One year ago, the Supreme Court ignored decades of precedent and ruled to overturn the right to abortion in America. Since that day, dozens of states have moved to restrict or ban access to abortions.
Given the shrinking availability of this essential medical procedure, new strategies are needed to help women. That is why, as an OB/GYN in Georgia, I propose that in the South, all women of reproductive age who are having sex with men take monthly pregnancy tests, even if they are on birth control.
Since most women seeking abortions are of low income and already have a child, routine pregnancy testing would enable early diagnosis and afford more time for individuals to research options and access services with the least disruption to work and family responsibilities. Women would regain control in states that have stripped them of their right to self-determination.
The South's landscape of limited and dwindling access to legal abortion services has fostered a hostile environment. Abortions are banned throughout pregnancy in Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, Texas, and West Virginia. In my state of Georgia, an early ban limits the procedure to a timeframe typically within two weeks of a missed period, referred to as a six-week ban. For many, that means the procedure is already out of reach by the time they even realize they might be pregnant.
South Carolina and Florida have also enacted six-week bans, though both are currently blocked by the courts. North Carolina's access decreased from allowing abortions up to 20 weeks to a ban beyond 12 weeks, to be implemented on July 1.
Figuring out access to an abortion in this landscape takes time that people don't have. They must either travel for services or choose to undergo a self-managed abortion. Both options carry immense emotional, financial, and logistical burdens.
A self-managed abortion is challenging for those who do not have easy access to the internet or a credit card to order medications online. People may not want to undergo the stress of a clandestine procedure. Alternatively, figuring out where to travel for care is complicated by the whiplash of bans being proposed, enacted, blocked, and unblocked by the courts.
Widespread availability of free or low-cost pregnancy tests can help overcome the barrier of late pregnancy diagnosis. Currently, women rely on missed periods as the main clue to pregnancy, but that's not possible for the 25 percent of women who have irregular periods. And individuals using hormonal birth control have variable bleeding patterns that can't be counted on.
While contraception effectively prevents pregnancy, it may provide a false sense of security. In the past month I've seen women presenting beyond six weeks due to a partner's failure to follow post-vasectomy instructions, misconceptions about the efficacy of emergency contraception, and misunderstandings regarding the need to use backup contraception when initiating use of a new method. In Georgia, it's now too late for them to seek an abortion.
Another unreliable prompt for pregnancy testing is counting on pregnancy symptoms. According to a study published in the Journal of Clinical Epidemiology, only 59 percent of women experienced symptoms by the end of week five of pregnancy, 71 percent by the end of week six, and 89 percent by week eight. For many, waiting for symptoms would be too late.
Urine pregnancy tests detect the pregnancy hormone human chorionic gonadotropin (hCG) with high sensitivity even before a missed period. Although testing too early may lead to false-negative results, monthly tests will significantly reduce the chances of undetected pregnancies.
The last thing I want to do is place yet another burden on women. Nonprofit organizations can play a crucial role by distributing pregnancy tests. When purchased in bulk, high quality urine pregnancy tests cost approximately one dollar each. Creative solutions for provision of tests, like the availability of condoms and tampons in vending machines, or given out for free in community centers, can be developed and implemented.
While early pregnancy diagnosis is crucial, it's important to ensure that all women who detect their pregnancies can access the care they need. Although providers in Georgia care for patients from as far away as Louisiana, care is limited to the first six weeks of pregnancy. Nonprofit abortion funds, such as ARC Southeast, provide individuals with funding and logistical support to travel for care. Supporting them can help women access care even when they determine they are pregnant after six weeks.
Since people in states with bans and restrictions have worse pregnancy-related outcomes than those from other states, we have a moral duty to help people access reproductive health care. For example, in 2021, states banning abortions experienced a maternal mortality rate 2.4 times higher, and a neonatal mortality rate 30 percent higher, than the corresponding rates in supportive states. And women of color suffer worse outcomes on both measures.
Early pregnancy detection can help facilitate access to abortions with the least disruption to people's lives until bans can be reversed. Novel solutions are needed to tackle the loss of autonomy experienced by women in the South and other places with bans. In this environment, providing women with access to monthly pregnancy tests is worth trying.
Mimi Zieman is a board-certified OB/GYN, the former director of family planning for Emory University School of Medicine, and worked on the CDC guidance for U.S. contraceptive care. She is the author of a medical guide titled Managing Contraception, as well as a play, The Post-Roe Monologues. Information about her forthcoming memoir, Tap Dancing on Everest, can be found at www.mimiziemanmd.com.
The views expressed in this article are the writer's own.
Uncommon Knowledge
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
