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The Reproductive Health Act Policy Evaluation

America, a country of progress, is not always open to change. Abortion in the past has been considered a women’s problem, which many argue now is an equity problem. Equity should be the golden standard not just for public health but for all areas of life. When looking at the history of abortion globally, the deep roots of politics, religion, and power have supreme.

Background

For centuries abortions have been performed regardless of society’s opinions. Abortion, which has been criminalized in many countries all over the world, also has a history of mortality rates from unsafe illegal abortions. One of the most important court decisions for America is the Roe vs. Wade. This case removed a barrier for women to have autonomy over their bodies. Before 1973, it was estimated that thousands of women died each year from either illegal procedures or a lack of access to care (Lantz, 2019). After the 1973 court ruling, the abortion rate went from 16.3 percent to 29.3 percent in 1981 (Nash, Dreweke, & Guttmacher Institute, 2019). In 2015, legal abortions in America totaled 638,169; these were voluntarily reported to the CDC. From 2006 to 2015, the number, rate, and ratio of reported abortions decreased to 24%, 26%, and 19% (CDC, 2018). Unintended pregnancy rates are an important statistic to look at for abortion rates globally. Low-income women under the federal poverty level, women of color, and women from ages 18 to 24 have been found to have high rates of unintended pregnancies (Nash, Dreweke, & Guttmacher Institute, 2019).

Access to abortion services, currently a huge concern, is drastically changing. From 2011 to 201, the number of clinics providing abortion in the United States declined by less than 4%, from 839 to 808 (Nash, Dreweke, & Guttmacher Institute, 2019). Between 2011 and 2017, the South had a net decline of 50 clinics, with 25 in Texas, and the Midwest had a decline of 33 clinics. By contrast, the Northeast added a net of 59 clinics, mostly in New Jersey and New York (Nash, Dreweke, & Guttmacher Institute, 2019). The continued decline in clinics is due to the spread of Republicans/pro-life ideology hard power affecting state laws in the hope Roe vs. Wade is removed in the future. Access to legal abortions is becoming more difficult due to political influence on policies around the United States. The anti-abortion policies are usually found in Republican states like Texas, Georgia, Louisiana, and Alabama. These states continue to have problems with proper legal access to abortion services. The Democrats tend to be pro-choice, and therefore New York is a prime example of this type of policy. Abortion has always had religious groups who press and lobby their beliefs on political power. It is common to see that state law reflects the political party power at the time, and the federal judicial law of Roe vs. Wade is frequently under attack in hopes of being removed.

Democrat political power has not always been the majority in New York. Surprisingly only three times in the past fifty years has New York’s senate been majority Democrat (Wang, 2018). Making this new bill, the Reproductive Health Act, indeed, a new creation of a new senate. The culture of New York state, usually progressive, is making it a leader of America headed for health care for all. Having comprehensive health care is not a new idea. Having abortion as a part of complete family planning services along with birth control methods has been thought of by public health researchers since 1971 (Contis & Hern, 1971). Why this was not slowly implemented decades ago is still a mystery, but it could be that America was dealing with more pressing matters like Vietnam and the Cold War.

Kingdoms Framework

Kingdoms’ framework entails looking at the problem, politics, and policies. A common problem for a policy is that the focus is placed on the policy and politics streams, whereas the problem source is given much less attention (Knaggård, 2015). Knaggård argues that the problem and policy streams overlap, and this hides the power present in defining public problems. In regard to abortion, the problem of illegal abortions has occurred for decades. The mortality of women and the concurrent health problems associated with women who lack access to health care are what need to be addressed. The problem with access to abortion is entangled with the political ideology. Therefore, politics will always be a needed factor for policy writing, matching Kingdoms’ framework. The abortion policies have dramatically changed this year as will direct result of a majority influence of Republican leaders ranging from multiple states to the white house.

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Reproductive Health Act

New York

New York’s newest policy, the Reproductive Health Act, was enacted in January 2019. This act allows women to have access to abortion care, and medical doctors will not have police legal codes instated in them. As well, the Reproductive Health Act repealed a statute that prohibited anyone but a medical doctor from performing an abortion and removed some restrictions on late-term abortions. The change also eliminated a requirement that parents must consent to an abortion performed on their daughter if she is a minor. Compared to other state policies in America, where policies ban abortion altogether like Alabama, abortion is becoming very split between political power. The public also is becoming more vocal about their abortion views, which has pushed some policies this year. Regardless of political affiliation, the Millennium development goals, which promote gender equality and empower women, are aimed at improving maternal health (. The considerable debate on abortion in America constantly questions does abortion supports these goals.

Global Abortion Policy Comparison

Legal abortions in the United Kingdom have been around since the Abortion Act of 1967, which covered England, Scotland, and Wales. Northern Ireland, governed by the UK since 1922, has had different abortion policies that restricted access to abortion until this past October (Page, 2019). After the policy change in October, no criminal charges will be brought against women who have an abortion or against healthcare professionals who provide and assist them.

Access to legal abortions is becoming easier due to political influence on policies and the influence of the Committee on the Elimination of Discrimination Against Women (CEDAW), whose report of recommendations for the elimination of all forms of discrimination against women provided guidelines for abortion policy (UK Legislation, 2019). The policy is primarily influenced by the UK Parliament and current citizens’ more protestant/other religious views and beliefs. By 2020, it is estimated that about 1,060 abortions will take place in Northern Ireland due to the policy change (Connolly, 2019). The Department of Health will be funding this service to ensure training and proper abortions with quality safety standards are met. The buffer zones around the two hospitals will be enforced for the safety of women to be able to get abortions. The abortion services will not go into effect until April 2020. Therefore the overall impact on women will not arise until then. The Abortion Act of 1967 was the original policy. In 2012, the Department of Health wrote policies regarding guidelines for the management of termination of pregnancies (Connolly, 2019). This policy caused fear among many health workers. The fear of prosecution for abortion or giving services has caused about 45 women a year with fetal abnormalities to travel to England for services. The new policy written in October 2019 makes sure that no criminal charges can be brought against the mother and the service providers (Connolly, 2019). An interesting fact as well is that women and girls who require abortion services will be financially supported by England for the services. Another interesting fact in the policy is that anyone protesting around the two abortion hospitals or causing obstruction could be prosecuted. These two policy additions are not included in the New York law but could be possible discussions in the future to consider for the United States. Globally, the Millennium development goals, contain goals that want to promote gender equality and empower women; and to improve maternal health. The considerable debate on abortion in America constantly questions does abortion supports these goals.

Evaluation of Policies

Evaluation of policy or bills before and after creation is crucial due to the impact it can have, whether positive or negative on populations. Using current research-based evidence does not always happen in the policy community. A December 2019 policy, currently being promoted in the state of Ohio, regards abortion services and is receiving considerable criticism for its use of outdated research-based evidence. This bill, lobbied by the Right to Life Action Coalition of Ohio, prohibits insurers from covering abortion services but allows for a procedure intended to re-implant an ectopic pregnancy in a woman’s uterus (Associated Press, 2019). The research that was collected to use for justification of this bill was case reports written in 1980 and 1917. A Maryland geneticist questioned the case studies and told State Representative Becker, who is proposing the bill, that the side effects of this rarely used procedure could be death for the mother. State Representative Becker ignored the medical input and continued to push the bill. After the literature was requested, he defended it, saying the literature was published and, if incorrect, should be corrected. This example demonstrates that more public health or medical professionals are needed to be involved due to the lack of research method education that can occur in the legislature.

The Reproductive Health Act (RHA), in comparison, has the aim to increase access to abortion clinics and keep abortion providers safe from criminalization. New York, while considered one of the few states where abortion is easily accessible, still faces challenges even after this law was enacted. Currently, there is not much evaluation data on the effect of the RHA. There is one article that has evaluated the RHA’s lack of influence on women over 26 weeks trying to receive abortion services. Currently in New York, few hospitals and clinics provide third-trimester abortions. The RHA aimed to address this but the language in the policy did not change the current practice and only codified what was already being done in the laws (Mogul, 2019). The RHA removed some restrictions on late-term (after 24 weeks) abortions but didn’t clear medical guidance. The author spoke to the health department, which clarified and agreed that the RHA does not change the fear of legal liability due to the RHA not giving regulations for the hospitals or clinics to go by.

Therefore, after evaluating a piece of this policy, it can be understood that more work needs to be done for the RHA and how it can change the standard operating procedure regulations for healthcare providers. Regardless of state ideology, documenting abortion or lack of abortion data is needed after policies have been implemented. Many public health professionals have written their concerns about the lack of literature and data available for Supreme Court decisions that could affect millions of women (Lantz, 2019). Lantz has stated that public health experts should quickly agree upon and implement the best evidence-based methods for documenting reproductive health policies. The author also reiterates that assessing burdens, costs, and unintended consequences of public policy is a standard practice that is good for policy analysis and evaluation. The US-based research currently in the literature for abortion applies to public opinion perspectives, which are used for the effects of other variables on policy (Forman-Rabinovici & Sommer, 2018). The author’s research found that female political participation internationally is significant in leading reproductive health policies more permissive.

References

    1. Associated Press. (2019, December 11). The lobbyist had hand in the bill sparking the ectopic pregnancy flap. Retrieved December 15, 2019, from https://www.usnews.com/news/best-states/ohio/articles/2019-12-11/lobbyist-had-hand-in-bill-sparking-ectopic-pregnancy-flap
    2. Connolly, M. (2019, October 22). Northern Ireland abortion law changes: What do they mean? Retrieved December 06, 2019, from https://www.bbc.com/news/uk-northern-ireland-50125124
    3. Contis, G., & Hern, W. M. (1971). United States government policy on abortion. American Journal of Public Health, 61(5), 1038-1041. doi:10.2105/ajph.61.5.1038
    4. Forman-Rabinovici, A., & Sommer, U. (2018). Reproductive health policy-makers: Comparing the influences of international and domestic institutions on abortion policy. Public Administration, 96(1), 185-199. doi:10.1111/padm.12383
    5. Knaggård, Å. (2015). The multiple Streams framework and the PROBLEM BROKER. European Journal of Political Research, 54(3), 450-465. doi:10.1111/1475-6765.12097
    6. Lantz, P. M. (2019). State laws restricting abortion: The need to document their impact. The Milbank Quarterly, 97(3), 645-648. doi:10.1111/1468-0009.12401
    7. Mogul, F. (2019, November 8). NY’s Reproductive Health Act was supposed to make it easier to get Late Abortions. It Hasn’t. WNYC.
    8. Northern Ireland (EXECUTIVE FORMATION etc) ACT 2019. (2019, October). Retrieved December 06, 2019, from http://www.legislation.gov.uk/ukpga/2019/22/section/9/enacted
    9. Page, C. (2019, October 22). Northern Ireland’s abortion and same-sex marriage laws have changed. Retrieved December 06, 2019, from https://www.bbc.com/news/uk-northern-ireland-50128860
    10. Wang. (2018, November 07). Democrats take control of the New York Senate for the first time in a decade. Retrieved December 16, 2019, from https://www.nytimes.com/2018/11/07/nyregion/democrat-ny-senate.html

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