This summer, a startling study from researchers at University of California, Berkeley revealed tampons from several brands contain toxic heavy metals like lead, arsenic, and cadmium. This finding follows the 2023 discovery that many menstrual products contain per- and polyfluoroalkyl substances (PFAS), even those marketed as PFAS-free. All of these contaminants are linked to major health problems. This article explores the emerging policy and legal responses to this issue.
Does History Matter?
by Elena Caruso
While the exact definition of self-managed abortion remains blurred, it currently tends to refer to the end of a pregnancy through the autonomous administration of pills outside of a public health facility. The World Health Organization (WHO) recommends self-management for pregnancies under 12 weeks, using a combination of mifepristone and misoprostol (or misoprostol alone) and it includes both medications in its list of essential medicines. In its Abortion Care Guidelines, the WHO states that medication abortion has “revolutionized” access to abortion care, emphasizing the novelty of this method.
While the origins of self-managed abortion with pills are not fully elucidated, it is generally accepted that this practice dates back to the second half of the 1980s in Brazil, when women discovered and disseminated the information that misoprostol (a medication legally available for the treatment of stomach and duodenal ulcers) could safely and effectively be used to prevent pregnancies. In the current debate on self-managed abortion, engagement with history is often limited to a few background sentences. This “ahistorical” approach can leave the impression that self-managed abortion lacks a significant and notable history.
When AI Turns Miscarriage into Murder: The Alarming Criminalization of Pregnancy in the Digital Age
by Abeer Malik
Imagine: Overjoyed at your pregnancy, you eagerly track every milestone, logging daily habits and symptoms into a pregnancy app. Then tragedy strikes—a miscarriage. Amidst your grief, authorities knock at your door. They’ve been monitoring your digital data and now question your behavior during pregnancy, possibly building a case against you using your own information as evidence.
This dystopian scenario edges closer to reality as artificial intelligence (AI) becomes more embedded in reproductive health care. In a post-Dobbs world where strict fetal personhood laws are gaining traction, AI’s predictive insight into miscarriage or stillbirth are at risk of becoming tools of surveillance, casting suspicion on women who suffer natural pregnancy losses.
The criminalization of pregnancy outcomes is not new, but AI introduces a high-tech dimension to an already chilling trend. At stake is the privacy and the fundamental right of women to make decisions about their own bodies without fearing criminal prosecution. Alarmingly, the law is woefully unprepared for this technological intrusion.
The Global Challenge of Unhealthy Diets: Front-of-Package Labeling for America
The alarming rise in diabetes and obesity rates in the United States has placed significant strain on health care systems and poses a serious public health threat. Americans’ overconsumption of ultra-processed foods high in sugar, salt and unhealthy fats is a concerning contributor. Globally, poor nutrition from such dietary habits plays a major role in the global burden of chronic diseases. In response, many countries have implemented policies to reshape their food environments. A prominent strategy is front-of-package (FOP) labeling systems, designed to help consumers make more informed choices, encourage healthier lifestyles, and push food manufacturers to align with public health guidelines by reducing ingredients such as sugar and salt.
Despite international momentum and calls from public health experts, the United States remains behind. Since 2009, the U.S. government has discussed the potential adoption of a uniform FOP label, with Congress directing the Centers for Disease Control and Prevention and Institute of Medicine (IOM) to produce recommendations on the topic. No standardized system exists but the U.S. Food and Drug Administration (FDA) is expected to propose new rulemaking on front-of-package labeling in 2024.
TikTok, Tobacco, and Addiction, Oh My!
On October 8, 13 states and the District of Columbia sued TikTok, alleging that the social media company’s algorithm is designed to “promote excessive, compulsive, and addictive use” in children. While each state’s complaint was filed separately in state court, the cases are coordinated around the claim that TikTok’s design is deliberately addictive, exploiting kids’ dopamine reward circuitry to reinforce their use of the platform
These claims stem from a public reckoning of the effects of social media on children. New research has also led the surgeon general to announce a mental health crisis among young people. The lawsuits, arising from the desire to hold platforms accountable for exploiting children’s susceptibility to rewarding stimuli during development, present a novel theory of liability based solely on an algorithm’s ability to cause addiction rather than adverse mental health outcomes. Holding TikTok liable could lead to major changes in social media algorithms, reducing mental health harm.
Third Places: A Framework for Communities AND Crisis Care
What makes a city livable? The answer, some say, is more “third places,” spaces distinct from one’s home (the first place) and one’s workplace (the second place). A third place, like a café, park, or library, fosters the sense of community and connection that makes a neighborhood great to live in. This imprecise yet uncomplicated framing effectively refocuses a complex set of social, economic, and urban design issues on a simple solution to the “livability” problem.
I believe that the “third place” framework also can usefully reframe another discipline: emergency mental health care. Individuals experiencing mental health crises lack an appropriate setting to receive care. Typically, individuals experiencing acute, emergency mental health crises-–whether related to substance use or not-–end up in one of two places: the hospital emergency room (ER) or a jail cell. The problem is that neither of these two places is well-equipped to treat someone in the midst of a mental health crisis. A third option is needed.
Introducing Petrie-Flom’s POPLAR and PULSE Affiliated Researchers on Psychedelics
The Petrie-Flom Center is excited to announce our affiliated researchers for the Project on Psychedelics Law and Regulation (POPLAR) and our new project, Psychedelic Use, Law, and Spiritual Experience (PULSE). Through research, writing, workshops, and other projects, POPLAR and PULSE affiliated researchers will provide expertise and a range of perspectives on psychedelics law and policy. We look forward to learning from them and sharing their insights with our audiences.
A full circle moment: legal risks to mifepristone and evidence for abortion with misoprostol alone
Photo credit: Farrah Skeiky
by Patty Skuster and Heidi Moseson
Medication abortion did not begin with a clinical trial; it began at home as self-managed abortion, or abortion without supervision from a clinician. Decades before the 2000 U.S. Food and Drug Administration’s (FDA) approval of mifepristone for abortion, which is taken alongside misoprostol, feminists in Brazil found an opportunity to self-manage abortion with misoprostol, based on warning labels that cautioned about the risk of miscarriage if taken while pregnant. The genesis of abortion pills was therefore in self-managed abortion with misoprostol alone.
Today, after several decades of clinical trials and heavy regulation of medication abortion, the practice of self-managed abortion with misoprostol-only is once again driving clinical practice. While medication abortion has been increasing in the U.S. since its introduction, major changes in recent years have dramatically increased usage. In 2021, the FDA relaxed enforcement of the requirement for in-person dispensing of mifepristone. This revolutionary change allowed the pills to be sent by mail for the first time, making them much more accessible. When, in 2022, the Supreme Court eviscerated the federal constitutional right to abortion in Dobbs v. Jackson Women’s Health Organization, the resulting abortion clinic closures led to even larger numbers of abortion seekers turning to medication abortion through telehealth and mailed medication from providers in supportive abortion states and clinicians outside the U.S. Combined, medication abortion now accounts for more than half of all abortions in the US.
Rethinking Mental Health Reform: A case for reviving community-based care
by Zain Khalid
October 10th marked the first anniversary of California’s Senate Bill 43 (SB 43), a major revision of the landmark Lanterman-Petris-Short Act of 1967, a de-institutionalization era law designed to “end the inappropriate, indefinite, and involuntary commitment of persons with mental health disorders.” The law loosened eligibility standards for civil commitment by expanding the existing “grave disability” criterion, making it easier to detain and hospitalize persons with mental illness against their will.
New York City’s mayor, Eric Adams, enacted a similar initiative in November 2022, the same year 40-year-old Michelle Alyssa Go, was tragically killed after being shoved onto the subway by an unhoused man with a long history of mental illness and patchy treatment. New York’s plan authorized emergency medical workers and police officers to involuntarily remove people with severe mental illness from the streets to be evaluated for hospitalization. Mayor Adams framed his plan in terms of the city’s “moral obligation” to help mentally ill citizens and California Governor Gavin Newsom spoke of a “life-and-death urgency” in advocating for SB 43.
These controversial initiatives are among the highest profile of a growing national trend toward expanding civil commitment laws: Ohio, DC, Tennessee, Alabama and Florida have introduced similar legislation in just the past year. Across the U.S., this turn toward civil commitment is driven by a triple whammy of unmitigated housing crises, an increasingly visible unhoused mentally ill population, and rising violent crime. But is civil commitment a defensible strategy in tackling this Gordian knot of intersecting social crises? Or does it merely serve to keep unseemly realities away from the public eye? To understand the role of civil commitment in addressing these challenges, we must begin by looking at how we got here. Read More
Doctors as Advocates for Self-Managed Abortion and Reproductive Justice
Photo credit: Martina Šalov
The International Federation of Gynecology and Obstetrics (FIGO) is the world’s largest alliance of national professional societies of obstetricians and gynecologists. FIGO supports comprehensive, equitable, and accessible sexual and reproductive health (SRH) for everyone, recognizing that these are fundamental human rights and essential components needed to achieve global health goals.
FIGO works through its technical committee and its programmatic arm to improve access to abortion across the globe. Over the last two decades, FIGO has been a global advocate and played an important role in encouraging progressive, evidence-based thinking on abortion with its 130+ national professional societies and other stakeholder groups. FIGO has worked to strengthen and support these societies in becoming national leaders on SRH and driving important improvements, including legal and policy developments, service provision, increasing supportive attitudes, and raising awareness and challenging bias.
What is the role of doctors in the de-medicalization of abortion?