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Biden’s planned actions on reproductive health care, explained

The president intends to reverse some of Trump’s biggest restrictions.

President Biden sits at a table signing documents with Vice President Kamala Harris standing behind him looking on.
President Joe Biden signs executive orders as Vice President Kamala Harris looks on during an event at the State Dining Room of the White House January 21, 2021, in Washington, DC.
Alex Wong/Getty Images
Anna North is a senior correspondent for Vox, where she covers American family life, work, and education. Previously, she was an editor and writer at the New York Times. She is also the author of three novels, including the New York Times bestseller Outlawed.

President Joe Biden on Thursday plans to make it easier for providers around the world to offer the full range of reproductive health care.

The president will sign a memorandum repealing the policy sometimes known as the “global gag rule,” which bans groups abroad that receive US aid from performing or even discussing abortion. Also called the Mexico City policy, it was first enacted by President Ronald Reagan in 1984. It then became something of a political light switch, turned off by every Democratic president and on by every Republican.

President Trump, however, expanded the policy — while previous Republican administrations had barred family planning organizations abroad that receive US aid from discussing abortion, Trump made the policy apply to any health organization that receives US money. It was part of a broader push by Trump to restrict access to abortion, one of his administration’s central policy priorities and one that ended up impacting every aspect of reproductive health care in the US and around the world.

On the campaign trail, Biden had promised to reverse that legacy and expand access to reproductive care. And repealing the global gag rule is likely just the first step. On Thursday, the president will also order a review of the Trump administration’s restrictions to the Title X family planning program, CNN reports. These restrictions have been called a “domestic gag rule” because they bar recipients of Title X funds in the US from performing or referring for abortion — a ban that Biden, as a candidate, pledged to reverse.

Reproductive health groups are already pushing Biden to go beyond his promises to shore up access to contraception, abortion, and other services in the US and worldwide. And just days into his term, his agenda around these issues is still taking shape. But if the Trump years were a time of ever-increasing restrictions on abortion and other reproductive health care, Biden is already moving in the opposite direction.

The “global gag rule” restricts funding for reproductive health around the world

The global gag rule “essentially allows US presidents to fight the country’s domestic abortion wars abroad,” as Sarah Wildman wrote at Vox in 2017. Since the landmark 1973 Supreme Court decision Roe v. Wade limited the extent to which the federal government could restrict abortion, social conservatives have sought other ways to limit the procedure — and restricting federal funding has been one of their biggest tools.

By denying US aid to reproductive health care providers, the global gag rule has the effect of reducing access to all services they provide, not just abortion — everything from contraception to STI screenings to prenatal care is affected. And the Trump administration broadened the impact even further with the expanded rule, which applied not just to family planning providers but to nonprofits that work on tuberculosis, malaria, and all other health issues. Suddenly, they too could lose their funding if they even brought up abortion with patients.

Research on the global gag rule reveals a devastating impact. For example, the reenactment of the rule by President George W. Bush led the US to reduce or eliminate contraceptive shipments to 16 countries, according to a 2019 analysis. “Condom corners” that distributed free condoms in rural Ethiopia, Ghana, and Kenya shut down. Planned Parenthood Association of Ghana closed 57 percent of its clinics, and nonprofits in Kenya, Tanzania, Zimbabwe, and elsewhere shuttered clinics as well.

This reduction in contraceptive services actually led to an increase in abortions, the opposite of the gag rule’s goal. A 2011 study of the impact of the rule under the George W. Bush administration, for example, found a 12 percent increase in pregnancies in rural Ghana, leading to an additional 200,000 abortions and 500,000 to 750,000 unplanned births, according to the Guttmacher Institute.

And under Trump, the rule continued to result in harms to reproductive health around the world. A 2019 study across Kenya, Nepal, Nigeria, and South Africa found that it reduced access to contraception, prenatal care, HIV testing, and screening for breast and prostate cancer, as well as abortion.

Biden promised last year to get rid of the rule, stating in his campaign’s reproductive health agenda that it “currently bars the U.S. federal government from supporting important global health efforts — including for malaria and HIV/AIDS — in developing countries simply because the organizations providing that aid also offer information on abortion services.” On Thursday, he will make good on his promise so that aid can be restored.

Biden also plans to review Trump’s restrictions on Title X

The president’s memorandum also directs the Health and Human Services Department to review the Trump-era restrictions on Title X, a federal family planning program aimed at low-income and other underserved Americans, CNN reports. Finalized in 2019, these restrictions bar health care providers that receive Title X money from performing or referring for abortions — even though they weren’t actually using the money to pay for abortions themselves (that was already banned by the Hyde Amendment).

The restrictions were largely viewed as an attempt to strip funding from Planned Parenthood, a longtime goal of Republicans. And indeed, Planned Parenthood exited the Title X program as a result of the new rule. So did many smaller providers — an estimated 981 clinics in total, according to Guttmacher. That reduced the program’s ability to provide contraceptive services by at least 46 percent, the group estimates.

And it wasn’t just birth control. Many Title X clinics also offer services like STI testing, prenatal care, and cancer screening — and in many cases, a Title X provider may be the only doctor a patient sees all year. With clinics having to reduce hours or services, or even shut down due to the lack of Title X money, some patients lost their only real source of routine medical care.

Biden has said he would reverse the Trump administration’s Title X rule — one of the key planks of his campaign’s reproductive health agenda was to “restore federal funding for Planned Parenthood.” His plan to order a review on Thursday appears to be the first step in that direction.

More questions remain on Biden’s reproductive health policy, both in the short and long term. For example, he has pledged to reverse the Trump administration’s broad exemptions to the Obama-era requirement that employer-provided health insurance cover birth control without a copay. But it’s not clear if the president’s executive actions on Thursday, which also include an order for federal agencies to examine Trump-era policies that could weaken the Affordable Care Act, will address those exemptions.

And reproductive health advocates want Biden not just to reverse Trump’s moves but to take larger actions to improve access to care in the US and abroad. They are urging him to champion the Global Health, Empowerment and Rights (HER) Act, which would permanently repeal the Mexico City policy. And Guttmacher has called on the Biden administration to significantly increase the US contribution to international family planning programs, from the $575 million currently set aside for 2021 to $1.66 billion. Reproductive rights groups have also called for a significant expansion of funding to the Title X program.

All those moves would require the approval of Congress, where Democrats now hold the slimmest of majorities. But Biden should lead on reproductive health not just with executive orders, but with all the tools at his disposal, including pressure on Congress, Zara Ahmed, associate director of federal issues at Guttmacher Institute, told Vox last year. “The Trump administration has gone after and attacked reproductive health on so many fronts, so aggressively, that our response and the response from the Biden administration has to be equally aggressive and equally multifaceted.”

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