Part A: A Reflection Essay
Reproductive health has been one the issues of public health in the US for some time. In fact, the weight of this issue has been quite profound to the level that it has constantly been used in presidential campaigns with regime after another promising to provide the best strategy for dealing with the loopholes of the current legislations. The present Trump regime promises to be quite stringent on abortion, which is one of the issues of reproductive health that lies under the Planned Parenthood policy. The President made it clear that his administration will not be supporting abortion, which is why some states have moved promptly to pass bills that would reduce the access to abortion for the thousands of their residents who might be in need for such services. The states of Ohio and Missouri are among those that have already indicated their desire to reduce the accessibility of abortion. For instance, in Ohio, the lawmakers passed the Heartbeat Bill, which limited the age at which aspiring parents would be allowed to have a legal abortion, which was as soon as the heartbeat of the fetus could be detected at six weeks (Knopp, 2013). On the other hand, Missouri recently enacted stringent laws on abortion that reduced the number of qualified and recognized abortionists in the state to only one service provider (Londberg, 2017).
The choice of this public health policy issue lies in my passion in teaching the younger American generation on the importance of reproductive health. The nation, despite having made significant landmarks concerning public health, appears to be struggling with dealing with the problem of teen pregnancy (Hoffman, 2015). In fact, the country has one of the highest incidences of teenage pregnancies in the world. In fact, the prevalence of teenage pregnancies in the US is higher compared to any of the developed nations around the world (Finer & Zolna, 2016). While some people might want to blame other issues, such as poor parenting (Abma et al., 2004), substance abuse (Kirby, 2001), and others for the menace of teen pregnancy in the nation, it should be understood that such issues are unfortunate for the youth and adolescents. Blaming parents and the children alike might not provide the required solution to the problem. Instead, policymakers should make it a public policy priority to reduce the prevalence and consequences of unplanned and early parenthood. Therefore, I feel that the recent anti-abortion policies are likely to increase the numbers of unplanned parenthood cases in the nation. Specifically, I argue that denying the millions of teenagers affected by teenage pregnancies an access to legal abortion implies that the government would be forcing them into untimely parenthood, which could be associated with other issues later in life.
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In the end, the policies being proposed and adopted presently would affect not only the youth and their families but also the government. For instance, when the number of young parents multiplies at the same rate of occurrence of teenage pregnancies, it is likely that the government, both state and federal, would have an increased burden of care considering that such young parents are never economically and psychologically prepared to meet the challenges of early parenthood (Hoffman, 2015). Specific examples can be drawn from nations in the developing world whose incidences of teenage pregnancies have been the leading causes for school dropouts and the spread of sexually transmitted infections among the female and male teenage populations. The government might also be forced to spend millions of dollars in programs that would target the mitigation of problems that might arise. The issue of reproductive health, especially the accessibility of legal abortion, therefore, affects the entire American society.
The issue of reproductive health concerns the nursing practice. For instance, existing literature suggests that nurses are essential in ensuring that society understands the critical need to control birth rates, manage infections that affect the reproductive systems, and improve the health of parents during and after pregnancy. Nurses may also be involved in the provision of psychological care for individuals who find themselves in difficult situations in relation to reproductive issues, such as miscarriages, premature births, and others (Berer, 2016). In the provision of these services, the nurses are supposed to be properly versed with the ethical, legal, and professional requirements for their practice. Therefore, nurses involve in the issue of reproductive health in the same way they deal with other issues of public health since their role remains to improve the positive outcomes of public health on the populations (Hanna, 2014).
Denying parents and the youth the youth an access to legal abortion is against the healthcare ethical principle of nonmaleficence, which means that that medical health practitioners should not do harm to the patients. Specifically, my values as a nurse direct that I should not be negligent in my provision of services to the public since negligence is a form of harm. Neglecting to intervene in nursing care for patients requiring reproductive health services, such as legal abortion would be to neglect the significant proportion of individuals in need of this type of care. It is suggestive that the anti-abortion policies, such as those that the states of Ohio and Missouri have adopted work against the principle of nonmaleficence in the provision of public health to the populations.
Part B: Policy Brief
The decision makers in the policy brief are Governors Eric Greitens and John Kasich of Missouri and Ohio respectively. The rationale for the choice of the governors is the fact that they are in charge of the administrative duties of their respective states, which means that they have the greatest capacity to influence policy adoption through their respective parliaments. The governors should understand that reproductive health interventions are among the most critical issues of public health. In fact, access to legal abortion should be one of the priories of public health in the nation and the states. Teens in the US are at a higher risk of giving birth compared to others in the industrialized world. For instance, teenagers in the US are 2.5 times more likely to get pregnant compared to their Canadian and Norwegian counterparts and approximately ten times more likely to experience the same condition in comparison to those in Switzerland (Darroch, Singh, Frost, 2013). Russia has the second highest incidence of teenage pregnancies among the developed nations, but American teenage females are still twenty-five percent more likely to be pregnant in comparison to those in Russia. Therefore, the administrative personnel should devise policies that would lower the incidence of teenage pregnancies.
Public health policies that directly target to lower the incidence of teenage pregnancies in the US have been a challenge. Despite the little effect that such efforts have attained, early and unwanted pregnancies are still at catastrophic levels. The availability of legal abortion services has been lauded as one of the approaches to the improvement of health outcomes for individuals who may be at risk because of their pregnancy conditions (Kero & Lalos, 2010). It is a medical risk, for instance, for underage persons to carry their pregnancies to completion because of the challenges faced at birth and during the progression of pregnancy. It would be advisable for the health departments to consider that denying such groups of people access to abortion risks their health as well as compels them into early parenthood (Hoffman, 2015).
The Planned Parenthood law has been under significant scrutiny from the public for some time now. Since the landmark ruling by the Supreme Court in the case of Roe v. Wade in January 1973, the US has been striving to stand by the decision reached (Ginsburg 1984). Specifically, the court determined that the right to privacy of a woman granted by the constitution applies to their right to make their personal decisions, which also entailed their right to have an abortion with political interference ( PPAF, 2018 ). While close to seventy percent of the American populace believe that the ruling in the case should be law, they have met with challenges in ensuring that mothers have access to services of Planned Parenthood. For example, the recent years have seen a rise in nationwide attacks on the critical ruling on Planned Parenthood even while most people consider the decision as one of the national fabrics of public health policy.
The opponents of abortion policies have made it increasingly cumbersome for the women to have an abortion. The Supreme Court is already expected to rule against some of the provisions in the Roe v. Wade later this year, which implies that the women are likely to be stripped of some of the privileges they have been enjoying concerned legal abortion ( PPAF, 2018 ). Furthermore, the present atmosphere indicates looming restrictions on abortion, which is already manifest in the moves that some states such as Texas, Ohio, and Missouri, among others, have taken towards reviewing their Planned Parenthood laws. Alongside these challenges, it should be noted that the existence of a federal ban on some procedures of abortion since 2003, especially in the second trimester of pregnancy, indicate the possible challenges that the proposed changes would meet.
Instead of institution the Heartbeat Bill and reducing the numbers of certified providers of abortion services to the population, the Senators might want to consider an alternative. Reducing the accessibility of abortion services is favored currently, but it is a little inhumane and against the ethical principles of nonmaleficence. Therefore, an alternative to this policy would be to reduce the necessity for abortion. This method should be the better of the two because it would first approach the reduction of the prevalence of unwanted pregnancies. It is worth noting that approximately fifty percent of all the pregnancies in the US are unintended ( PPAF, 2018 ). The incidence of such types of pregnancies would be managed effectively when policy made it possible for the women to stay committed to sexual education, which entails medically accurate knowledge on contraception and abstinence. The objective could also be attained through increasing insurance cover and federal and state funding for services of family planning, increasing the levels of access to emergency contraceptives, and dealing with the cases of domestic violence as well as sexual abuse ( Arons & Saperstein, 2006 ).
Tackling the issue of abortion without dealing with the factors that increase the need for such services would be exposing the American women to unnecessary torture, especially when it is considered that illegal abortions have been in existence even in the wake of stringent legislation. For example, before enacting legal abortion in the US, illegal abortions made up to a sixth of all the cases of childbirth and pregnancy-related deaths ( PPAF, 2018 ). However, following the enactment of the laws, abortion procedures are now ninety-nine percent safe. Therefore, the laws on abortion in the two states should be reviewed for the better of the women while avoiding to raise an alarm on the prevalence of abortions. The success of the alternative proposed in this report would be measured from statistics that would track the prevalence of unwanted pregnancies among the youth in the two states. Specifically, the state department of health would be involved in the collection of the necessary data that would then be availed to the policymakers to determine the prevalence.
Part C: A Plan for Working with Interested Groups
The Planned Parenthood Action Fund has expressed interest in the proposal to stop the enactment of anti-abortion laws. The organization has been involved in advocating the right to access legal abortion services for over four decades in different states around the US. The organization is non-partisan and independent, which means that it does not have the tendency of supporting one of the sides of the political divide involved in the wrangle between supporting and banning abortion. The group has been advocating the access of the public to essential program of healthcare through legislative advocacy, grassroots organizing, voter engagement, activism, and education. Therefore, the goal of the group in promoting Planned Parenthood resonates with the proposal in this document, which is to reduce the levels of suffering of the public that would result from a ban on abortion.
Three CBPR principles would be useful in promoting the partnership with the Planned Parenthood Action Fund. The first of the three is that CBPR enables co-learning as well as capacity building for all partners. It is useful noting that information is one of the most powerful tools in arguing the viability of the proposal in this document. The second principle is that CBPR balances findings from research and action to ensure that partners mutually benefit. Information about health and the procedures that individuals and the government should take to promote health are critical for the development of an environment in which everyone understands the burden of unwanted pregnancies. The last principle is that CBPR promoted long-term processes as well as devotion to sustainability, which is why the program should improve public health.
The three principles consider the fact that the purpose of public health policies is to improve the health outcomes of the people. Therefore, for such programs to be effective, it is required that policymakers undertake significant research to establish the best intervention practices that would improve the positive outcomes of policy adoption, especially through improving the quality of life of society. The partnership would be useful since it helps in educating the public on the ways of reducing the incidence of unwanted pregnancies, which would raise the need for abortion. At the same time, it would be useful in educating society and convincing policy makers to improve the access to safe and legal abortion if need be.
Four steps would be involved in the attainment of the objectives of this proposal. The first one would be to approach the necessary decision makers through the Planned Parenthood Action Fund organization. The contact between the Governors and the officials of the group would be to inform the decision-makers of the novel strategies to dealing with the problem of abortions. The second step would be to seek funding from the relevant groups to reach the public with the proposed ideas on planned parenting. However, this step would only work if the first one succeeds. The last step would be to assess the effectiveness of the strategy through metrics comparing the access to services that promote planned parenting and the outcomes of the rate of unwanted pregnancies among a sample of the target population in the two states. The study would be useful in theory and practice through evidence-base practice. The last procedure would be present the findings of the study to the policymakers for consideration.
The role of the organization in this process, therefore, would be to advocate the voice of the public through evidence from research that their intervention would be useful if adopted. The organization may also collaborate with other pressure groups to increase the likelihood that the government would hear their voice and in sensitizing the public in the need for proper reproductive health. In this case, the public shall have the responsibility of committing themselves to the directives of the program, especially in enrolling to the study that would provide information of the relationship between the proposed initiative and the outcome on public health.
The chosen three principles of CBPR suggest that the most effective plan for the evolution of the process would be to analyze the manner in which research findings are interpreted to influence the life of society. In this case, the metrics of analysis would fall into three categories. The first one would be to assess determine the levels of enrollment of society into the proposed research program. In this case, the program should not struggle to find enough participants considering that the first procedure would be to conduct public education programs to sensitive them of the importance of such investigation. The second step would be to evaluate the levels of articulation of the study findings into policy by the concerned decision makers. The results of the research should be compelling enough to influence an adoption of the proposed changes to the current policy that would support favorable policy. The last step would be to test the effect of the policy on the quality of public health outcomes. The objectives of the intervention would be to reduce the factors that contribute to the high incidence rates of teenage and other types of unwanted pregnancies. Therefore, the assessment should use metrics on sexual abuse, gender biasness, domestic violence, access to contraceptives in both emergency and normal situations, and enrolment in programs of reproductive health among others. At the top level of the analysis, the assessment should be effective in reducing the incidence of abortion and indicate success in its application.
Strengths and Weakness of the Top-to-Bottom and Bottom-to-Top Approaches
The biggest strength of the top-to-bottom approach in ensuring policy adoption is the fact that fact that it makes the implementation process quick. The reason for this argument is that the information being implemented is considered a directive that should be adopted within the shortest time possible. The second advantage of the procedure is that it enables the development of policy according to the goals and objectives of the organization and the relevant administrations. However, this approach would be disadvantageous for the fact that it might fail to capture some of the most useful metrics because of the hastiness of the process. Contrarily, the bottom-to-top approach is effective in the mobilization of different stakeholders, especially the public. However, the process is quite slow, which is why it might be undesirable for emergencies.
References
Abma, J. C., Dawson, B. S., Martinez, G. M., & Mosher, W. D. (2004). Teenagers in the United States; sexual activity, contraceptive use, and childbearing, 2002.
Arons, J., & Saperstein, S. (2006). The Right Way to Reduce Abortion - Center for American Progress . Retrieved 12 April 2018, from https://www.americanprogress.org/issues/women/news/2006/01/20/1796/the-right-way-to-reduce-abortion/
Berer, M. (2016). Provision of abortion by mid-level providers: international policy, practice and perspectives. Bulletin of the World Health Organization , 87 (1), 58-63.
Darroch, J. E., Singh, S., & Frost, J. J. (2013). Differences in teenage pregnancy rates among five developed countries: the roles of sexual activity and contraceptive use. Family planning perspectives , 244-281.
Finer, L. B., & Zolna, M. R. (2016). Unintended pregnancy in the United States: incidence and disparities, 2006. Contraception , 84 (5), 478-485.
Ginsburg, R. B. (1984). Some thoughts on autonomy and equality in relation to Roe v. Wade. NCL Rev. , 63 , 375.
Hanna, D. R. (2014). Moral distress: the state of the science. Research and Theory for Nursing Practice , 18 (1), 73.
Hoffman, S. D. (2015). Kids having kids: Economic costs & social consequences of teen pregnancy . The Urban Insitute.
Kero, A., & Lalos, A. (2010). Ambivalence-a logical response to legal abortion: a prospective study among women and men. Journal of Psychosomatic Obstetrics & Gynecology , 21 (2), 81-91.
Kirby, D. (2001). Emerging answers: Research findings on programs to reduce teen pregnancy . National Campaign To Prevent Teen Pregnancy, 1776 Massachusetts Avenue, NW,# 200, Washington, DC 20036.
Knopp, J. L. (2013). The Unconstitutionality of Ohio's House Bill 125: The Heartbeat Bill. Akron L. Rev. , 46 , 253.
Londberg, M. (2017). New abortion restrictions just took effect in Missouri. Here is what that means . Retrieved 12 April 2018, from http://www.kansascity.com/news/politics-government/article180566851.html
Planned Parenthood Action Fund (PPAF). (2018). Roe v. Wade . Retrieved 12 April 2018, from https://www.plannedparenthoodaction.org/issues/abortion/roe-v-wade
