Kathrin LaFaver, MD: Thank you for joining us today for a special Medscape feature on reproductive rights and how this affects neurology. I'm here with Dr Sara LaHue, who is a neurologist and assistant professor of neurology at the University of California, San Francisco (UCSF), and recent first author of a viewpoint in JAMA Neurology titled Reproductive Rights in Neurology — The Supreme Court's Impact on All of Us.
Most of us are aware of the recent Supreme Court decision and how it affects abortion care. Reproductive rights have been all over the news in the past few months. As a neurologist, I'm curious: What motivated you to write about this topic?
Sara C. LaHue, MD: I was very upset when the initial draft of the Supreme Court decision came out. Within a day or so, I assembled a team of neurologists to talk about what we might do to raise awareness around this issue. I think it's very important that neurologists speak up about abortion and reproductive rights in general. We have patients who also require this type of care, and neurologic health is inextricably linked to reproductive health.
So within a few days of when the draft was leaked, we had drafted our own viewpoint for JAMA Neurology. Our hope was that we could show that this topic is very wide-ranging. It's not just something that affects only our colleagues in ob/gyn, but it affects all of our patients.
LaFaver: Could you expand a bit further on the intersection between women's health and neurology, especially related to birth control and abortion access?
LaHue: My interest in this area began with discussions around medication use. We prescribe so many medications in neurology for a variety of medical conditions. Those recommendations change depending on the patient's family planning goals. It's very important that neurologists are aware of the risks for birth defects and other teratogenic effects of the medications we prescribe.
But we also need to be aware that for the vast majority of medications that we prescribe as neurologists, we really don't have any data at all about birth defects. And so this becomes a really important topic when prescribing medication to a patient who is interested in becoming pregnant or who has the capacity for pregnancy. Decisions about what medications are appropriate might be adjusted depending on the patient's reproductive goals.
For example, there are medications that we might prescribe that we know can cause birth defects, such as methotrexate (which has been in the news recently) and many others. Although it's recommended that patients with the capacity to become pregnant should be on birth control if they are taking a medication that can cause birth defects, but no method of birth control is 100% effective. So it's very important that we have these conversations with our patients about the need for birth control, but also to acknowledge that there are times when access to the full spectrum of reproductive healthcare, including abortion, might be necessary when treating patients with neurologic disease.
LaFaver: There has been an explosion of new medications for conditions such as epilepsy and multiple sclerosis, which has expanded our ability to treat these patients.
Let's say your patient is a young woman with multiple sclerosis. How might your treatment decisions differ if you practice in a state where access to abortion isn't available? How would that, in practical terms, change a treatment decision?
LaHue: The concern is that there may be some changes in practice. I know that some groups are looking at this nationally to see if this is indeed happening.
For the example you gave, let's take the discussion around birth control. Often, medications prescribed for epilepsy can increase the risk for birth defects, or we might not actually know the full gamut of harms associated with a particular medication and we have to assume that there is some theoretical risk. No form of contraception is 100% effective. This is a particular problem for people with epilepsy, even those who are taking hormonal contraceptives, because sometimes the medications that we prescribe can affect the efficacy of those contraceptives.
So even in the best-case scenario, when someone is using a hormonal form of birth control as prescribed, there is always a chance — especially if the medication we're prescribing affects birth control efficacy — that contraception is not going to be working as well. I was really struck by data that showed that contraceptive failure risk associated with oral hormonal contraceptives is about 1% for the general population, but 3%-6% for women with epilepsy. So especially for this population, it's important for us to think about how abortion bans will affect medical treatment decisions by eliminating that option.
LaFaver: You also mentioned in your article that restrictions to reproductive rights may serve to widen health disparities and disproportionately affect women of lower socioeconomic background, as well as Black and Hispanic women. Could you tell us more about that?
LaHue: At UCSF, there's a longitudinal study called the Turnaway Study. It's an incredible study. I recommend that listeners have a look at the vast amounts of data that they've collected over the years on the impact of abortion bans on a wide variety of factors, including socioeconomic status. They had a very clever design, which was the basis for the name of the study being called Turnaway. They took a group of women who were seeking abortion and compared those who are able to successfully obtain that abortion with those who, for various reasons, were turned away from receiving an abortion.
Studies like this allow us to understand the economic impact of abortion bans and lack of access to abortion care. This group, and other data from the Centers for Disease Control and Prevention (CDC), have demonstrated that although it's usually women who seek abortion, those who are unable to access abortion are further entrenched in cycles of poverty, are less likely to access jobs, and are more likely to stay within their lower socioeconomic stat. So this is an example of how these healthcare policies also have a dramatic impact on economic opportunities for women who may need this as an option in their reproductive choices.
LaFaver: Changing gears a little bit, beyond our patients, access to reproductive rights may also affect decisions of physicians on where they're going to practice. Do you have any thoughts on how these changes might impact the physician landscape in different states?
LaHue: It's important to remember that doctors are also patients, and an estimated 1 in 10 women physicians have had an abortion. So while we care for patients who may need access to abortion, we are also part of a group of people who may also require it for ourselves. And I think it's also important to emphasize that doctors face more obstetric complications than the general public. In particular, a recent study in JAMA Surgery showed that women surgeons have higher rates of infertility as well as pregnancy complications. Now imagine if you're a pregnant resident and you get invited to give a talk at a conference that's being held in one of these states where abortion is banned. Would you risk going to this conference? I think there are some very important questions to be asked here in terms of where physicians can feel safe living and practicing. Not just with being mobile for attending conferences, but also thinking about where one is going to be forming the basis of one's career. So I do worry that there may be a reduction in the number of physicians in states with restrictions on reproductive rights.
LaFaver: It's something for physician advocacy groups to watch. Finally, I wonder if you have advice on what each of us can do to support our patients and provide some practical resources.
LaHue: This is where advocacy is important to emphasize, especially in local elections, not just the national elections, and to stay abreast of what's on the ballot. In some elections, reproductive rights are on the ballot. And it's very important to understand when that is going to be coming to your community. That's one way that physicians can take action and advocate for their patients. Also by joining national organizations related to reproductive rights, and to one's own medical society as well. These are ways for physicians to stay active and remain vocal about their concerns around these reproductive rights bans.
LaFaver: Thanks so much for pointing out these practical steps. And thanks everyone, for joining us for this Hot Topics viewpoint on reproductive rights and neurology. I encourage everyone to read Dr LaHue's article for yourself, which will expand a bit more on the points we talked about today.
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Cite this: Kathrin LaFaver, Sara C. LaHue. Why Neurologists Should Care About Reproductive Rights - Medscape - Sep 26, 2022.
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