A Double Threat to Reproductive Health: Environmental Contaminants and a Lack of Access to Healthcare

A Double Threat to Reproductive Health: Environmental Contaminants and a Lack of Access to Healthcare

BU epidemiologist writes that communities with limited access to reproductive healthcare are also at the highest risk from exposure to pollutants, like heavy metals and PFAS

“Individuals at the greatest risk for infertility and pregnancy complications from environmental exposures may also be more likely to have limited access to necessary reproductive care,” writes BU public health researcher Samantha Schildroth. Photo via iStock/PixelsEffect

Across the United States, access to reproductive healthcare is being threatened, especially after the June 2022 repeal of Roe V. Wade ended the national right to abortion in the United States. At the same time, people with limited access to reproductive care may also face a greater risk of exposure to environmental contaminants that can affect fertility and pregnancy health. This double threat—exposure to environmental pollutants that negatively affect reproductive health and poorer access to reproductive healthcare—has significant implications for the health of pregnant people and infants. Yet, environmental health rarely enters the conversation when scientists and policymakers are considering reproductive care access.

As an environmental epidemiologist specializing in understanding the role of chemical exposures on reproductive and perinatal health—the period immediately before and after birth—I’m alarmed at the latest data.

Even before the Supreme Court overturned Roe, there were clear inequities in access to reproductive medical care, with pregnant people from minority communities who were living in politically conservative or rural areas or of lower socioeconomic status less likely to have access to prenatal care, abortion, and fertility services. Limited access to reproductive care increases the risk for poor pregnancy outcomes—such as preterm birth, miscarriage, birth defects, and low birthweight—that are already prevalent in the United States. Limited care also reduces birth rates, and has been shown to negatively affect the long-term health, economic stability, emotional well-being, and physical safety of the pregnant person. 

Following the repeal of Roe, several states have instituted restrictive laws or total bans on abortion and moved to limit access to fertility services, like in vitro fertilization (IVF). Not only do such regulations reduce access to abortion and fertility services in these geographic areas, but they have the added consequence of creating care deserts as medical practitioners leave states with restrictive laws, with implications for prenatal and perinatal care. One study, for example, estimated that abortion bans could increase pregnancy-related mortality by 24 percent, with greater mortality among Black and African American individuals (39 percent increase) due to existing racial inequities in pregnancy-related mortality.

Concurrently, exposure to environmental contaminants, such as air pollution, metals, and endocrine-disrupting chemicals (EDCs) that dysregulate hormonal function, may increase the risk of infertility, miscarriage, and poor perinatal health—and these exposures tend to disproportionately impact low-income and minority pregnant people. This means that individuals at the greatest risk for infertility and pregnancy complications from environmental exposures may also be more likely to have limited access to necessary reproductive care.

What are the consequences for the long-term health, economic stability, and emotional well-being for these individuals? The truth is that we don’t know, because no study has investigated how environmental exposures could exacerbate the negative effects of limited access to reproductive healthcare services. The environment is a strong driver of reproductive and perinatal health, and exposure to environmental contaminants is common in the United States. The Centers for Disease Control and Prevention, for example, estimates that 97 percent of Americans have detectable levels of per- and polyfluoroalkyl substances (PFAS), a class of EDCs that are associated with infertility, miscarriage, and poor perinatal health, in their blood. 

These data highlight the importance of considering the environment for reproductive health, yet environmental determinants rarely connect with research and policy decisions considering reproductive care access. It is plausible that exposure to both environmental contaminants and limited access to care could have negative cumulative health effects, contributing to the documented socioeconomic and racial inequities in infertility and poor perinatal health.

Further research is needed to investigate this hypothesis. Ideally, studies considering both environmental exposures and sociopolitical factors affecting access to reproductive healthcare could serve to inform policies aimed at improving health, like targeting environmental regulations in communities already facing reduced reproductive medical services.

Despite, or because of, the political climate that has enabled state-level regulations limiting fertility and abortion care, it is necessary now more than ever to find creative and innovative ways to protect the reproductive and perinatal health of our most vulnerable communities. Addressing environmental exposures, particularly inequitable exposures that disproportionately affect communities targeted by restrictive reproductive regulations, could be one way in which public health experts can intervene and support healthy pregnancies.

Samantha Schildroth (SPH’23) is a postdoctoral research associate in the Boston University School of Public Health department of epidemiology. Her research focuses on understanding the role of environmental chemical exposures on reproductive health, perinatal outcomes, and children’s health.

“Expert Take” is a research-led opinion page that provides commentaries from BU researchers on a variety of issues—local, national, or international—related to their work. Anyone interested in submitting a piece should contact thebrink@bu.edu. The Brink reserves the right to reject or edit submissions. The views expressed are solely those of the author and are not intended to represent the views of Boston University.