February 3, 2014 — How hard is it for women in Appalachia to get an abortion, and what’s the impact on their health if access is a problem?
Jennifer O’Donnell wants to know the answers to those questions. As part of her research, she has waited inside waiting rooms in health clinics and outside shopping centers in Kentucky, Tennessee, and Virginia to ask women if they’d be willing to share their experiences seeking reproductive health services.
A doctoral candidate in maternal and child health in the Department of Social and Behavioral Sciences at Harvard School of Public Health (HSPH), O’Donnell is gathering data for research on how ‘who you are’ and ‘where you live’ impacts access to abortion services. “We often hear how poor rural women’s access to abortion is, but there’s not much evidence to back it up,” said O’Donnell.
O’Donnell was one of several HSPH doctoral student speakers at a day-long Women’s Health Symposium in Kresge 502 on January 23, 2014, presented by the Reproductive, Perinatal, and Pediatric Epidemiology and the Maternal and Child Health concentrations at HSPH. Other speakers included keynoter George Davey Smith, professor of clinical epidemiology from the University of Bristol, UK; Janet Rich-Edwards, associate professor in the Department of Epidemiology at HSPH; and Karin Michels, also an associate professor in the department, who served as moderator.
Lack of access to abortion services can have serious public health implications, O’Donnell said. For instance, nine states severely limit such services after 15 weeks of gestation, meaning that women living in those states may have to travel farther, wait longer, or pay more for care for abortions at later gestation. Or women unable to get abortions, who continue with an unwanted pregnancy, may fail to adopt healthy prenatal behaviors or refrain from unhealthy behaviors. O’Donnell hopes the data she gathers will help shed new light on rural women’s experiences accessing abortion services as part of reproductive health services and health care in general, teasing out details about access overall.
Folates in pregnancy
Audrey Gaskins, a doctoral candidate in the Departments of Nutrition and Epidemiology, presented research on the association between pre-pregnancy folate intake and risk of miscarriage (loss of a pregnancy before 20 weeks of gestation) and stillbirth (death of a fetus in utero after 20 weeks).
Experts have recommended since the early 1990s that women take pre-pregnancy folic acid supplements to prevent neural tube defects in infants, based on evidence from several studies. But other studies, looking at potential effects of these supplements on risk of miscarriage, have found contradictory results; some have suggested they might increase the risk, while others have found the opposite.
To address the conflicting findings, Gaskins and colleagues examined folate intake in a large prospective cohort of women, the Nurses’ Health Study II. They found that the higher a woman’s folate intake was prior to pregnancy, the less likely she was to miscarry, and that folic acid supplements conferred an even stronger benefit than folates from diet. Gaskins added that the study also revealed a link between higher folate intake and reduced risk of stillbirth—the first to do so.
Oral contraceptives, colorectal cancer, and mortality
Brittany Charlton, a doctoral student in the Department of Epidemiology, presented research on the link between oral contraceptives (OCs)—the most prescribed drugs among U.S. women of childbearing age—and colorectal cancer, colorectal adenomas (from which most colorectal cancers arise), and mortality. “We’re at a unique point now, 50 years after OCs were introduced, where we can really look at some of the long-term effects” of these drugs, Charlton said.
Based on data from the Nurses’ Health Studies I and II, Charlton’s research suggests that long-term OC use protects against colon cancers, but may not have a protective effect in cancers diagnosed at older ages; that there’s no association between OC use and colorectal adenomas; and that OC use doesn’t appear to increase the risk of death overall.
Given that OCs currently on the market contain much lower hormone doses than previous formulations, it’s important to study the new drugs and how women are using them, Charlton said. “It’s really imperative that we understand the full impact of contraceptives so that women can make informed choices about what’s right for their bodies,” she said.
photo: Aubrey Calo