Last week the Washington Post reported on the Trump administration’s plan to build an international anti-abortion coalition that aims to outlast the Trump presidency and seemingly reframe how reproductive health is defined.
Most illustrative of this attempt to redefine reproductive health is a comment from Department of Health and Human Services (HHS) spokesperson Caitlin Oakley saying it is unfortunate that the meaning of sexual and reproductive health has “evolved in the multilateral setting to include abortion.” As a reproductive health expert and OB-GYN physician who provides the full spectrum of reproductive health care—including abortion care—I have some choice thoughts on the matter.
In the more than two years since President Obama left office, we have seen a dramatic erosion of reproductive rights in the United States orchestrated by ideologically driven politics and ill-equipped leadership within HHS. Their priorities—creating an exemption to the Affordable Care Act’s birth control benefit that would allow virtually any employer to deny coverage, prioritizing abstinence-only sex education, imposing “gag rules” on family planning funding both nationally and internationally, and implementing policies that discriminate against LGBTQ people—have enormously harmful effects on the patients I took an oath to protect.
When Oakley spins the Trump administration as “unequivocally support[ing] the empowerment of women and girls,” but simultaneously laments that the meaning of sexual and reproductive health “has unfortunately evolved in the multilateral setting to include abortion,” I think of the devastated patient I saw recently with fetal holoprosencephaly (failure of brain formation) at 23 weeks’ gestation. She might soon face a reality where her elected officials force her to carry her non-viable fetus to term and then watch it die. That’s what will happen when meaningless gestational age barriers to abortion—such as the ones supported by the Trump administration—are enacted, and when a one-size-fits-all approach to obstetrics emerges.
Sex. Abortion. Parenthood. Power.
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And for argument’s sake, let’s go down that path a bit further, since recently, anti-choice politicians are keen to perseverate on non-existent medical practices they believe occur during abortions later in pregnancy in spite of countless patients and abortion providers accurately describing what the reality of abortion care looks like.
When the perinatologist first showed my patient the ultrasound image of the fetus’ brain at 21 weeks (and then again at 22 weeks after the time it took to complete an amniocentesis to test for genetic abnormalities, and again at 23 weeks after the fetal brain MRI was in and her family had adequate time to process the gravity of this diagnosis), she was devastated and in a place she never imagined possible.
Having to decide where and how to terminate her very wanted pregnancy was made infinitely easier by not having the Trump administration in the exam room with her. Rhetoric-spewing politicians do not know how to practice medicine. They have no place in the patient-provider relationship, a relationship that must be based on trust: not in the exam room and not in making claims about what is and isn’t reproductive health care.
Similarly, when the Trump administration moved to terminate over $200 million in Teen Pregnancy Prevention Program grants used to help lower teen pregnancy rates and instead redirect funding to abstinence-only initiatives, I feared for my patients. Like the 16-year-old girl I saw last week for birth control counseling who might never have known how to ask for help in protecting herself against pregnancy or sexually transmitted infections if efforts to remove access to critical education for young people across the country were successful.
Thanks to teen pregnancy prevention programs, my patient knew that under the current provisions of the Affordable Care Act, she could access free, long-acting reversible contraception. She knew that the IUD she eventually received was the most responsible and effective reproductive health choice for her at this point in her life.
And I worry too about the patients who don’t have access to comprehensive health care, education, and social services, many of whom are being strategically targeted by the administration in their attacks on reproductive health. Take, for example, the newly finalized restrictions on Title X federal family planning funding, which bar clinics receiving those funds from offering abortion referrals. More than 40 percent of people utilizing Title X funds receive their care at Planned Parenthood—an organization that provides essential health care for women in rural America. What makes them think they can pull the wool over anyone’s eyes is beyond me, especially when the world is watching.
I encourage everyone to ask what is really at the root of this false redefinition. Why is this administration so fiercely invested in controlling reproductive decisions domestically and abroad?
As a physician whose job it is to care for my patients, I won’t stop asking and I won’t stop providing comprehensive, compassionate care. I urge these politicians to get out of my patients’ way.