For SELF, by Jen Gunter, M.D.
These are your reproductive rights under Trump.
When I consider what the United States would look like if Donald Trump were to be elected president, the thing that worries me most is how his policies would affect the women of this country. As an ob/gyn I am confronted daily with the complexities of women’s healthcare — medical, emotional, financial. Under a President Trump it would only get worse, and more dangerous.
As an ob/gyn I am confronted daily with the complexities of women's healthcare — medical, emotional, financial. Under a President Trump it would only get worse, and more dangerous.
Trump has asserted that he will be pro-life, yet some people continue to believe he is not really against abortion and it is all just posturing for votes. After all, Trump has held multiple opinions on both abortion and Planned Parenthood not just over the years, but over the course of this election cycle. Surely, then, an assault on choice is just another pompous claim, like a wall. Right? It’s not.
Make no mistake about it: Donald Trump is an anti-abortion candidate. He has recently stated that he believes abortion is only acceptable in cases of rape, incest, or where the life of the mother is in jeopardy. I say that anyone who thinks abortion, emergency contraception, and even IUDs won’t be legislated out of existence if Trump is given executive power is wrong or lying to themselves. Here’s why.
Trump’s Agenda is anti-choice and anti-science.
In 1999 Trump said, “I am very pro-choice,” but views evolve and what Trump says he will do now is what matters. What he says now is summarized for public consumption in a letter he wrote to pro-life leaders dated September 2016. His first four goals are:
- Nominating pro-life justices to the Supreme Court
- Making abortion illegal at 20 weeks unless the life of the pregnant person is in danger
- Defunding Planned Parenthood
- Making the Hyde Amendment permanent
This is a very anti-choice agenda. Let’s take it point by point.
On Supreme Court Justice nominees: Trump has released a list of 21 potential nominees for the Supreme Court — all are conservative and many come with a strong anti-reproductive rights portfolio. A ninth Supreme Court Justice who is anti-choice is not even a subtle invitation for a direct challenge on Roe v. Wade. Without the federal protection of Roe v. Wade, states are free to legislate as they please; currently 19 states have laws that would outlaw or severely restrict abortion, which would immediately go into action if the protection of Roe were removed.
On late-term abortions: Signing the Pain-Capable Unborn Child Protection Act into law will essentially stop abortions at 20 weeks. Everything about the law is offensive, from its flawed foundational principle that a 20-week fetus can feel pain—in fact, a 20-week fetus does not have the hardware to feel pain (laws that ignore science are a particular concern as I find the idea of a post-factual society frightening)—to the “rape exception” that requires reporting a rape to law enforcement in order to legally terminate a resulting pregnancy. In addition to harming women seeking abortions for personal reasons, the Act would put many more at risk. Pregnant women who are very sick at 21 weeks with ruptured membranes and an infection may have their life-saving abortions delayed until their fetus dies in utero. Yes, there is a provision for the life of the mother, but doctors don’t know how to apply those laws. Trust me, I’m a doctor and I don’t know. What if a zealous district attorney thinks you made the wrong call? Malpractice insurance doesn’t cover criminal charges. A pregnant woman in Ireland, Savita Halappanavar, died because of a similar law, as the medical team waited too long. Waiting for a woman to be at death’s door is bad medicine. Making doctors afraid to practice medicine: also bad. This is a blueprint for maternal deaths.
On the withdrawal of federal dollars for Planned Parenthood: Defunding Planned Parenthood and allocating their funding elsewhere will harm women as there is no guarantee these other centers will provide contraception services. In Texas, $1.6 million that would have gone to Planned Parenthood is going to the Heidi Group, an anti-abortion organization that promotes “alternatives to abortion [for] low-income women” as well as “life affirming hope and dignity to girls, women, and their families seeking self-sufficiency.” An anti-choice group who has never delivered medical care is going to provide contraceptive services? Right, and I have a bridge to sell you, too. The loss of publicly funded family planning services will be devastating. After Planned Parenthood lost funding in Texas, maternal death rates suddenly doubled between 2010 and 2012, per findings in a September study in Obstetrics & Gynecology. The researchers can’t connect the dots directly—but surely it’s no coincidence. Health centers supported by Title X (the only federal grant program dedicated solely to family planning) helped prevent nearly one million unintended pregnancies in 2014 alone, according to the Guttmacher Institute. More that than 400,000 of those would have been unintended births and 300,000 would have been abortions.
On making the Hyde Amendment permanent: Hyde bans federal dollars for abortion coverage except in the most extreme circumstances (rape, incest, life endangerment). That means Medicaid won’t cover most abortions. Medicaid is the main source of health care for low-income women, women who also have a much higher rate of unplanned pregnancies. Abortions are often delayed in this group as they struggle to come up with the money for a procedure; as a result, many women end up with later procedures and suffer more financially. Seventeen states provide extra coverage for women on Medicaid to obtain medically necessary abortions—the rest of the country abides by the minimal federal funding requirements.
That seems bad. But it’s actually even worse. Take a look at what he’s done already — and whom he’s aligned himself with.
What someone does is more telling than what they say they will do, and what Trump has done is release his anti-choice manifesto via the Susan B. Anthony (SBA) List, a political action group dedicated to making abortion illegal. In the letter, Trump tells us that he has turned over the reins of his campaign’s “Pro-Life Coalition” to Marjorie Dannenfelser, an anti-choice activist and self-styled feminist. She is the current SBA List President, believes that “to lose the connection between sex and having children leads to problems,” and has stated erroneously that contraception and family planning are the cause of abortion.
In fact, the SBA List advances the lie that IUDs and emergency contraception are abortion. So, if these are the people he’s getting behind him, then yes, under a Trump Presidency those will be up for grabs too. Trump has very recently backed the idea of over-the-counter oral contraception, which, while fine safety-wise, sends a subliminal message to anti-choice employers (and anyone else who wants to dump birth control from their health plan) that he’s got their back. If insurers don’t have to pay for IUDs and injectable contraceptives, many will drop them, and without publicly funded clinics to make up the short fall, that leaves the most effective forms for birth control unaffordable for many women.
A key Trump advisor on domestic policy is John Mashburn, who is strongly anti-choice.
And don’t forget that Donald Trump chose Mike Pence as his Vice Presidential running mate. Pence has said Roe v. Wade should be “consigned to the ash heap of history where it belongs” and has made no secret of his disdain for Planned Parenthood. He was the first to introduce legislation aimed at defunding Planned Parenthood (back in 2007) and was willing to “hold up this entire budget over defunding Planned Parenthood.” In Congress, Pence cosponsored “personhood” bills designed to criminalize abortion and restrict access to some forms of birth control, and a bill aimed at limiting federal funding for abortion for woman who suffered “forcible rape,” code for what former GOP representative Todd Akin described as “legitimate rape.” As Governor of Indiana, Pence signed eight anti-abortion bills into law, including one of the most extreme, invasive abortion laws in the country, which, among other outrageous provisions, would require women who miscarry to give those remains to a funeral home or other facility for cremation or burial. The law inspired an Indiana woman to launch a Facebook page called Periods for Pence, where she encouraged women to call Pence’s office to report on the status of their menstrual cycle. Pence’s office received thousands of protest calls and messages via social media.
Trump has been slowly refining his anti-choice talking points—and with his choice of vice presidential candidate, his Supreme Court list, and engaging the SBA List in this way, he is demonstrating that it’s not just talk. The goal is illegal abortion, but that’s not all we’ll get. Given his trajectory—and the allies he’s enlisting— his policies will also endanger access to IUDs and emergency contraception, veritably ensuring that the only forms of birth control available for most women will be over-the-counter birth control pills, condoms, and diaphragms. (And, no, insurance won’t cover the diaphragm or the fitting.) Want sex education? Publicly funded centers will only be too happy to tell you that sex is for procreation.
As an ob/gyn this vision of the future frightens me. And it should frighten you, too.
Jennifer Gunter, M.D., is a board certified ob/gyn based in San Francisco. She is also board certified in pain medicine by the American Board of Pain Medicine and by the American Board of Physical Medicine and Rehabilitation. She is the author of The Preemie Primer, blogs regularly at DrJenGunter.wordpress.com, and can be found on Twitter @DrJenGunter.
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