How secure are abortion rights in Washington? Fairhaven’s Hilary Schwandt discusses her work in reproductive healthcare both in Africa and in Washington state
With Roe v. Wade overturned by the Supreme Court, uncertainty about abortion access is more prevalent than ever. Although Washington state leaders currently seek to preserve abortion access, there are still many issues to address and the political climate may change.
Fairhaven College of Interdisciplinary Studies Associate Professor Hilary Schwandt has been researching reproductive health topics, including abortion, for years. She’s done several studies about public perceptions on abortion and other forms of reproductive health services in Ghana, Nigeria, and Rwanda, where she is doing another field study this summer. In 2018, she co-published a study on the transparency of abortion policy in Washington state’s hospitals.
We interviewed Schwandt about how access to abortion might change in Washington after the end of Roe, and what proponents of expanding this right should watch out for. Schwandt’s responses and the questions have been edited for clarity and brevity.
Within the broad field of reproductive research, what is your area of study?
My primary focus in reproductive health, which I love that you acknowledge is so broad, is unwanted pregnancy prevention. I also enjoy doing research on abortion and HIV. Most of my research is in sub-Saharan Africa and Washington state.
What are the key findings of your 2018 study about reproductive health policies in Washington hospitals, and why do they matter?
The main findings of our study, which was inspired by a student-led class project and co-authored with those same students, were that the hospital reproductive health policies were ineffective, for the most part, in providing clarity to the public about what contraception and abortion services they provided, and that this did not differ by Catholic affiliation of the hospital.
These findings matter because most people who are served by hospitals are unaware of any restrictions on the reproductive care they may need - and will not be informed about these restrictions during emergency scenarios, either. I appreciate our state government's attempt to make these restrictions more transparent to the public and felt disappointed in the outcome of these efforts. Through this research it was very clear that hospitals hold a lot of power in deciding what reproductive health care is offered and what isn't. Health providers also wield a lot of power as they can raise conscientious objections to abortion and therefore opt-out of providing services. The general public seeking services from these hospitals and providers have the least amount of power - in that the awareness of these potential restrictions and lack of willing providers are hidden from the public prior to and during care-seeking. Furthermore, in the general public, power and privilege are unequal by race and class, so those with the least amount of privilege in our state are impacted the most by this situation. I appreciate how our political leaders have been working on this issue of raised awareness, but I know we have a long way to go yet.
Has this situation changed since 2018?
Yes! I had the pleasure of testifying in Olympia on a bill (HB 1686) now law 2SSB 5602 that directly responded to our research findings and recommendations in that hospitals have to complete a checklist regarding reproductive health care provisions instead of submitting a policy with no guidance from the government on what has to be included in that policy. This feels like a step in the right direction, but it is certainly just a step; it is not enough.
Washington state has the second-highest number of hospital beds in a Catholic hospital facility in our nation, at nearly 50 percent. There are also a number of places in our state that are served solely by a Catholic hospital, including Bellingham. Since our publication in 2018, more mergers between previously secular and religious health conglomerates have taken place, which means hospitals that previously provided abortion no longer do so. The share of care in our state under Catholic jurisdiction prior to this study was already concerning on the national stage, and that share has continued to increase since.
In the 2018 study you and your fellow researchers say that information about reproductive services such as abortion were vague in many Washington hospitals. Does that matter more now that Roe v. Wade is overturned?
I do not think it matters more - I think it matters the same. It mattered before and it still matters. It is possible that these policies will actually become more transparent as we become a destination state for abortions, given restrictions in our neighboring states and beyond, and those traveling long distances for their care will need to be informed on exactly where to go for the care that they need. It is possible that this future scenario might actually raise awareness of current access points in our state. This is entirely speculative, however, and incredibly hopeful.
Do you think this problem with vagueness regarding reproductive health services in hospitals will get worse now that Roe is overturned?
It is hard to imagine a worse scenario in this regard, as we have already seen it and at least at this point we do have the checklists. As noted above, my optimism pushes me to envision a scenario where the grassroots and government work on these issues perhaps grows stronger and louder so access to this information is pervasive. I am also hopeful that our government will continue to make strides in finding ways to protect the general public from the harm that occurs from incomplete information, particularly in terms of reproductive health emergencies, which can lead to fatal outcomes. A maternal death is so very tragic, and only made more so when it could have been prevented by a simple, safe procedure that was withheld due to the beliefs of others.
How does Washington's reproductive care situation compare to states that are restricting abortion access now that Roe v. Wade is overturned. Should Washingtonians be concerned about their access, and if so what should we be concerned about?
Currently, Washingtonians need not be concerned about their access, given the current political climate in Olympia. Unfortunately, abortion access is determined by politicians and judges in this nation, not medical professionals, so it remains a precarious situation that can change quickly under new leadership with differing opinions about abortion access.
In one of your recent studies, you outlined ways that families can be educated about contraceptive methods and abortion. What can we do in this country to lower risk perceptions for abortion, especially in Washington where the state government is preserving access?
When done by medical professionals, abortion is one of the safest medical procedures. As the WHO states: "Abortion is safe when carried out using a method recommended by WHO, appropriate to the pregnancy duration and by someone with the necessary skills." However, I am pretty sure it is not health risks that make people anti-abortion in the USA. The risk associated with abortion is typically in terms of morality, and it is usually a value judgement placed on others’ actions.
One way to educate those opposed to abortion in the USA would be to first remind people that pregnancies are carried by live individuals, and would not survive without them. I would also suggest teaching folks about the potential negative impacts on the individuals carrying the unwanted pregnancy - in terms of mortality, morbidity - as well as the other negative aftereffects, including emotional/mental health and changes in future educational, occupational, and earning potential. Studies on these negative impacts exist. However, messaging from these studies are not commonly found in popular media, so efforts to share these findings in mass media would likely help raise awareness of these outcomes.
Fairhaven College of Interdisciplinary Studies Associate Professor Hilary Schwandt studies reproductive health care in Africa and Washington state, and is spending part of this summer doing a field study in Rwanda.