Title : Anti-abortion legislature’s impact on public health: The case of access to the anti-rheumatic drug methotrexate
Abstract:
After the US Supreme Court’s decision to overturn Roe vs Wade in June 2022, which protected the constitutional
right to abortions in the United States, some US states restricted access to abortions by criminalizing providers,
regulating abortion procedures, and prohibiting abortive medications. It has become clear that the impact of these
legislations goes beyond abortion, and one clear example of the reach the overturn had in the public’s health is
related to reducing access to drugs used to treat rheumatic and musculoskeletal diseases. These disorders are
diseases that affect the joints, bones, muscles, and connective tissues in the body and result in pain, swelling, and
deformities that reduce the quality of life. One of the most common drugs to treat these disorders is methotrexate.
Studies show that methotrexate can induce abortions, which puts it under the abortive medications umbrella. Data
suggests that abortion restrictions are impacting methotrexate access. We conducted a mixed-methods study using social media (SoMe) to understand the experiences of people with rheumatic diseases after the abortion ban. We performed two data collection trials on the first anniversary of the overturn for six weeks using key terms
“methotrexate” and “methotrexate and abortion”. We retrieved X (formerly Twitter) posts using Keyhole software.
1,526 posts including “methotrexate” mainly (41.1%) from US users were collected, and adding “abortion” as a
keyword narrowed the number of posts to 103, also from a majority of US users (78.3%). Most users were female
(76.2%). Texas was the state with the largest number of posts in both trials (12.9% and 16.1%), this is not surprising as Texas is one of the fourteen states that implemented anti-abortion legislation directly banning the use of abortion-inducing medications including methotrexate. The term “methotrexate” reached 6 million unique users with over 7 million impressions, and when “abortion” was added it reached over 164,000 unique users with more than 200,000 impressions. These showed the relevance of the topic on a SoMe platform such as X. We conducted a content analysis of the posts using Leximancer software, which revealed a high association between methotrexate and abortion-related topics through concept mapping. We used this information to identify three main themes in the posts: (1) Denial of Methotrexate; (2) Denial of Methotrexate Treatment for Women; and (3) Methotrexate as part of Reproductive Healthcare. The qualitative analysis showed a year after the ban there is more concern around the access to methotrexate. Our results highlighted that abortion legislation has endangered access to this drug, posing a significant threat to the health of people with rheumatic disorders. It also highlighted healthcare inequities for women of reproductive age as they are likely to lose access to their treatment due to scrutiny from abortion restrictions and enforcers. By understanding the impact the legal overturn of protections for abortion access has had on those suffering from rheumatic and musculoskeletal diseases, we can begin to fully realize the full implications this legal decision has had outside of reproductive healthcare.
Audience Take Away:
- This work will discuss the public health impact of legislation around abortion restrictions for non-reproductive health outcomes
- We will show methodology using social media analysis to better understand health outcomes
- This work will also explore the use of AI tools such as Keyhole and Leximancer in the analysis of information to gain a real-time understanding of public health experiences
