Erik McGregor/Sipa via AP Images
A coalition of physicians, AIDS activists, medical students, and women's health and rights advocates stage a political theater piece in front of the globe outside Trump International Hotel on May 25, 2017; to protest Trump's global gag rule, which expands the policy restriction to all U.S. global health funding.
Even as he prepared to ruin the planet with his climate accord pullout, President Donald Trump found time in May for another pet project: making life less equitable and more dangerous for women in America and around the world. By the end of his first 100 days in office, Trump and hard-right enablers in his administration and Congress had already made significant headway in that damaging quest, logging potent early strikes against women's reproductive rights and well-being. And now, they're going even further.
First, the latest. A leaked 125-page draft regulation posted online on May 31 by Vox showed the Trump administration poised to dramatically weaken Obamacare's popular preventive services requirement that health insurance plans cover the full range of contraceptives without a co-pay-including longer-acting, more effective, and more expensive options, like intrauterine devices (IUD).
Under the religious-right-pleasing draft revision, now undergoing an expedited internal agency review, hundreds of thousands of women could lose their guarantee of no-cost birth control, and by deeply problematic means. Its terms would allow any for-profit or nonprofit employer or insurer to opt out of providing the required contraception coverage by claiming either a religious or moral objection.
Put another way, the draft rule would discriminate against women by letting bosses, including huge, publicly traded for-profit corporations with no religious affiliation, deny a valuable health benefit critical for women's ability to make their own childbearing decisions and general progress in life-all based on an assertion of beliefs the affected workers may not share. Ample grist, in sum, for the legal challenges being contemplated by groups like the National Women's Law Center, the ACLU, and Center for Reproductive Rights.
The relaxed birth-control mandate concocted by Team Trump goes far beyond the unfortunate but much more limited accommodation the Supreme Court granted in its 2014 Hobby Lobby decision to "closely held" private for-profit businesses with religious objections, or the possible compromise for nonprofit religious objectors, like Catholic hospitals, universities, and social-service groups that the high court described last year in Zubik v. Burwell. Both rulings assumed that the government could still ensure employees' full contraceptive coverage.
By contrast, the 34,000-word explanation of the intended policy shift downplays the proven importance of easy access to affordable contraception. In Trumpian fashion, the document asserts that the Affordable Care Act "does not require that the guidelines be 'evidence-based' or 'evidence-informed.'"
News of the elephantine draft exemption followed on the heels of a new attack against Planned Parenthood contained in Trump's fiscal 2018 budget proposal, unveiled on May 23.
Planned Parenthood was already on the chopping block. The harsh Obamacare replacement approved earlier in May by the GOP-led House excludes the nation's largest family-planning provider from Medicaid reimbursements for vital services like contraception, cancer screening, and sexually transmitted disease testing and treatment. Trump's proposed budget, overall full of cruel cuts that disproportionately hurt women, would freeze out Planned Parenthood entirely, making it ineligible to participate in the entire array of federally funded health programs extending beyond Medicaid-cancer screenings and Zika virus prevention, for example-and Violence Against Women Act grants to combat sexual assault. That is, if Trump's suggested scrapping of those grants doesn't come to pass.
Trump's plan to escalate the Planned Parenthood attack, it bears noting, came just days after a persuasive Guttmacher Institute report by Kinsey Hasstedt dispelling the myth favored by House Speaker Paul Ryan and others that federally qualified health-care centers could easily absorb the millions of women who now rely on Planned Parenthood for quality contraceptive care.
Trump's budget so aggressively bludgeoned domestic social spending and foreign aid it was declared dead on arrival by congressional leaders. But beware:
The president's bad ideas about Planned Parenthood funding could live on in future Republican budget machinations on Capitol Hill.
Consider, finally, Trump's mendacious Mother's Day launch of "Women's Health Week," an annual ritual of the U.S. Department of Health and Human Services rendered a glaring oxymoron by his administration's zestful pursuit of female-unfriendly policies and programs. Trump's prepared statement for the occasion spoke of "the importance of providing women access to the best, evidence-based health information and care."
The insincerity of that rhetorical pose was driven home a day later, on May 15, when the State Department unveiled implementation details for one of the worst moves of Trump's reckless, error-packed presidency-his misbegotten January 23 order imposing a vastly expanded version of the odious "global gag rule" (also known as the Mexico City Policy) carried out by every Republican president since Ronald Reagan in 1984, and rescinded by every Democratic president, including Obama.
This medical and free speech atrocity, grotesquely enlarged by the current size-obsessed White House incumbent, and rebranded, in Orwellian style, the "Protecting Life in Global Health Assistance" policy, bars U.S. financial assistance to nongovernmental groups abroad that provide abortions or truthfully advise women about abortion even using their own non-U.S. government funds. An under-remarked-upon aspect of the rule forbids groups receiving U.S. aid from engaging in legal and political advocacy to promote changes in a country's abortion laws and policies that would reduce unnecessary deaths and injuries from unsafe abortions-a massive problem.
"What the gag rule does so stunningly, in defiance of basic democratic values, is use U.S. health funding to get well-informed advocates to shut up about what they know is right for their own country: access to safe and legal abortion," Nancy Northup, president of the Center for Reproductive Rights, summed up in an interview.
Under Trump's GOP predecessors, the global gag rule was applied to U.S. family planning and reproductive health assistance to overseas groups, totaling about $600 million-causing enormous harm by shutting down urgently needed clinics in underdeveloped countries, shrinking access to contraception, and denying safe abortions, maternal care, and help in preventing HIV-AIDS. Trump's gag rule, the May 15 announcement confirmed, extends to some $8.8 billion in global health assistance, greatly magnifying the sphere of potential injury.
"There's a global abortion-rights movement that's made a tremendous amount of progress in the last two decades," stressed Patty Skuster of the global reproductive health and rights organization Ipas. "Reinstating the global gag rule on this enlarged level will shrink the number of individual and organizational players, inevitably weakening not just services, but social and policy change around unsafe abortions."
Serra Sippel, president of the Center for Health and Gender Equity (CHANGE), is struck by the State Department's failure to carefully assess the real-world impact of the bloated gag rule before putting into it into effect. "Officials said that when a recipient-NGO declines to comply with the gag rule's conditions, the money will simply be reallocated to other organizations," she told me. "But finding good substitutes for experienced and committed groups foregoing U.S. aid won't be easy."
This human rights and foreign policy blunder is consistent with Trump's general disregard for women's health and rights, but it's hardly "pro-life." Marie Stopes International, a leading provider of reproductive care to the world's most vulnerable women, has already said it won't sign the global gag rule pledge. Without alternative funding, the group estimates, loss of its services from 2017 to 2020-roughly the duration of Trump's first term-could result in as many as 6.5 million unintended pregnancies, 2.1 million unsafe abortions, and 21,700 maternal deaths.
Like earlier White House churning on reproductive-rights issues, the new White House developments come amid ongoing efforts by Republican-led states to impose a creative array of laws and regulations to impede the exercise of the constitutionally protected right to a safe and legal abortion, including sweeping new abortion limits just enacted in Texas despite the Supreme Court's firm 2016 rejection of an earlier set. Yes, Texas again.
