Sexual and Reproductive Health Disparities in Massachusetts and How to Combat Them Through Research and Evaluation- Part 1: Disparities in Access to Abortion, Contraception, and Gynecological Care

Note: In this blog series, we aim to provide an overview of key areas within sexual and reproductive health, but the posts will not include all elements of this broad topic. We also acknowledge that these posts talk about gender in a binary way, as there is currently limited data on these topics specific to nonbinary and trans people.

Part 1: Disparities in Access to Abortion, Contraception, and Gynecological Care

After nearly 50 years, Roe v. Wade was overturned on June 24, 2022, a huge blow to the long fight for reproductive rights in America. As a result, 12 states have completely banned abortion, and many more have severely restricted it, leaving millions of people of reproductive age without access to safe, legal abortion (1).

Though Roe was overturned, abortion will be protected by law in Massachusetts. As of June 2022, the age of consent for abortions is 16 years old, and abortions can be performed up to 24 weeks and past 24 weeks if the life of the fetus is at risk (2). However, despite Massachusetts having progressive abortion laws in comparison to other states, many people across the state still face disparities in abortion access. One of the main reasons for this is a lack of abortion providers in Western and Southeastern Massachusetts as well as Cape Cod, Martha’s Vineyard and Nantucket- the nearest abortion provider to Hyannis is over 60 miles away; the nearest provider to Provincetown is over 100 miles away (3). In a study of Massachusetts public universities, due to the lack of providers and a lack of access to abortion medication on university campuses, students had to travel an average of 103 minutes each way on public transport to get to an abortion clinic (4). This shows that abortion is difficult to access in Massachusetts for people in certain geographical areas, those who rely on public transit, and those that do not have the time to travel to a clinic.

In addition to abortion disparities, there are many other sexual and reproductive health (SRH) disparities that people in Massachusetts face regularly, particularly those from marginalized communities.

Routine OB/GYN visits are important particularly for the purposes of cervical cancer screening, typically done through pap smears, pelvic exams, colposcopies, and HPV tests. However, in a study with African-born immigrant women in Boston, it was revealed that they faced unique barriers to accessing gynecological services, including but not limited to “stigma, lack of partner support and resources to access care” (5). Additionally, racial disparities in gynecological care exist. According to 2018 data from the MA Department of Public Health, Non-Hispanic black women have cervical cancer incidence and mortality rates 2x higher than those of white women. NH Black women are getting screened for cervical cancer at similar rates to white and Hispanic women, however, they are being diagnosed later, and therefore are less likely to be diagnosed with Stage I or II cervical cancer (6).

In the state of Massachusetts, there are multiple laws requiring public and private insurance coverage of contraceptives, and another law allowing pharmacists to prescribe contraception is currently pending (7). However, other barriers to contraception access persist. Low-income women have reported difficulty in acquiring contraceptives due to the cost of copays and clinic visits and lack of time to go to the clinic, especially if they cannot take time off of work and lose wages in the process (8). Additionally, homeless and housing-insecure women and women struggling with drug addiction reported difficulty in acquiring contraceptives not only due to the cost, especially if they do not have insurance, but also because of the lack of storage and reliable transportation, and provider stigma (9).

Overall, despite having many safeguards for abortion and contraception in place here in Massachusetts, there is still much need to increase access to these services as well as general OB/GYN care for all people of reproductive age.

The next post in this series will discuss disparities in maternal and infant health and mortality, disparities in sexually transmitted infection prevalence, as well as causes of sexual and reproductive health disparities.

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