Much progress has been made in the use of more effective
contraception and in the reduction of unintended pregnancies in the United States. Donald Trump's sexual and reproductive health policy changes threaten
women in the USA and across the world, warns an expert in the Journal of Family Planning and Reproductive Health Care.
Professor Daniel Grossman from the Department of Obstetrics, Gynecology
& Reproductive Sciences at the University of California, San
Francisco, warned, "Trump's policies could roll back progress on women's health."
‘Trump's re-imposition of the Mexico City Policy prevents US-funded organizations from providing, informing about, or advocating abortion care in their countries.’
A concerning development is Trump's re-imposition of the Mexico City
Policy, also known as the Global Gag Rule, which prevents US-funded
organizations from providing, informing about, or advocating for
abortion care in their countries.
"If reducing abortion were the aim of this policy," Grossman says,
"it is not at all clear that this is effective," as data suggests the
policy was associated with an increase in abortion in sub-Saharan
African countries. This is possibly because affected organizations lost
funding for contraceptive supplies.
Furthermore, Trump has made statements in support of reversing the
Roe v. Wade 1973 landmark ruling that made abortion legal. While it is
unclear that this ruling could be overturned, it is worrying because
"state legislatures and the US Congress will certainly feel emboldened
under the new administration to pass more restrictive legislation,"
For example, the US House of Representatives passed a bill that
would deny insurance coverage of abortion care to millions of women, and
Trump indicated he would sign into law a federal ban on abortion after
20 weeks' gestation.
Several policy proposals have the potential to severely limit access to contraception, adds Grossman.
This includes prohibiting clinics affiliated with Planned Parenthood
from receiving federal funding from sources such as Medicaid, and Title
X, which help low income individuals. Evidence has shown after clinics
in Texas were excluded, contraceptive use declined significantly, and
unintended pregnancy increased.
Furthermore, if the Affordable Care Act (ACA), also known as
Obamacare, is repealed, as Trump has promised, this may lead to more
The ACA provides women with insurance to access contraception
without additional payments, and research shows women's expenditure has
fallen and contraceptive use appears to have increased. The recent
decline in national abortion rates has been partially related to
improvement in contraceptive access and use.
"These gains may be reversed if the contraceptive coverage guarantee under the ACA disappeared," warns Grossman.
Other benefits at risk under the ACA include companies reverting to
biased policies that cause women to pay more for health insurance, and
the decline of well-woman visits with screening for sexually transmitted
infections, and mental health and substance use disorder services.
"Perhaps most concerning," Grossman adds, "is low income individuals
in states that have expanded public insurance coverage, as part of the
ACA may soon find themselves lacking any health insurance if federal
funding is withdrawn."
In addition, other anticipated policies could discriminate against
women and lesbian, gay and transgender individuals, and impact access to
sexual and reproductive healthcare services.
"It remains to be seen how many of these proposed policies will
really go into effect," explains Grossman. "But regardless, it is clear
that the US political war on women has reached an all-time apex. 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