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Coming to consensus on an appropriate role for health departments in abortion

This story was written by Claudia Zaugg, MPH and originally published in JPHMP Direct.

Even when scientific evidence is clear, political controversy about a public health issue can make it difficult for public health agencies to know how to proceed. This has been very clear during the COVID-19 pandemic, as public health officials have feared backlash while doing their work. But the pandemic is only the latest example of ways in which political controversy makes appropriate public health action more difficult.   

In our recent article in the Journal of Public Health Management and Practice, “Reaching Consensus on Politicized Topics: A Convening of Public Health Professionals to Discuss Appropriate Abortion Activities for US Health Departments,” my colleagues — Nancy Berglas, Regan Johnson, and Sarah Roberts — and I describe a recent effort to engage public health professionals in discussions of how they could approach another politically controversial topic – abortion.  

As a public health professional who has worked both in academia and directly with health departments, I know how important it is to focus on the policies and other structural factors that affect the health and well-being of communities. The research evidence is clear: being unable to obtain an abortion harms the health and well-being of women, children, and families. A few years ago, members of our research team published a commentary describing what a public health practice approach to abortion could look like. Based on my experiences, though, I know that there’s a huge gap between research and implementation. Our colleagues in health departments have expressed a desire to engage with abortion in ways that de-center politics, but neither the research nor the commentary provide the tools to meet these needs. 

To address this gap, we hosted a 2-day virtual convening with over 30 public health professionals, including 20 people from state and local health departments across the US. Participants were tasked with coming to consensus about activities related to abortion that are consistent with public health frameworks and identifying ways to support health departments in implementing such activities. This effort needed to be guided by health department professionals working on the ground, informed by relevant evidence, and acknowledge the realities of operating in diverse political environments. 

What did we learn at the convening?

Participants believe that key public health values can and should guide health departments’ work on abortion, including commitment to scientific evidence, ensuring access to care, and health equity.
Participants were able to come to consensus on a menu of activities related to abortion that are appropriate for health departments. Example activities include: 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.
Participants agreed that supporting health departments in implementing these activities will require significant work, including: getting broader buy-in from other public health professional organizations, training the health department workforce, and coordinating best practices and lessons learned.

How can health departments use the convening outcomes in their own work? 

Health departments can use the menu of abortion-related activities to choose activities that are relevant and feasible in their jurisdiction. They can also connect with us to learn about health departments that have started working on this vision and what challenges and opportunities they’ve encountered.  

Why now? 

This work has become even more critical given the recent enactment of Senate Bill 8 (SB 8) in Texas, which bans abortion after 6 weeks gestation. SB 8 prevents the majority of pregnant people in Texas from obtaining abortion care. Since SB 8 has passed, policy makers in a handful of other states have suggested they will introduce similar legislation.  

SB 8, however, is just the most recent and most extreme restrictive abortion policy enacted in a US state over the past decade. Since 2011, US state legislatures have enacted 566 restrictive abortion policies, 83 of which have been enacted in 2021Many 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.  

As states continue to enact restrictive abortion policies, public health agencies will need to plan for their implications. These may include increased need for abortion services as more people travel to their state for abortion services or an increased need for maternal and child health services as more people continue their pregnancies. Our menu of activities outlines activities relevant to such planning. 

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

Editor's Note: 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, including the Menu of Activities Related to Abortion for State and Local Health Departments. This change was a direct result of the efforts made by the research team.