Health Department Engagement on Abortion

The goal of the Health Departments Engagement on Abortion project is to engage public health professionals working inside and outside of health departments in describing ways for public health professionals to engage in activities related to abortion that are consistent with public health frameworks and values. Through this project, researchers have identified the type of activities related to abortion currently being done by health departments, interviewed public health professionals to understand their processes, challenges, and opportunities in engaging in activities related to abortion, and engaged health department professionals in articulating and endorsing a set of activities that are consistent with public health frameworks and values. These activities are relevant in the current context and can guide public health efforts to prepare for and respond to a possible overturn of Roe v. Wade.

Key Findings

By the mid-2010s, most health department activities related to abortion were legally mandated and engaged in only in the ways prescribed by the law.

Health department professionals recommend instead that key public health values and frameworks should guide health departments’ work on abortion, including commitment to scientific evidence, ensuring access to care, and health equity.

The “Menu of activities related to abortion for state and local health departments” (linked above and below) offers public health professionals a guide to appropriate activities for health departments, including providing evidence-based information about abortion to policy makers and the media and estimating the current and future need for abortion services in their jurisdiction

Study Design

Using the 10 Essential Public Health Services framework, ANSIRH researchers and collaborators published a commentary to describe how health departments should engage with abortion. The researchers argue that health departments should facilitate people’s ability to obtain an abortion and promote the use of scientific evidence base in abortion-related laws, policies, regulations, and implementation of essential public health services.
Through a systematic investigation of health department websites and key informant interviews with health department staff, we discovered that health department activities related to abortion largely reflects what the law requires, rather than the range of core public health activities. However, some agencies at both the state and local level, bring public health principles and approaches to their abortion-related work.
In May 2020, ANSIRH held a two-day convening to engage public health practitioners in health departments in defining activities related to abortion that are appropriate for health departments to engage in. Participants also developed a plan for supporting health departments to use accepted public health frameworks and values to guide their work related to abortion. An executive summary of the outcomes from this convening, including the “Menu of activities related to abortion for state and local health departments” can be found here.
In October 2021, The American Public Health Association (APHA) adopted a policy statement titled “Improving the Role of Health Departments in Activities Related to Abortion.” The Policy Statement endorses the approach that was articulated at the convening.

Implications

Since 2011, US state legislatures have enacted 566 restrictive abortion policies, 83 of which have been enacted in 2021. Many of these laws are not evidence-based, and many harm rather than help the health and well-being of people seeking abortion and their families. Health departments have been tasked with implementing these laws, despite their public health harms. The menu of activities and the APHA policy statement provide an alternative for health departments to use to guide their activities.

As public health professionals navigate the possibility that legal abortion will no longer be available in many U.S. states, the menu of activities provides some guidance about activities that may be relevant and important for health departments to prepare. For example, in states where abortion would remain legal if Roe were overturned, health departments may consider collaborating with local abortion providers to assess their current capacity and their needs should many more people travel from out of state. In states where abortion would become illegal if Roe were overturned, health departments may need to plan for an increased need for maternal and child health services as more people unable to obtain abortions continue their pregnancies.

For health department professionals looking to take public health action related to abortion, we hope that the learnings from this project can provide clarity on a possible path forward.