President Donald J. Trump’s policy initiatives focusing on women’s sexual and reproductive health matters, such as abortion, contraception and maternity care, are a concern for medical and public health, according to a commentary published in the Journal of Family Planning and Reproductive Health Care.
“The past decade has seen improvements in the use of more effective contraception and a reduction in unintended pregnancy in the USA, and it is worrisome that Trump’s policies could roll back progress on women’s health,” Daniel Grossman, MD, from the department of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, wrote.
Trump’s reimposition of the Mexico City Policy, also known as the Global Gag Rule, prevents U.S.-funded organizations from providing, informing about or advocating for abortion in their countries; however, it is unclear that this policy is effective in reducing abortion, according to Grossman. In fact, data from more than 250,000 women from 20 countries indicates that an increase, rather than a decrease, in abortion in sub-Saharan African countries was associated with the policy, possibly because the organizations lost funding for contraceptive supplies, resulting in more unwanted pregnancies, he argued.
Furthermore, while Trump has publicly supported reversing Roe vs. Wade, it is not clear that the ruling could be overturned soon, Grossman wrote. However, he emphasized that, “the threat to abortion access in the USA should not be minimized.”
“State legislatures and the U.S. Congress will certainly feel emboldened under the new administration to pass more restrictive legislation,” he added.
Grossman noted that a bill that would deny insurance coverage of abortion care to millions of women was passed by the House of Representatives. In addition, Trump has indicated that if passed by Congress, he would sign into law a federal ban on abortion after 20 weeks’ gestation.
Several of Trump’s policy proposals, such as prohibiting Planned Parenthood clinics from receiving federal funding from Medicaid or Title X, could severely limit access to contraception, he added. Data show that 2 years after Planned Parenthood clinics in Texas were eliminated from a state-funded fee-for-service family planning program, contraceptive use significantly declined and unintended pregnancy increased, indicating how detrimental this policy could be, Grossman wrote.
If the ACA is repealed, as promised by Trump, there will be more restrictions to women’s sexual and reproductive health, he continued. The ACA has provided women with insurance access to contraception without additional payments and decreased out-of-pocket expenditures, which appears to have increased contraceptive use, he wrote. Evidence suggests that the improvement in contraceptive access and use has partially contributed to the recent decline in abortion rates in the United States, he added.
“These gains may be reversed if the contraceptive coverage guarantee under the ACA disappeared,” Grossman warned.
In addition, repeal of the ACA may allow insurance companies to revert to gender-biased policies and charge more for plans that include maternity care, as well as eliminate other benefits including well-woman visits with screening for STIs and mental health and substance use disorder services, he wrote. If federal funding is withdrawn, low-income individuals, currently protected by the Medicaid expansion of ACA, may lose health insurance, he added.
Other policies that Trump has proposed would permit discrimination for religious or moral reasons against women and lesbian, gay and transgender individuals, among others, thus further impacting access to sexual and reproductive health services, according to Grossman.
“In these early days of the Trump administration and new Congress, it remains to be seen how many of these proposed policies will really go into effect,” he concluded. “But regardless, it is clear that the U.S. political war on women has reached an all-time apex. In the face of this rhetoric, women’s health physicians have a critical role to play: We must be a loud voice in support of evidence-based health care that is unencumbered by political interference.” – by Alaina Tedesco
Disclosure: Grossman reports no relevant financial disclosures.