women’s health

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In abortion ban states, sterilization spiked after Dobbs and kept climbing

Can’t blame ’em —

Sterilizations spike with abortion bans and declining access to care and contraception.

A woman holds a placard saying

Enlarge / A woman holds a placard saying “No Forced Births” as abortion rights activists gather at the Monroe County Courthouse for a protest vigil a few hours before Indianas near total abortion ban goes into effect on September 15, 2022.

The more abortion access is jeopardized, the more women turn to sterilization, according to a new report in JAMA that drew on health insurance claims of nearly 4.8 million women in the US.

In states that enacted total or near-total abortion bans following the US Supreme Court’s Dobbs decision in June 2022, the rate of sterilizations among reproductive-age women that July spiked 19 percent. A similar initial spike was seen across the nation, with states that either limited or protected access to abortions seeing a 17 percent increase.

But, after that, states with bans saw a divergent trend. The states that limited or protected abortion access saw sterilization procedures largely level off after July 2022. In contrast, states with bans continued to see increases. From July 2022 to December 2022, use of sterilization procedures increased by 3 percent each month.

The study adds to previous data finding that overturning Roe v. Wade and limiting legal access to abortion spurred reproductive-age people to seek permanent contraception. A study published in JAMA Health Forum in April, for instance, found an abrupt increase in tubal ligation and vasectomies in people aged 18 to 30 shortly after the Dobbs decision. The current study furthers the finding by assessing trends of sterilization procedures in the context of state abortion laws and policies.

The surge in sterilization is just one of the many ways reproductive healthcare in the US has been rocked or upended by the Supreme Court’s 2022 decision. In June, a study in JAMA Network Open found that states with the most restrictive abortion policies saw declines in prescriptions filled for birth control pills and emergency contraception. The finding suggests that the abortion bans and limitations have disrupted and created barriers to contraception access in restrictive states.

On Tuesday, meanwhile, the March of Dimes released a report painting a bleak picture for Americans who become pregnant. The analysis found that over half of US counties do not have a hospital that provides obstetric care. In the last two years, 1 in 25 obstetric units shut down. Further, 35 percent of counties in the US are considered maternity deserts, meaning that 1,104 counties in the US do not have a birthing facility or even a single obstetric clinician. Living in a maternity desert is associated with receiving less prenatal care and higher rates of preterm birth. Those 1,104 counties are home to 2.3 million women of reproductive age who gave birth to over 150,000 babies in 2022.

The US continues to have the highest rate of maternal deaths among any high-income country, with Black women seeing the highest death rates, according to the latest report from the Commonwealth Fund.

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Barbie movie “may have spurred interest in gynecology,” study finds

Do you need a gynecologist? —

The movie apparently sparked some questions.

A digital advertisement board displaying a Barbie movie poster is seen in New York on July 24, 2023.

Enlarge / A digital advertisement board displaying a Barbie movie poster is seen in New York on July 24, 2023.

This post contains spoilers—for the movie and women’s health care.

There’s nothing like stirrups and a speculum to welcome one to womanhood, but for some, the recent Barbie movie apparently offered its own kind of eye-opening introduction.

The smash-hit film ends with the titular character making the brave decision to exit Barbieland and enter the real world as a bona fide woman. The film’s final scene follows her as she fully unfurls her new reality, attending her first woman’s health appointment. “I’m here to see my gynecologist,” she enthusiastically states to a medical receptionist. For many, the line prompted a wry chuckle, given her unsuspecting eagerness and enigmatic anatomy. But for others, it apparently raised some fundamental questions.

Online searches in the US for “gynecologist”—or alternate spellings, such as “gynaecologist”—rose an estimated 51 percent over baseline in the week following Barbie‘s July 21, 2023 release, according to a study published Thursday in JAMA Network Open. Moreover, searches related to the definition of gynecology spiked 154 percent. Those search terms included “gynecologist meaning,” “what is a gynecologist,” “what does a gynecologist do,” “why see a gynecologist,” and the weightiest of questions: “do I need a gynecologist.”

The “Barbie effect”

The study’s authors, led by researchers at Harvard Medical School, assessed 34 query terms that fit into six categories of searches, including “gynecologist,” “gynecologist definition,” “gynecologist appointment,” “doctors,” “doctor’s appointment,” and “women’s health.” The last three served as controls for more general interest in medical information. As the authors put it, the three control searches helped establish “whether unobserved contemporaneous factors influencing health-seeking behavior more generally may have contributed to gynecologic-related search volume.”

While the researchers noted clear spikes in “gynecologist” and “gynecologist definition” searches, they saw no changes in search trends for the three control search categories during the week after the movie’s release: “doctors,” “doctor’s appointment,” and “women’s health.” This suggested that the increase in gynecology-related searches may, in fact, be linked to the movie rather than some increased interest in health care generally.

The researchers also did not see a corresponding increase in searches related to gynecology appointments, suggesting that the transient online interest in gynecology didn’t translate to online searches for actual gynecological care, with queries such as “gynecologist near me.” The researchers speculate that two factors might explain this. For one, there’s the possibility that the data couldn’t capture care-seeking decisions. It may be that there’s a longer, variable time gap between newfound awareness of gynecology and the decision to seek care. The second possibility is that the people searching for basic information about gynecology may not need gynecological care themselves.

Overall, the authors conclude that “Barbie’s closing line may have spurred interest in gynecology.” The finding is supported by earlier work that also suggests popular culture can have measurable influences on health literacy and awareness among the general public, the authors conclude. For instance, when journalist Katie Couric live streamed her colonoscopy, there was a transient 21 percent increase in colonoscopies, and when actress Angelina Jolie penned an editorial about her experience with breast cancer, there was a transient 64 percent increase in genetic testing for breast cancer risk (BRCA testing). But while the “Barbie effect” seems to have raised some awareness of gynecology, it remains unclear if it will lead to a measurable improvement in health outcomes.

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