Access to Fertility Care: Findings from the 2024 KFF Women’s Health Survey

Introduction

Access to fertility care is a critical aspect of women's health, and recent findings from the 2024 KFF Women’s Health Survey have shed light on the challenges and opportunities in this area. The survey, which included a nationally representative sample of 6,246 adults aged 18 to 64, provides valuable insights into women's experiences and opinions regarding fertility care. This article will delve into the key findings of the survey, exploring the current state of access to fertility care and the implications for women's health.

The Survey's Objective

The 2024 KFF Women’s Health Survey aims to track and document women's experiences and knowledge related to health and well-being. The survey covers a broad range of topics, including access to fertility care, abortion experiences, and health care costs. By focusing on these areas, the survey seeks to understand the challenges and disparities in women's health care, ultimately informing policy and practice improvements.

Key Findings on Fertility Care

One of the most significant findings of the survey is the impact of abortion restrictions on women's access to fertility care. The survey highlights that 13 states have banned abortion with few exceptions since the 2022 overturning of Roe v. Wade. This has resulted in substantial barriers for women seeking reproductive health services, including essential care related to fertility.

Abortion Access and Fertility Care

The survey reveals that state abortion bans have far-reaching implications for all obstetrician-gynecologists (OB-GYNs) in affected states, not just those who provide abortion care. Many OB-GYNs described the distress of having to delay essential patient care, the fear of legal ramifications, and the mental health effects of these restrictions. These challenges contribute to occupational stress, compassion fatigue, and burnout among healthcare providers.

Delayed Care and Legal Gray Areas

A qualitative study involving 54 OB-GYNs practicing under abortion bans in 13 states highlighted the complexities of providing care. Many participants reported needing to delay medically necessary procedures until patients were at risk of death or permanent impairment. This delay puts women in precarious situations, with some participants questioning the legal definitions of what constitutes a life-threatening condition. For instance, one OB-GYN noted, "The way our legal teams interpreted it, until they became septic or started hemorrhaging, we couldn’t proceed…[it] puts women in a very challenging, risky position".

Counseling Restrictions

The survey also reveals that many healthcare providers face restrictions on counseling patients about abortion options. These restrictions, often due to aiding and abetting clauses, have limited the ability of healthcare providers to discuss abortion as an option. This has resulted in providers feeling pressured to counsel patients in ways that feel legally defensible, such as referring patients outside the state for services that are not available locally. One participant described this issue: "In [STATE]…I can’t counsel you on termination, but I need you to understand that there are locations outside of [STATE]... that don’t have the same laws."

Economic and Racial Disparities

The survey underscores the significant economic and racial disparities in access to fertility care. Women in states that have not expanded Medicaid eligibility are among those most at risk of lacking coverage. Additionally, women in states with low rates of Medicaid expansion, such as Texas, Georgia, and Oklahoma, have higher uninsured rates compared to states like Massachusetts, the District of Columbia, and Vermont.

Mental Health Implications

Mental health conditions are a critical aspect of preventable pregnancy-related deaths. The survey notes that states with higher rates of screening for postpartum depression also have lower rates of this condition. However, the absence of comprehensive mental health services exacerbates the challenges faced by women, particularly in states with restrictive abortion policies.

Economic Burden of Pregnancy and Childbirth

The economic burden of pregnancy and childbirth is another significant aspect of fertility care. A study examining health costs associated with pregnancy, childbirth, and postpartum care found that women who give birth incur nearly $19,000 in additional health costs compared to women who do not give birth. This includes both the amount paid by insurance and out-of-pocket expenses. The study highlights that these costs vary significantly by the type of delivery, with vaginal deliveries averaging $14,768 and cesarean sections averaging $26,280.

Women's Opinions on Access to Fertility Care

The 2024 KFF Women’s Health Survey provides insights into women's opinions about access to fertility care in their states. The survey reveals that women have mixed views on the current state of fertility care. Many women express frustration over the lack of comprehensive reproductive health services, particularly in states with restrictive abortion laws. For instance, one participant noted, "It just doesn’t feel very fair to patients…I have reviewed all options that are available, but then my hands are kind of tied in terms of them saying, ‘Well, how do I get this?’ Or, ‘What’s next?’ I feel I’m just abandoning them.”

Policy Implications

The findings from the 2024 KFF Women’s Health Survey have significant policy implications. To address the disparities in access to fertility care, there is a need for comprehensive reproductive health services. This includes expanding Medicaid eligibility to ensure that all women have access to necessary care. Furthermore, addressing the mental health implications of restrictive abortion policies is crucial for improving overall women's health outcomes.

Conclusion

Access to fertility care is a complex issue deeply intertwined with state policies and judicial decisions. The 2024 KFF Women’s Health Survey provides valuable insights into the challenges faced by women seeking reproductive health services. By understanding these complexities, policymakers can work towards creating a more equitable system where all women have access to comprehensive fertility care.

---

References

• [KFF Women’s Health Survey] : https://www.kff.org/womens-health-policy/dashboard/womens-health-survey/
• [Health Costs Associated with Pregnancy, Childbirth, and Postpartum Care] : https://www.healthsystemtracker.org/brief/health-costs-associated-with-pregnancy-childbirth-and-postpartum-care/
• [US Obstetrician-Gynecologists' Perceived Impacts of Post–Dobbs v. Jackson] : https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814017
• [2024 State Scorecard on Women's Health and Reproductive Care] : https://www.commonwealthfund.org/publications/scorecard/2024/jul/2024-state-scorecard-womens-health-and-reproductive-care