Last week the Trump-Pence Administration announced changes to Title X, the nation’s family planning program. In as few as 60 days from the announcement, a “gag rule” could be in place that would affect more than four million patients across the country. It forces all medical providers receiving federal assistance to refuse to “perform, promote, refer for, or support abortion as a method of family planning.”
That means a doctor couldn’t tell a patient that abortion was a legal, safe option, even if asked. If they did talk about abortion, the clinic would lose access to Title X funds that help their patients pay for birth control, pap smears, cancer screenings, STI testing, treatment and more. While this Gag Rule practice hasn’t been implemented in the US before, it is a mainstay in stipulations that the U.S. places on all healthcare aid funding to all foreign countries.
The Global Gag Rule (GGR) was initiated by the Reagan Administration in 1984, and it’s been a political football ever since. When a Democrat wins the White House, it is revoked; when a Republican wins, it’s reinstated. The GGR requires countries receiving aid from the US to “neither perform nor promote abortion as a method of family planning.” This includes aid from the U.S. that pays for contraception, safe pregnancy and child delivery.
Donald Trump signed an executive order reinstating the gag rule as one of his first presidential acts. Additionally, he expanded the GGR to include all healthcare aid from the U.S.; this includes programs for HIV and AIDS, maternal and child health, malaria, tuberculosis, Ebola, and other infectious diseases.
The results of the GGR? According to the World Health Organization, every day, approximately 830 women die from preventable causes related to pregnancy and childbirth. Complications during pregnancy and childbirth are the leading cause of death for 15- to 19- year-old girls globally. This happens because of the GGR because lack of access to safe abortions does not stop abortions. According to the Guttmacher Institute, an international reproductive rights policy nonprofit, “abortions occur as frequently in the two most-restrictive categories of countries [abortion banned completely or allowed only to save the pregnant person’s life] as in the least-restrictive category. Bans equate to unsafe conditions, not less abortions.”
In the continent of Africa, about 93 percent of women of reproductive age in Africa live in countries with restrictive abortion laws. Despite this, between 2010 and 2014 an estimated 8.2 million induced abortions occurred each year there; only 1 in 4 of them were done safely. The suffering caused by prohibiting these procedures is unnecessary.The Global Gag Rule is a shameful export and a moral failure.
The Hyde Amendment (language in the yearly labor health and human services and related agencies appropriations ) and the GGR are both policies that separate abortion care from healthcare. Lawmakers are required to vote each year on The Hyde amendment, cleverly imbedded in the appropriations process for Medicaid since 1976, has been successful barring Medicaid from covering abortion care, except in the case of rape or to save the life of a pregnant person. Congressman Henry Hyde was transparent about his intentions when he first introduced his amendment: “I certainly would like to prevent, if I could legally, anybody having an abortion; a rich woman, a middle-class woman, or a poor woman. Unfortunately, the only vehicle available is the… Medicaid bill.”
Despite his desire to impact women on all socioeconomic levels, Hyde’s Amendment hurts poor women. Because of deep-seated systemic racism, women of color are more likely to rely on government insurance. Singling out folks on Medicaid with this rule is economically prejudiced and explicitly targets people who are already economically disadvantaged.
Add up the cost of the procedure itself, travel to and from a clinic, possible overnight stays in a hotel due to mandatory waiting periods, gas or air costs, food, lost wages, childcare (the majority of women who decide to end a pregnancy already have one or more children) and the out of pocket expenses for abortion can add up very quickly for anyone, but creates a situation of inaccessibility for women in poverty.
Women are the experts on their lives and their families, but if they’re economically underprivileged, somebody else is making the decisions when it comes to their reproductive health.
Both the Hyde Amendment and the GGR, silo abortion care from the umbrella of reproductive healthcare. A common misconception when anti-abortion operatives advocate for the GGR and the defunding of Planned Parenthood, is that they are ensuring “no taxpayer funds go to abortions.”
Clearly, they already don’t; but they should. One in three women will have an abortion in their lifetime. Abortion care is more highly regulated than any other health service, despite having fewer complications when done legally and safely than colonoscopies, wisdom teeth removal, and actual childbirth.
The Trump-Pence Administration continues to promote policies that make it harder to prevent pregnancy, damn near impossible to get an abortion and difficult to raise a child in a safe, affordable environment. Looking at unplanned pregnancies, the rate is five times higher among poor women. Lack of access to effective birth control due to cost, proximity to doctors and transportation is a big contributor. These issues disproportionately affect people of color, and that is especially true in Pennsylvania.
According to Merck for Mothers, a non-profit set up by the pharmaceutical company, Merck, to fight against maternal fatalities around the world, “black women are three to four times more likely to die in childbirth than white women,” regardless of socioeconomic status. Black women make up 11% of our population, but 31% of all pregnancy-related maternal deaths.
This is unacceptable, and the national numbers aren’t much better. Last month, abortion providers in Pennsylvania filed a lawsuit with the state to end the Medicaid Abortion Coverage Ban, addressing the siloing of abortion care. Sue Frietsche, an attorney with the Women’s Law Project, said of the suit: “People have studied what happens to low-income women who are deprived of access to abortion and it is devastating to their lives.” Elicia Gonzales of Women’s Medical Fund, an organization that exists to connect patients in need with the funding to pay for abortions added “The entire purpose of Medicaid is to prevent people from having to choose between healthcare and necessities like food and heat.”
Abortion is healthcare. But while no taxpayer funds go toward abortions, they absolutely should.