Women's health rights drive expansion of ACP policy

Given that May is Women's Health Month, it feels important to dive into how ACP's women's health policy was developed and has evolved over the past several years, and what we can hopefully look forward to in the future.

I recall a time several years ago when I realized that ACP's policy regarding women's health was limited to only a few paragraphs in our policy compendium. This seemed to be a significant policy gap that I started advocating for us to fill.

Thankfully, it was at about that time when our Health and Public Policy Committee decided to take on this issue through robust policy development focused on the overall health of women, as well as women in medicine. This led to the publication of two position papers, "Women's Health Policy in the United States" and "Achieving Gender Equity in Physician Compensation and Career Advancement," as well as original research, "Compensation Disparities by Gender in Internal Medicine," in 2018.

When I started talking about the need for ACP policy on women's health to be filled out further than just a few paragraphs, there was definitely some initial hesitancy. The biggest concern, as one might expect, was how we would address the issue of abortion. Internal medicine physicians are not typically the ones performing abortion procedures; however, they are often involved in referring patients for these services and can also be engaged in prescribing medication for abortions.

The Health and Public Policy Committee was starting to consider this, as well as broader women's health issues, when a Board of Governors resolution was brought forward by the New Mexico Chapter at the fall 2017 meeting. The final resolution was as follows: "RESOLVED, that the Board of Regents develop policy recommending access to comprehensive reproductive health services, including all medically-accepted forms of contraception and abortion."

The preponderance of testimony by the Chapter Governors supported the resolution, and they recommended that it be adopted to the Board of Regents. The Board of Regents agreed and voted to approve the resolution for implementation. Given this newly passed resolution, the Health and Public Policy Committee, with input from the Ethics, Professionalism, and Human Rights Committee, was compelled to develop policy that aligned with the interests of the ACP Chapter Governors.

Therefore, the 2018 position paper on women's health policy included the following statement:

"ACP believes in respect for the principle of patient autonomy on matters affecting patients' individual health and reproductive decision-making rights, including about types of contraceptive methods they use and whether or not to continue a pregnancy as defined by existing constitutional law. Accordingly, ACP opposes government restrictions that would erode or abrogate a woman's right to continue or discontinue a pregnancy. Women should have sufficient access to evidence-based family planning and sexual health information and the full range of medically accepted forms of contraception."

This language was sufficient regarding the topic of abortion and broader access to comprehensive reproductive health care services, as federal abortion protections were supported by prior case law via Roe v. Wade and Planned Parenthood of Southeastern Pennsylvania v. Casey. However, in 2021, the Supreme Court took up the case of Dobbs v. Jackson Women's Health Organization, which concerned a Mississippi state law that would ban abortion after 15 weeks. On June 24, 2022, the Supreme Court ruled in favor of Mississippi and went even further by reversing Roe v. Wade and Planned Parenthood of Eastern Pennsylvania v. Casey, eliminating any federal constitutional right to abortion, giving the states the authority to regulate or ban abortion at any stage of pregnancy.

This meant that to ensure that ACP policy continued to align with the original intent of the 2018 paper and the Board of Governors' resolution, we needed to make an immediate update. This updated policy statement, approved by the Board of Regents on May 23, 2022, primarily revised the constitutional law language from the original paper, instead stating that ACP "opposes government restrictions that would erode or abrogate one's right to continue or discontinue a pregnancy that may result from the Supreme Court ruling in Dobbs v. Jackson Women's Health Organization."

This revision was viewed as a short-term fix to enable the College to continue with our advocacy on the topic in a consistent manner; however, the Health and Public Policy Committee felt it was important to further update and expand upon ACP's policy on reproductive health given the changing landscape after Roe and Casey were overturned. This led to the current policy recommendation, which was published Feb. 28, 2023:

"ACP believes that individuals have the right to make their own decisions, in partnership with their physician or health care professional, on matters affecting their individual reproductive health, including about types of contraceptive methods they use and whether or not to continue a pregnancy. ACP opposes government restrictions that would erode or abrogate equitable access to reproductive health care services, including family planning, sexual health information, the full range of medically accepted forms of contraception, and abortion, that are evidence-based, clinically indicated, and guided by biomedical ethics."

Of note is that this is the first time that the College specifically used the word "abortion" in our policy and that the policy language was also revised to be more gender neutral. Additionally, this new reproductive health policy brief served to reaffirm ACP's "opposition to inappropriate government interference in the provision of medical care, the importance of protecting the privacy of personal health information, the need for public policy to address underlying social drivers of health that perpetuate health inequities, and the goal of ensuring that all have access to equitable health care regardless of where they live or work."

Further, the brief includes new policy that supports one's right to travel to obtain medical care, for medication to be appropriately shipped and delivered, and for the provision of travel and logistic supports by payers to patients who cannot obtain reproductive health care services in their locality or region.

Beyond this unfortunate saga related to abortion and comprehensive reproductive health care access, which is still a very active area of ACP advocacy, it is important to note that the original ACP position paper on women's health contains a number of other policy recommendations that are still relevant and part of the College's ongoing work. This includes recommendations such as:

• noting that internal medicine physicians "are well-suited to provide high-quality women's health care and that clinicians in all specialties and fields, including internal medicine, who care for women should receive appropriate training in health issues of particular relevance to the population of women seen in their practice setting";
• stating that women should "have access to affordable, comprehensive, nondiscriminatory public or private health care coverage that includes evidence-based care over the course of their lifespans" and that health insurers should not be allowed to charge higher premiums or impose higher cost sharing on women because of their gender;
• calling for support for "the goal of universal access to family and medical leave policies that provide a minimum period of 6 weeks' paid leave";
• citing the importance of increased availability of screening tools for intimate partner or sexual violence and increased patient education about intimate partner and sexual violence; and
• increasing efforts to improve the representation of women's health in clinical research to close the knowledge gaps related to specific women's health issues.

In recent months, we have seen progress on some of these recommendations. In November 2023, President Joe Biden announced the White House Initiative on Women's Health Research. Then, on Feb. 21, the First Lady, Jill Biden, EdD, stated that there would be a $100 million investment in Advanced Research Projects Agency for Health, or ARPA-H, a program developed to launch big ideas in health care, to initiate the "Sprint for Women's Health."

Additionally, on March 18, the White House released an Executive Order on Advancing Women's Health Research and Innovation. It calls on numerous federal agencies to improve research and data standards to better incorporate and study women's health, including identifying ways to improve participation of women in clinical trials. The Executive Order also states that agencies must prioritize grantmaking and other funding that furthers women's health research, with a particular focus on race-, ethnicity-, age-, socioeconomic-, disability-, and environmental-based disparities, women's midlife health, and translational research that can result in improved health outcomes.

This is particularly exciting and important in an environment where we are seeing more and more misinformation regarding women's health, such as viral TikTok or Instagram videos that disparage the use of birth control with numerous false claims. Birth control pills and intrauterine devices have been in use for many years and are safe and effective, so if misinformation can call them into question, imagine what other likely false narratives can be shared about areas of women's health that are less researched, such as menopause.

As a woman in menopause who took birth control pills for much of my life, and who has benefited from the use of in vitro fertilization, which is also at risk, these topics matter deeply to me. This is why I am grateful that ACP is taking on the challenging issue of women's health in our country and will continue to advocate passionately for it. I do hope you will all continue to join me in these efforts.