Despite his electoral defeat, President Trump’s war on reproductive health and rights is far from over: Trump-appointed judges, Mitch McConnell’s Senate, and GOP controlled state governments will continue to try to curtail everything from abortion rights to contraceptive access. But the tide of battle has turned. Starting Jan. 20, there is much that the new administration can do to restore reproductive health and rights here and abroad.
Upon taking office, President-elect Joe Biden can and should rescind Trump’s expanded “global gag rule,” which prohibits overseas organizations receiving U.S. foreign assistance from discussing or referring patients to abortion services. The order has jeopardized access to health care for millions in low-income countries and callously endangered the lives of many women and girls.
Biden must also act swiftly to re-engage with the global community, including rescinding by executive order Trump’s withholding of U.S. funding for the World Health Organization and the UN Population Fund (UNFPA), a vital supplier of family planning and reproductive health services to women in developing countries.
Biden can accomplish these things right away, with the stroke of a pen. However, unraveling the regulatory knots tied by the Trump/Pence administration may take longer, but is no less urgent.
For example, the Biden/Harris administration must reverse the Trump/Pence “domestic gag rule.” Before Trump disrupted the program, Title X-supported clinics delivered family planning services to 4 million low-income households a year. Then the Trump administration issued regulations barring Title X-grantees from counseling patients about their abortion options or referring them to an abortion provider. They could either withhold abortion information from patients or lose their federal funding. That forced Planned Parenthood and other family planning providers to leave the program. As a result, the number of people served by Title X clinics dropped by 800,000 last year.
Trump-era rules permit health care providers to discriminate against LGTBQ+ patients, and regulatory changes to the Affordable Care Act allow employers to deny employees coverage for contraceptive services, simply by citing a moral or religious objection. The Biden/Harris administration must roll back these sweeping, oppressive exemptions to protect sexual and reproductive health and rights. It must also repeal Trump-era changes to the “public charge” rule that denies health care benefits to immigrants, a blatant attack on immigrants’ rights. It creates fear and confusion, deterring many from seeking the reproductive health services they need and are legally entitled to receive.
To do all this effectively, Biden needs to appoint qualified experts to fill the executive branch positions and tell them to get busy dismantling the morass of anti-choice regulations. For example, he will need to direct his new Secretary of Health and Human Services to review the FDA’s in-person dispensing requirement for mifepristone, a safe and effective medication for abortion.
The new administration will also need to reflect renewed U.S. commitment to reproductive health and rights in White House budget requests. Funding increases are needed for the Teen Pregnancy Prevention Program and the Personal Responsibility Education Program, both of which play important roles in reducing teenage pregnancies. Funding for ineffective, ideologically-driven abstinence-only programs must be dropped immediately.
New legislation is also needed. But if Mitch McConnell (R-Ky.) is the majority leader in the Senate next year, that prospect is dim. Without broader Congressional support, chances of modifying or repealing long-standing prohibitions on federal funding of abortion, like the Hyde and Helms amendments, are slim.
The in-coming administration can issue new orders and regulations, and Congress may even pass new legislation. But they are all subject to judicial review. What is done can be undone by ideologically hostile judges. Trump and McConnell deliberately stacked the federal judiciary by appointing a record number of conservative justices, which created a hostile legal environment for reproductive health and rights for decades to come. Biden’s judicial appointments will have to restore some balance.
Biden has a long to-do list — from fighting the pandemic to restoring a measure of trust with the international community — but it is crucial that in the mix of pressing issues, he demonstrate a commitment to reproductive health and rights and act immediately to reverse the Trump-era damage. It will be a long road. But the longer the road, the more urgent it is to take the first step.
Bridget Kelly is research director of the Population Institute, a nonprofit based in Washington, D.C. that supports reproductive health and rights.