Terry McGovern: Sexual and reproductive health and rights under a Biden administration

The Trump Administration devoted itself to destroying the sexual and reproductive health and rights of women and girls, seizing any and all opportunities to strip women and girls of bodily autonomy. Whether it is eroding international protection for sexual and reproductive health or stacking courts with anti-choice judges, the Trump administration has damaged the health of women and girls around the world. 

We can expect better from a Biden Administration, and there are many potential fixes, but there will be many challenges.  With Justices Barrett, Kavanaugh, Alito, and Thomas on the court, Roe v. Wade is at risk. Though today the decision still stands, the state level impositions on the right to abortion are endless. Over the last ten years, over 479 restrictions have been imposed on access to abortion, all while Justice Bader Ginsburg was still on the Court. I predict the chipping away will continue on the Court, but the precedent of Roe will stand. 

The damage the Trump Administration has wreaked goes far beyond installing anti-choice judges or potentially weakening Roe. Its handiwork includes a far more expansive and impactful Global Gag Rule (GGR), broadening its reach from just US family planning assistance to all US global health assistance, and to organizations that work with gagged entities even if they themselves do not receive any US global health assistance. Countless women and girls worldwide lost access to contraception and safe abortion services. Health systems have been torn asunder by the GGR, and the result is an increased number of pregnancies and riskier abortion procedures. The expansion has done so much damage, but what it has not done is reduce the number of abortions

The Trump Administration has taken a similar tact in the US by “gagging” Title X, the nation’s only federal funding source for family planning. Title X provides grants to health centers across the US so that they can provide comprehensive family planning and preventative health services to low-income, under-insured, and uninsured individuals. Under Trump’s rule changes, Title X recipients are effectively prohibited from offering or even referring for abortion services, even if those services are provided with non-Title X funds. Title-X funding also covers testing and treatment for STDs, cervical and breast cancer screenings, HIV testing, as well as other preventive health services, and new restrictions put these services at risk. Six states—Maine, Washington, Oregon, Utah, Vermont, and Hawaii—no longer receive any Title X funding at all. Clinics have had to reduce hours, cut services, or charge more for services.

The Trump Administration has also attacked the reproductive rights of women and girls forced to migrate. Under the Trump Administration, the Office of Refugee Resettlement (ORR) instituted a policy of blocking pregnant young people from accessing abortion care and coercing them to carry pregnancies to term against their will. And in 2018, the Trump Administration reversed a policy that presumed pregnant people should not be detained, now allowing U.S. Immigration and Customs Enforcement (ICE) to make opaque decisions about whether a pregnant woman should be detained on a case-by-case basis. There was a 52 percent increase in the number of pregnant detained women in ICE custody under the Trump Administration; during its first two years, the number of undocumented women in government detention who miscarried nearly doubled

Even in the face of these damaging policies, President-elect Biden can make some immediate improvements. He can reverse the Trump Administration’s Global Gag Rule as well as the new restrictions on the Title X rule without the Senate. He can also direct the Secretary of Health and Human Services by executive order to issue guidance to remove the Food and Drug Administration’s in-person dispensing requirement for mifepristone, a medicated abortion tool, for the duration of the pandemic, consistent with similar waivers issued in other contexts to reduce risk of COVID-19. 

On the global scale, he can direct his appointees to advance the health and rights of individuals worldwide by fully re-engaging with the United Nations, including re-joining and re-funding the World Health Organization and the UN Population Fund. At the U.S. Southern Border, the new administration can reverse the policy allowing pregnant women to be detained and halt deportations without due process (a Trump administration emergency rule issued purportedly to curb the spread of the virus but without public health support) to reduce the number of pregnant women deported to unsafe conditions. And, Biden can push the Department of Homeland Security to issue a directive immediately prohibiting the detention of any pregnant or postpartum person or a primary caregiver of a child, and immediately releasing any person found to be pregnant or vulnerable. 

Other solutions, such as overturning the Hyde Amendment, which prohibits the use of federal funds for abortion, or the enactment of a law that would permanently repeal the Global Gag Rule or permanently protect the right to abortion in the US, are dependent upon the support of Senate Republicans. The fate of the Affordable Care Act, which is a start to building a more rights-oriented health system in this country, rests in the hands of the Supreme Court. Polls show that the majority of American people support the right to abortion and certainly, the right to access contraception and preventive care, but Biden will need the support of Congress—and split Democrat/Republican Senate—to fully protect these rights.

Terry McGovern is the Harriet and Robert H. Heilbrunn Professor and Chair of the Heilbrunn Department of Population and Family Health and the Director of the Program on Global Health Justice and Governance at the Columbia University Mailman School of Public Health.

Competing interests: none declared.