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FORUM Beyond Roe vs. Wade Tarayn Grizzard Photo by Jeff Cleary It is nearly impossible amid the deluge of media coverage to forget that 2003 marks the 30th anniversary of the landmark Roe vs. Wade decision, which granted American women the right to terminate a pregnancy. Ever since 1973, the abortion debate has remained a central moral, political, and medical issue in this country. It has divided churches, changed physician practices, and irrevocably altered political careers in the process. There is an entire generation of young adult women who have never known a time when abortion was illegal. The sturm und drang of the abortion debate has so far done little to shake the Supreme Court's ruling, although the continued challenges are a concern for many abortion rights activists. The current presidential administration, with its hostility toward abortion rights, is keeping many activists anxious and sleep-deprived. Despite all of this, however, there seem to be few direct threats to Roe vs. Wade. In fact, the entire tone of the debate seems to be shifting. The violence that has been associated with abortion rights appears to have dissipated slightly. Conservative magazines and newspapers have written articles about moving beyond overturning Roe vs. Wade and concentrating on different aspects of the issue--articles that never would have been published in these journals four or five years ago. Finally, two years ago after years of controversy, mifepristone, formerly known as RU-486, was approved by the FDA for termination of early pregnancy. Perhaps it is time to move even further beyond the Roe decision, broadening the focus to universal reproductive health. Yet the reproductive choices of women in the U.S. are still constrained in other ways that garner little attention or public outcry. As a result, many aspects of reproductive health have been neglected despite their importance to millions of American women. Perhaps it is time to move even further beyond the Roe decision, broadening the focus to universal reproductive health. The Contraception Quandary One of the additional important issues is contraception. Many women in the U.S. have difficulty regulating their fertility with contraceptives because they cannot access or afford them due to restrictive insurance and Medicaid policies on prescription drugs. Ironically, the same policies that allow men access to Viagra for erectile dysfunction may not pay for birth control pills. Emergency contraception, taken the morning after unprotected sex, is sometimes unavailable to rape survivors in U.S. hospitals and clinics even though its primary function is contraceptive (preventing ovulation) as opposed to abortifacient (preventing implantation). On the other hand, in underserved minority communities as recently as 10 years ago, women often were pressured to accept Norplant contraceptives and, in the case of the Indian Health Service, some women were sterilized after childbirth without their foreknowledge or consent. Little media attention was paid to these offenses, and change, especially within the Indian Health Service, came very slowly. Choosing Fertility In the majority of the U.S., infertile women must pay out of pocket for increasingly expensive fertility treatments due to insurance and Medicaid policies, the majority of which will pay for tubal ligations. This inconsistency leaves many women who are infertile due to illness, advanced age, or sheer bad luck unable to choose to have children without a significant and typically prohibitive financial burden. Agitation and organization over this issue has made changes in a few states--Massachusetts among them--but little has been done nationwide to make this choice possible for all women. Choice in one's reproductive health has come to be regarded in the U.S. solely as the decision to terminate or not terminate a pregnancy. But that is not the whole story. It makes compelling sense on this 30th anniversary of Roe vs. Wade to look beyond shoring up the Supreme Court decision to securing other, long-ignored, and equally important reproductive freedoms for all American women. --Tarayn Grizzard, a third-year medical student at HMS