unit 6

docx

School

Georgia State University *

*We aren’t endorsed by this school

Course

024

Subject

Medicine

Date

Oct 30, 2023

Type

docx

Pages

Uploaded by MasterTankDugong10

NSG423.12.01.01 Discuss the history and significance of reproductive Introduction Women’s health encompasses a woman’s access to reproductive health services, including contraception, abortion, adoption, and infertility treatments. Reproductive rights include having the ability to determine if and when to have children. Reproductive health is foundational to the health of a nation and is a basic human right. Infant mortality and maternal mortality are measures used to assess the health of a nation and are correlated with the nation’s access to reproductive healthcare. There are multiple barriers to reproductive health access globally. In recent years, reproductive health has become a controversial social and political issue. Prior to this, there was little regulation over abortion and there was no medical knowledge of contraceptives. The politicization of these issues has led to restrictive legislation and policies that limit access to reproductive health care and create disparities that affect the health of women, children, and communities. This section will further explore the controversial topics of contraception and abortion. The policies related to these issues and their effect on global women’s health. Reproductive health policy Reproductive health is a foundation of public health. Since 2002, the countries of the United Nations (UN) sought to determine the highest priorities for promoting health and reducing poverty globally. In 2015 the UN member states adopted the 2030 Agenda for Sustainable Development, that includes 17 Sustainable Development Goals (UN, 2015). Several are specific to the health and well-being of people with capacity for reproduction, including gender equality, good health and well-being, and reduced inequalities. These goals are essential to improving maternal and child health and to ensure reproductive well-being for people of all ages. When viewed as a human rights framework, reproductive justice posits that individuals have a human right to have children and to determine the conditions under which they birth (Ross & Solinger, 2017). Individuals have a human right to decide if they will become pregnant or not, have a baby, and have the full range of options for preventing or ending pregnancies. In addition, individuals have a right to parent the children they already have with dignity, free from violence from other individuals and the government. Finally, individuals have the human right to disassociate sex from reproduction. Using this framework, it is easier to understand that reproductive health serves as a barometer for the health of a nation.

Historical perspectives on women's health and U.S. policy In the second half of the 20th century, women's health—defined here as access to the full range of reproductive health services, including abortion, adoption, contraception, and infertility treatment—became a controversial topic that was viewed through a religious lens. However, this had not been the case earlier in American history. Until the middle of the 19th century, legal abortion, like so much else in this country, was governed by British common law. This held that abortion was criminal only if performed without due cause after the woman felt fetal movement, which usually occurs at about the 16th week of pregnancy. This was known as the “quickening doctrine” after the medical term for the mother's perception of fetal movement. It is not even clear that late abortions were prosecuted. In fact, in 1800, there was no American legislation at all on the subject of abortion. Similarly, there was no legislation on contraception because there were no medically recognized means of preventing conception (Mohr, 1979). In the early 19th century, there were no laboratory tests to reliably diagnose pregnancy. Common signs and symptoms of early pregnancy, such as absence of menstruation and nausea, can be caused by other factors. Thus a physician, or a woman herself, could take steps to correct her blocked menstrual flow. There were widely advertised products and medicines to help women restore menstruation or cure blocked or delayed menstruation. The fine print stated that the products should not be used by married women because they could cause miscarriages; this served as a signpost to women who wanted to end a pregnancy. Such was the nonchalant view of abortion that these ads could be found not only in newspapers but also in the religious press (Brodie, 1994). Many of those drugs and practices were unscientific and ineffective. Some, such as douching with carbolic acid, were downright dangerous. It was actually the concern about the danger of these methods that led to the first antiabortion laws in some states in the 1820s. Given that many of the early providers of abortion were nurses, lay midwives, and granny midwives who were committed to caring for individuals across the reproductive spectrum, the Flexner Report and the professionalism of medicine, combined with perceived danger of abortion, criminalized termination of pregnancy (Ehrenreich & English, 2010). It also should be noted that abortion is safer than carrying a pregnancy to term (Raymond & Grimes, 2012). Furthermore, some women have always been so distressed by an unwanted, unintended, or mistimed pregnancy that they have knowingly risked their lives to end the pregnancy. Not surprisingly, then, women were accessing illegal abortions before it was decriminalized in

the United States and were dying from infections from unhygienic abortions. Survivors of these procedures often became so scarred that they lost their fertility. The story of abortion policy in the United States is long and tangled (Roye, 2014). By 1880 most states had antiabortion laws, and by 1910 every state had them except Kentucky, where the courts had outlawed the practice. Some of the laws enacted in the late 1800s remain on the books and 23 of 50 states will revert back to abortion being illegal if the 1973 Roe v. Wade decision is overturned (Center for Reproductive Rights, 2018). In the mid-20th century, physicians began to agitate to legalize abortion, this time out of concern for their patients' health. Religious bodies, such as the Southern Baptist Convention, advocated for the legalization of abortion to help women who were at risk of being maimed and killed by illegal, unsafe procedures. Indeed, members of the clergy banded together and formed networks to help women access safe abortions. The best known of these, the Clergy Consultation Service on Abortion, was formed by Reverend Howard Moody, a Texas-born Baptist minister (Moody, 1971). For complex reasons, having primarily to do with politics, power, and money rather than women's health or public health, abortion became a hot button political issue after Roe v. Wade . Currently, the introduction of laws limiting women's access to reproductive healthcare, and the fate of those laws, depend on who is in power in a given state and in the federal government. Roe v. Wade has been attacked by state and federal legislators who want to overturn the law. For example, in 2000, in the case of Stenberg v. Carhart, a sharply divided Supreme Court struck down a Nebraska statute banning so- called partial birth abortion because the law placed an undue burden on a woman's right to have an abortion because it did not allow for an exception when the mother's health is threatened by continuing the pregnancy. Yet an almost identical federal law, the Partial-Birth Abortion Ban Act of 2003, was upheld by the Supreme Court in 2007 (Mears, 2007). A partial-birth abortion, correctly called intact dilation and evacuation, is a rare procedure typically performed to protect the mother's health or when a fetus is found to have a severe, often life-limiting congenital defect. Despite this legal success, abortion opponents realized that it would be very difficult to have Roe v. Wade struck down, so they turned their efforts to the states. In some states, abortion is very difficult to access, especially for poor women, because of multiple reasons, including but not limited to distance traveled to abortion clinics, mandated waiting period between a required visit to the abortion facility and the procedure, and other Targeted Restrictions of Abortion Providers (TRAP) laws (Guttmacher, 2018b). These regulations can entail days off from work and finding transportation and childcare on multiple occasions. Other states are likely to have no abortion

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

providers in the near future because of onerous and medically unnecessary requirements being placed on these facilities, such as a requirement that the physical building where abortions are performed meet the same standards as an ambulatory surgery center and a requirement that the abortion doctor have admitting privileges at a local hospital. Currently, women's access to abortion varies widely by the state in which they reside and remains contentious. When women's reproductive health needs are not met Infant mortality The infant mortality rate (IMR) in the United States is much lower than it is in the world's poorest countries; however, in 2017, the rate in the United States was higher than the rate in Saint Kitts and Nevis and other resource-poor nations (Central Intelligence Agency [CIA], 2017). Three critical factors influencing pregnancy outcomes are: 1. Age at which women conceive. For biological reasons, teenage mothers and mothers in their 40s are more likely than women in their 20s and 30s to have infants who do not survive. 2. Spacing of pregnancies. The chance of dying in infancy increases by 60% to 70% for a child born less than 2 years after an older sibling. 3. Having too many children. Children born fourth or higher in birth order have a threefold greater risk of dying than those lower in birth order. In the United States, access to birth control (defined as whether or not a state pays for comprehensive contraceptive services for poor women through Medicaid) influences the IMR. A state's failure to allow Medicaid to pay for comprehensive contraceptive services is a statistically significant predictor of a higher IMR (Roye, 2014). In addition, large family size and unplanned pregnancies and births place children at risk for physical abuse and neglect (Aztlan-James, et al., 2017; Guterman, 2015). Even when you consider socioeconomic status (SES), Black women are more likely to have low birthweight babies and preterm births (Centers for Disease Control and Prevention [CDC], 2016), which can lead to infant mortality. In states that expanded Medicaid, in response to the Patient Protection and Affordable Care Act (ACA), infant mortality decreased more than it did in nonexpansion states (Bhatt & Beck-Sagué, 2018). Clearly, one easily implemented solution to these problems is to provide women with access to the full range of contraception and safe abortions.

Maternal mortality Although the United States saw a sevenfold reduction in maternal mortality in the 20th century (Loudon, 2000), deaths related to pregnancy and childbirth persist even though most are preventable. Evidence shows that maternal mortality is greatly underestimated. As with infant mortality, the global ranking of the United States on maternal mortality is dismal, worse than a number of lower-resource Eastern European nations; moreover, unlike most nations, the rate in the United States has increased since 1990, whereas it has decreased in most other nations (World Bank, 2018). Predictors of maternal mortality are similar to those for infant mortality. Recent data have shown that the Black-White disparity gap—where Black women are three to four times more likely to die from a pregnancy-related complication (CDC, 2018)—is preventable when healthcare professionals and teams are able to recognize signs and symptoms of deterioration (Main et al., 2017; Macdorman et al., 2016). Several efforts have been focused on raising awareness of the epidemic of maternal morbidity among Black women, including the fact that a little more than half of pregnancies in the United States are unintended (Finer et al., 2016). New data highlight an urgent need to reduce so called “mother blame” (McLemore, 2019; Scott, Britton, & McLemore, 2019; McLemore, 2018) to begin to reduce maternal morbidity and mortality. Clearly, access to comprehensive reproductive healthcare for all people with the capacity for pregnancy would have a significant effect on public health by improving health outcomes for mothers and children. What is equitable reproductive health policy? One might wonder why reproductive health deserves special attention from policy experts. First, women's unique reproductive health needs have been targeted by politicians because of the potential for pregnancy. Over the years, as reproductive healthcare has advanced (including contraception and abortion techniques), it has become a focus of political rhetoric and a hot- button issue. This has extended to political battles over who has control over the pregnant body, including the criminalization of pregnancy (Paltrow & Flavin, 2013). Second, women's reproductive health needs are a nexus where health and sex (thus sexual taboos) meet. With our history of Puritanism, sex has always been a particularly sensitive topic in the United States. Moreover, there is a misguided concern that any discussion of sex will lead to promiscuity. The context of the issue of women's health is the resurgence of orthodox religion, particularly the Religious Right, in the 1970s. Indeed, Randall Balmer, an evangelical Christian and religious historian, said that after holding a 2-year

seminar on fundamentalist religions, an Ivy League university determined that: “the defining feature of fundamentalism, across religions, is an attempt to control women and their sexual behavior” (Roye, 2014). This religious influence has increased over the years, making it more difficult for women to access needed healthcare. It has, in many ways, overtaken the discussion of women's health and affected policymakers who now may feel that by preventing access to reproductive healthcare, they are taking a moral stand. However, as we have seen, there are serious public health consequences for everyone when women are not able to access comprehensive reproductive healthcare. As a result of this religious influence over legislators in some states, there were more abortion restrictions enacted by states that have not been shown to improve reproductive health. As of June 1, 2018, in the United States, 1327 state level sexual and reproductive health policies had been introduced; 21 were abortion restrictions and only 75 provisions that improve access to healthcare were enacted (Guttmacher, 2018a). In addition, two recent reports (National Academies of Science, Engineering, and Medicine [NASEM], 2018; Ravi, 2018) have shown that limiting abortion access contributes to poor maternal health outcomes. Reproductive justice-informed policies In 2018, more than 80 pieces of legislation were introduced to address maternal morbidity and mortality in the United States and only one was signed into law by President Trump (Mahone, 2019; Congress.gov, 2018). Many of the proposed bills addressed different aspects of factors known to be associated with poor reproductive health outcomes, including implicit bias, education and training for the healthcare workforce; greater access to midwives, doulas, and other health professionals; and the establishment of maternal morbidity and mortality review committees. These policies are important and crucial to improve reproductive health outcomes but are not sufficient. Policies that support a reproductive agenda where all individuals are able to become pregnant, prevent or end pregnancies, and have supports to parent with dignity free from violence from individuals or the state are important to achieve reproductive health equity. Barriers to reproductive health access include stigma, discrimination, traditions, restrictive laws and policies, and a lack of knowledge about women’s’ rights to reproductive health services. NSG423.12.01.02 Identify issues related to contraceptive access Abortion policy and contraception

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

There are thoughtful people on both sides of the abortion debate nowadays. Many of those who oppose legal abortion earnestly believe that abortions are tantamount to infanticide, and therefore, abortions should be outlawed. However, among those who hold this view, there remains debate about whether abortion should be allowed in cases of incest, rape, or threat to the life of the mother. This is a key point because if women in need of an abortion were not able to get that care and were thus fated to die as a result of a severe complication of pregnancy, then there is room for legitimate discussion among them about whether policies banning or allowing abortion are also tantamount to killing women. Indeed, as noted previously, access to safe abortions reduces maternal and infant mortality significantly. The ACA mandates comprehensive preventive healthcare for women, including contraceptive services without copays and access to contraception, particularly for poor women. Women who can afford to get healthcare and pay for contraception have always been able to purchase it. However, for poor women who rely on public insurance (i.e., Medicaid), access may again depend on the state in which they reside. Some states allow full access to contraception (and abortion) for poor women, although other states do not. In 2018, several changes were enacted at the Department of Health and Human Services (DHHS) under the Trump Administration that included the installation of administrators who worked throughout their careers to restrict access to contraception and to promote abstinence-only education (Byrd, 2018). In addition, the 2019 rules for grants supported by the Title X program, which provides contraception and family planning services to low- income people who do not qualify for Medicaid, changed the eligibility for funding from programs that offer comprehensive contraception services to those offering the rhythm method of contraception and abstinence, despite their lower rates of efficacy. These funds currently support clinical providers including Planned Parenthood, some federally qualified health centers, and other public health–run clinics; however, under the new proposed rules, organizations that do not provide clinical services such as crisis pregnancy centers (also known as “fake clinics”) could be eligible for funding. In 2019, states filed multiple challenges to the rule change, and its impact is under consideration in the House of Representatives. Another public health issue related to contraception that became a political football is approval of over-the-counter (OTC) access to emergency contraception (EC): the morning-after pill. EC had been used successfully for years overseas before it became available in the United States. It is a very safe medication (usually 1 or 2 doses of a common birth control pill formulation), which may prevent pregnancy if taken within 3 to 5 days of unprotected intercourse. Commercial preparations include Plan B and Ella. Despite the U.S. Food and Drug Administration's scientific panel overwhelmingly agreeing that EC should be available to women OTC, it took

years to receive approval because of political opposition. The objection stemmed, in part, from the erroneous belief by some that EC causes an abortion by preventing implantation of a fertilized ovum. EC first became available OTC for women aged 18 and older, despite the evidence demonstrating that it is a safe medication for all women. In 2013 a judicial ruling finally made it legally available for adolescent and adult women of all ages. Affordable Care Act The ACA could dramatically improve the reproductive health landscape for women who have insurance. As noted, it mandates comprehensive preventive healthcare for women, including contraceptive services, without copays (White House Blog, 2013). This care was included in the ACA because of a recommendation in the Institute of Medicine's (IOM's) 2011 report Clinical Preventative Ser vices for Women: Closing the Gaps , calling for women's health services be covered without copays when a network provider delivers them. It should be noted that religious organizations, with a specific religious mission, are exempt from this regulation (Liptak, 2013). However, other employers, who have for-profit, nonreligious businesses, such as Hobby Lobby, a chain of craft shops with stores across the country, sued to exempt themselves from this regulation because the employers have personal objections to contraception. In 2014 the Supreme Court ruled that the owners of “closely-held” profit-making corporations (with company shares held by one person or a small group of people) cannot be forced by the ACA to provide their employees with contraceptives that offend their religious beliefs. In 2018, these rules were further codified within the DHHS to widen the number of employers who could claim religious exemption (National Women's Law Center [NWLC], 2018). The proposed rules were meant to protect the “conscience” of physicians and other healthcare providers to refuse to provide services such as care to transgender individuals or people seeking infertility treatment for same sex couples. Benefits associated with access to contraceptives include empowering women and their partners to determine if and when to have children, increasing a woman’s autonomy in her household, enabling women to complete their education, and increasing a woman’s earning power to improve the economic security of her family. Access to contraceptives also has the potential to reduce the abortion rate, protect adolescent health, and decrease the maternal mortality rate.

: NSG423.12.01.03 Summarize ethical concerns related to abortion Abortion The abortion debate sparks passionate, emotion-laden arguments in political, social, legal, religious, and moral arenas. Issues of self-determination arise regarding the mother's right to control her body and her life (right to choose) in contrast to the rights of the unborn fetus to a chance at life (right to life). Those in the right-to-life camp believe that abortion constitutes murder of an unborn person, suggesting that it is a legal as well as an ethical matter. This has raised questions about the role of government in dealing with this ethical concern. Those who hold to the right to choose maintain that the right to privacy regarding healthcare decisions includes a woman's reproductive choices, implying that governmental regulation is an infringement on this privacy. Values in relation to life are fundamental considerations with regard to abortion. Such values include beliefs about when life begins, considerations regarding the quality of life for children who are unwanted, and concerns about the mother's life and health. Some believe that life starts at conception, whereas others hold that life begins only when a fetus is viable outside the womb. Discussions regarding viability continue to change as technology enables the survival of babies of lower and lower birth weights, resulting in saving some imperiled newborns of the same gestational age as some aborted fetuses. Opponents of abortion hold the position that because a fetus possesses humanity, it must be accorded all human rights, including the right to life. Proponents of abortion argue that, based on autonomy, a woman has a right to her own body and that no woman should be forced to bear a child that she does not want. Because abortion is a situation in which two lives are involved, dilemmas arise regarding who has rights and whose rights take precedence. Those who support the right to abortion base their argument on the woman's autonomy and feel that the woman's rights override those of the fetus. Those who oppose abortion argue from the stance of the sanctity of life of the fetus, believing the rights of the fetus overshadow those of the pregnant woman. Depending on one's stance, there is concern that either the woman or the fetus becomes viewed as an object or a thing. From either perspective, the consideration of abortion presents a dilemma for those involved.

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

In spite of vehement public discourse, there is no agreement about the morality of abortion in our society. It is a complex issue with many facets to consider. Although debate generally focuses on areas related to the rights of the woman or the fetus, Mahowald (2000) suggests that it is also important to consider the morality of circumstances that provide fertile ground for abortion. She notes that immoral conditions that sometimes contribute to a woman's seeking abortion include poverty, lack of social and medical supports for pregnancy and parenthood, stereotypical views of sex roles and biological parenthood, and a eugenic mentality that welcomes only those babies that meet the parents' desired specifications. She stresses the need for society to direct more effort into rectifying these conditions. The debate over this issue has raged in the United States since the 1973 Roe v. Wade Supreme Court decision. The resolution of this case struck down laws against abortion but left the possibility of introducing restrictions under some conditions. Efforts toward that end continue today with mixed results for both the pro-choice and pro-life factions. Increasing efforts are focused on the need for parental notification/consent. The right to reproductive choice and access continues to be debated, and the argument affects nursing practice in both acute care and community settings. Historic references to abortion can be found as far back as 4500 bc (Rosen, 1967). Abortion has been practiced in many societies as a means of population control and termination of unwanted pregnancies, yet sanctions against abortion are found in both ancient biblical and legal texts. It is interesting to note that the ancient sanctions against abortion generally related to fines payable to the husband if the pregnant woman was harmed. This form of sanction derived from the concept of the woman and fetus as male property. Greek philosophers, including Aristotle and Plato, made a distinction between an unformed fetus and a formed fetus. A fine was levied for aborting an unformed fetus, whereas the aborting of a formed fetus required “a life for a life.” The number of gestational weeks that determine whether a fetus was formed was not stated, although the time of human “ensoulment” was understood: Aristotle believed that a male fetus was imbued with a soul at 40 days’ gestation (quickening) versus 90 days for a female (Feldman, 1968). The subject of ensoulment became part of the ongoing debate regarding the time when the developing fetus becomes human. In other words, When does life begin? Judeo-Christian theologians generally came to identify the beginning of life as occurring at conception or at the time of implantation. However, even within this tradition, the Jewish Talmud and Roman law stated that life begins at birth because the first breath represents the infusion of life. These varied views are still held today.

Social customs and private behavior regarding abortion have frequently differed from theological teaching. The first legal sanctions against abortion in the United States began in the late 19th century. Before that time, first- trimester abortions were not uncommon and, in fact, were advertised, supporting the idea that abortion before quickening was acceptable. The ethical debate about abortion today is a continuing struggle to answer the question of when life begins and to determine an answer to the following questions: 1. Does the fetus have rights? 2. Do the rights of the fetus (for life) take precedence over the right of the mother to control her reproductive functions? 3. When is abortion morally justified? 4. Should minors have the right to abortion without parental consent or awareness? 5. Should fetal stem cells be used for research, helping to end the suffering of patients with chronic disorders such as Parkinson disease? The struggle to answer these questions has polarized individuals into pro-life and pro-choice camps. Yet opinion polls on the subject have shown that very few people are against abortion in all circumstances or favor abortion as a mandatory solution for some pregnancies. Most Americans express views somewhere between these extremes, and the legal battle to maintain or restrict abortion access continues. The controversy has escalated into violence in some areas of the country, with abortion clinics and personnel subjected to attack; some abortion providers have been killed. This violence has resulted in the decreased availability of abortion services in many areas. In recent years, some pharmacists have refused to fill prescriptions for birth control pills and the “morning after” pill, claiming that this violates their moral beliefs, exacerbating the pro-life/pro-choice debate. The Roman Catholic Church has been the religious group most frequently identified with the pro-life movement, but there are other groups—religious and otherwise—that support a ban on abortion. Pro-life proponents generally condone abortion only to save the life of the mother. These antiabortion groups are often criticized by pro-choice as extremist, against women, and repressive. The pro-choice movement is vocal in championing the woman's right to choose and promoting the safety of legalized abortion. They cite the tragedy of past “back alley” abortions and compare restrictions on abortion to infringements on the civil liberties of women. Within the pro-choice movement are many individuals who favor restrictions on abortions after the first trimester and oppose the use of abortion as a means of birth control.

Pro-life proponents often view pro-choice supporters as antifamily extremists who do not represent the views of the majority of Americans. How does the abortion issue affect nursing? Nurses are involved as both individuals and professionals. The following are some general guidelines to consider. Evaluate your values and beliefs in relation to abortion and how you can best apply these values to your work and to possible political action. If you choose to work in a setting in which abortions are performed, review Provision 1 of the ANA Code of Ethics for Nurses : “The nurse practices with compassion and respect for the inherent dignity, worth, and uniqueness attributes of every person” (ANA, 2017, p. 1). This statement outlines your responsibility to care for all patients. If you do not agree with an institution's policy or procedure regarding abortion, the patient still merits your care. If that care (e.g., assisting with abortions) violates your principles, you should consider changing your job or developing an agreement with your employer regarding your job responsibilities. If you cannot provide the care that the patient requires, plan for someone else to do so. You do not have to sacrifice your own values and principles, but you are barred by the ANA Code of Ethics for Nurses from abandoning patients or forcing your values on them. Such abandonment would also constitute legal abandonment, and you would be subject to legal action. Some hospitals have developed conscience clauses that provide protection to the hospital and nurses against participation in abortions. Find out if your institution has such a clause. Consider your response and the possible conflict in the following situations:  You are a labor and delivery nurse working on a unit that performs second-trimester saline abortions in a nearby area. You are not a part of the staff for the abortion area, but today, because of short staffing, you are asked to care for a 16-year-old who is undergoing the procedure.  You work in a family-planning clinic that serves low-income women. Because of escalating violence against abortion providers, the nearest abortion clinic is 100 miles away. You are restricted from providing information regarding abortion services because of federal guidelines.  A 41-year-old mother of five has expressed interest in terminating her pregnancy of 6 weeks’ gestation. She confides that her husband would beat her if he knew she was pregnant and contemplating abortion.  You are teaching a class on sexuality and contraception to a group of high school sophomores. Two of the girls state that they have just had

Your preview ends here

Eager to read complete document? Join bartleby learn and gain access to the full version

Access to all documents
Unlimited textbook solutions
24/7 expert homework help

abortions. In response to your information regarding available methods of contraception, one of the girls states, “I’m not interested in birth control. If I get pregnant again, I’ll just get an abortion. It's a lot easier.”  You have a history of infertility and work in the neonatal ICU. You are presently caring for a 24-week-old baby born to a mother who admits to having taken “crack” as a means of inducing labor and “getting rid of the baby.” The mother has just arrived in the unit and wants to visit the baby. These sample scenarios are meant to illustrate the conflicts that personal values, institutional settings, and patients may create for the recent graduate. In your responses, consider how you might lobby or participate in the political process to change or support existing policies regarding abortion and access to such services. The landmark case Roe vs. Wade overturned prior laws that made most abortions in the U.S. illegal on the grounds of violating women’s right to privacy granted by the Constitution. Because of Roe vs. Wade, access to an abortion was deemed a constitutional right. States were given rights to restrict abortion access during the 2 nd and 3 rd trimester. Since 1973, Roe v. Wade has been challenged multiple times in the Supreme Court but has been upheld with each decision.