Liz Miranda, D-Boston, to expand Medicaid coverage for doula services — a type of non-medical support that is provided by trained professionals who offer physical, emotional, and educational support to birthing people before and after pregnancy — is another priority for REN this session. 

“You'll notice that financial barriers are a really resounding theme that can put a character out of reach, especially for low-income pregnant birthing and postpartum people,” Teylouni said. “This bill mandates mass health coverage of doula care to take a step to put doula care services in reach for many pregnant people.”