JOHN GEYMAN, MD FOR BUZZFLASH AT TRUTHOUT
The escalating war on women being waged by Republicans and the Trump administration knows no bounds and violates a long history of protections for women in previous administrations over almost 50 years. Their ultimate goal is to overturn Roe v. Wade, which decriminalized abortion in 1973. In their failed bills in Congress earlier this year, the GOP and its pro-life forces attacked women's health care by attempting to restrict access to contraception and abortion, cut Medicaid and defund Planned Parenthood. Beyond his many misogynous statements, Trump has said that a woman should be "punished" for having an abortion. Soon after his inauguration, he reversed long-standing abortion-related US policy by expanding the so-called Global Gag Rule, which prevents foreign recipients of US funding from offering counseling, information or advocacy services for abortion care. Under that rule, health professionals cannot mention abortion as an option, regardless of health risks or even if a woman asks. Now his latest attack on women -- signing an executive order that allows employers with a moral or religious objection to stop insurance coverage for contraceptive services, as has been required by the ACA, that can affect up to 62 million women.
These new policies represent a stunning reversal of women's rights dating back to the Title X Family Planning Program, enacted under Republican President Nixon in 1970 with the goal to "promote positive birth outcomes and healthy families by allowing individuals to decide the number and spacing of their children." Congress passed another bill in 1975 that authorized a network of family planning centers across the US. By 2014, there were some 4,400 such centers in operation.
As Planned Parenthood clinics, 97 percent of services provided include breast exams, other preventive services such as screening for cervical cancer and sexually transmitted infections; less than 3 percent of these services are for abortion care. Over the years, Title X has greatly reduced the number of abortions in the US by preventing unintended pregnancies.
Especially worrisome are extreme policies being enacted in some states. As examples, Texas (which has the highest maternal mortality rate in the developed world) has enacted a bill that prohibits insurers in individual and employer plans from covering abortion unless the woman's life is in danger. Ten states prohibit all private insurance plans from offering abortion coverage. In Kentucky, Republicans are trying to shut down the last remaining abortion clinic, while physicians providing abortion services are being harassed at their clinics or homes and their faces and home addresses are plastered on WANTED-style flyers and postcards distributed in the neighborhoods where they live. A new law in Arkansas allows husbands to sue their wives for having abortions -- even in cases of rape and incest.
Trump's selection of anti-choice Neil Gorsuch to the Supreme Court lends support to the Hobby Lobby decision, which put the rights of corporations above the rights of women by restricting their access to reproductive health care. He will likely favor repeal of Roe v. Wade should that issue be brought before the Court.
The role of religion is a major contributor to these over-the-top developments leading us away from a civilized society in their adverse and unconstitutional impacts on women. The edicts of Catholic bishops, as one example, expressed in their Ethical and Religious Directives (ERDs) directly restrict basic needs of women in their childbearing years in these ways:
• "Catholic hospitals may not promote or condone contraceptive practices.
• Abortion is never permitted.
• In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.
• Direct sterilization of either men or women, whether permanent or temporary, is not permitted in a Catholic health care institution.
• Catholic health services must . . . require adherence (to the Directives) within the institution as a condition for medical privileges and employment.
• Other ERDs prohibit abortion even in cases of rape or incest and in-vitro fertilization." (United States Conference of Catholic Bishops, 5th ed., 2009).
These edicts block the ability of women to make their own reproductive choices, and further lack recognition that about 90 percent of Catholic women disregard them in practice. The ERDs have a pervasive influence across the country in that ten of the largest health systems in the US are Catholic-sponsored, where health professionals are prohibited from providing health services or honoring patients' health care requests in these areas. A national study of some 1,200 obstetrician-gynecologists in 2012 found that more than one-half of those practicing in Catholic hospitals experienced conflicts with their institutions over religiously-based policies for patient care.
The issue of reproductive justice is enormously important when we consider the large numbers of people affected by current anti-choice policies. According to the Guttmacher Institute, there are 61 million US women in their childbearing years (15 to 44), 70 percent of whom are at risk of unintended pregnancy in being sexually active and not desiring to become pregnant. The average desired family size in this country is now two children. In order to achieve this, a woman needs to use contraceptives for about three decades. Couples not using any method of contraception are at about an 85 percent risk of becoming pregnant over the course of a year. Two-thirds of US women use nonpermanent contraceptive methods, such as the pill, patch, implant, IUDs and condoms. The others rely on sterilization, including 25 percent of women and 8 percent of men. Only 2 percent of Catholic women rely on natural family planning through the rhythm method.
The broad benefits of contraceptive use is vitally important for women. Again, as described by the Guttmacher Institute:
The ability to delay and space childbearing is crucial to women's social and economic advancement. Women's ability to obtain and effectively use contraceptives has a positive impact on their education and workforce participation, as well as on subsequent outcomes related to income, family stability, mental health and happiness, and children's well-being. However, the evidence suggests that the most disadvantaged U.S. women do not fully share in these benefits, which is why unintended pregnancy prevention efforts need to be grounded in broader antipoverty and social justice efforts.
Lower-income women are at highest risk for unintended pregnancies, with nearly one-half of all births nationwide being patients on Medicaid, and of course, the newborns themselves. The futures of these women and their children have been blighted by Republican policies that prevented expansion of Medicaid under the ACA in 19 states and likely sharp cuts in Medicaid in coming months and years. Sister Joan Chittister, O.S.B., describes the hypocrisy of the pro-life movement in these words:
I do not believe that just because you're opposed to abortion, that makes you pro-life. In fact, I think in many cases, your morality is deeply lacking if all you want is a child born but not a child fed, not a child educated, not a child housed. And why would I think that you don't? Because you don't want any tax money to go there. That's not pro-life. That's pro-birth. We need a much broader conversation on what the morality of pro-life is.
When it comes to sound and fair public policy, the case for full access to reproductive health care has already been made. These examples make the point:
• A family planning initiative in Colorado involving about 30,000 participants using long-acting reversible contraceptives (LARCs) experienced a 40 percent decline in teen births, a 34 percent drop in teen abortions, and a saving of $5.85 in short-term Medicaid costs per dollar spent on the program.
• According to a study in 2006 to 2010,the odds of becoming a teen mother were twice as high for teenagers who did not use a contraceptive method at the time of first sex as for those who did use a method.
• The Congressional Budget Office (CBO) estimates thatdefunding of Planned Parenthood, even for a year, would increase Medicaid spending by $21 million in the first year, and $77 million by 2026.
In response to this expanding war on women, a broad backlash is taking place throughout our society, as illustrated by these examples of a pro-choice counter-movement:
• More than 4 million women and their supporters participated in the Women's March in Washington, DC, and elsewhere around the country on the day after Trump's inauguration in protest to his announced policies on women's health care; that was larger than any other such event in US history.
• More than a dozen national groups have joined together to propose a pro-choice progressive platform for the Democratic Party.
• Nine states have enacted legislation in 2017 that expands access to contraception by requiring insurers to cover contraception, allow pharmacists to dispense contraception without a doctor's prescription, or both.
• A recent poll by the Kaiser Family Foundation found that three-quarters of the American public, and a majority of Republicans, favor continued federal funding of Planned Parenthood for non-abortion services.
• Three states (Massachusetts, California, and Washington) and the American Civil Liberties Union (ACLU) are suing President Trump over his recent decision to allow more employers to opt out of providing no-cost birth control to women employees claiming religious or moral objections.
The increasing assault on women by Trump and Republicans may well backfire against them in the upcoming 2018 and 2020 election cycles.
The pro-choice counter-movement is gaining strength across the country, 50 percent of the electorate are women, and Trump's ratings stand at just 32 percent approval and 67 percent disapproval. As a likely progressive Democratic candidate for the presidency in the 2020 election, Senator Elizabeth Warren has this to say about the GOP's war on women: "Access to birth control is about freedom and the ability to plan and build a future. This attack on basic health care is wrong."
Women's health issues are certain to play an important role in deciding the outcomes of these elections. We have almost 50 years of progress on this front that needs to be protected and expanded against the cruel and intolerant beliefs of conservatives in this Congress and the Trump administration.
John Geyman, M.D. is the author of Common Sense about Health Care Reform in America (2017), Crisis in U.S. Health Care: Corporate Power vs. The Common Good(2017), and The Human Face of ObamaCare: Promises vs. Reality and What Comes Next (2016). Visit:http://www.johngeymanmd.org/