How has the current U.S.

political climate impacted accessibility to

reproductive health care?

Emma Poitras

Senior Project Advisor: Lori Fisher

Abstract

Accessibility to all reproductive health services is essential to an individual’s well being and
reproductive health. The current political climate has impacted legislation in a variety of ways,
but it is apparent that the changes have impacted accessibility to contraception negatively. The
legislation implemented has affected ​a large majority of our domestic population causing major
concern by women and men alike.​ I identify key factors in legislation throughout this essay that
have made the largest impact on accessibility as well as the factors that have improved or
preserved reproductive health services. Through my research on the link between political
climate and the election of Donald Trump, I can determine that through the Trump presidency,
legislation has been implemented with the intention to limit accessibility to contraception and
other necessary reproductive health services. These trends in legislation and political climate
suggest that the change in political climate has made a major impact on legislation and a person’s
accessibility to reproductive health care services.

12th Grade Humanities

Animas High School

March 11, 2019

 Part 1: Introduction

In 2017, the teen birth rate dropped to the lowest it has been since 1991 due to increased

access to reproductive health services as well as improved sex education. Accessibility to all

reproductive health resources has been proven vital to maintaining the improvement in

reproductive health services and sex education. The quality and consistency of these services

largely depends on political climate, in addition to other factors such as state of residency and

occupation.

Historically, reproductive health providers and services have been targeted by legislative

changes. The changes to legislation concerning reproductive health laws are closely related to the

U.S. political climate which is apparent with our current political party in office. This impact has

been observed both on a national level through legislation that applies countrywide, as well as on

a state to state level where legislation responds in a variety of ways to the always changing

political climate. The Trump presidency has made a large impact recently in states such as

Texas, where it is becoming increasingly difficult to have full accessibility to reproductive health

services. The current political climate has posed itself as threatening to the accessibility of

reproductive health services by implementing legislation that could potentially make one's

occupation, location or financial status the deciding factor as to whether they have access to

these services.

The risk that the political climate poses to many people in terms of reproductive health

extends past contraception. Accessibility to STI testing, vaccinations, and other reproductive
health services is necessary and should always be available. This accessibility is threatened by

the U.S. political climate and impacts government-funded programs such as Title X and Planned

Parenthood. The changes in the United States’ political climate have led to modifications to

legislation which have since negatively impacted accessibility to reproductive health care in a

variety of ways.

Part 2: Historical Context/Background Knowledge

Reproductive health services, specifically contraception and abortion services have been

questioned, debated, and ridiculed since being introduced to the U.S. Many figures throughout

time have made accessibility to contraception possible by fighting legislative laws that were

enacted with the intention to limit reproductive health services. The Obama administration

brought a shift in political climate by implementing Obamacare, which was helpful and positive

in providing affordable contraception and health services through programs such as Title X.

While Obamacare remains intact, the shifting political climate has made efforts to dismantle

programs such as Title X, a program that works closely with Planned Parenthood, which has

played a huge role in improving access to reproductive health services and sex education.

Many prominent figures have participated in the fight for accessible and affordable

contraception and healthcare, and with each new political party in office the decisions and

legislation regarding abortion is challenged. An influential women in the fight for rights and

access to abortion was N​orma Leah McCorvey Nelson, who led the legally liberating Supreme

Court case Roe v Wade in 1973. The case debated upon a woman’s right to have a safe and legal
abortion and eventually was won by McCorvey and supporters. Margaret Sanger posed as a

strong female figure in the fight for accessibility and legalization of reproductive health services.

Her work and lifetime fight eventually led to the creation of Planned Parenthood, a significant

organization responsible for providing reproductive health services to a large majority of

Americans. Through resistance of legislation that limits reproductive health services, resolutions

such as the creation of Planned Parenthood have been made possible.

Contraception didn’t become fully legal until 1972 and is now fully available all over the

country. In some states it is completely free but unfortunately, in others, the current political

climate has made obvious impacts on legislative changes in the wake of the Trump election.

The current political climate threatens accessibility to all reproductive health services due

to the Trump administration's efforts to defund government-funded programs such as Title X.

Title X is vital in keeping reproductive health services available to everyone by remaining

affordable and accommodating to all social groups. Improvement in sexual education and

​ espite Trump’s
contraception access has resulted in teen birth rates decreasing dramatically.​ D

promises and attempts to repeal the Affordable Care Act, also known as Obamacare, the ACA

remains intact. The Affordable Care Act provides families and individuals with access to

healthcare at a lowered cost, this applies to anyone with incomes below the 100% poverty line.

Title X, or ​officially named Public Law 91-572, is a federally funded grant program that is

responsible for funding health centers in order to provide all reproductive health services.

Under the ACA is the contraception mandate, which is legislation requiring employers with
health insurance to cover part of or all of their employees cost of contraception.

The contraception mandate has been modified since the election of Donald Trump. The

modifications respond to the political climate, being that the changes made now limit access to

employees of some religious employers. These modifications implemented prove that the current

political climate has negatively affected access to contraception and other reproductive health

services.

Part 3: Research and Analysis

Impacts of The Changing Political Climate

The shifting political climate in wake of the election of Donald Trump poses a threat to

access to contraception. Proposed legislation suggests changes to Title X that would block all

funding to programs like Planned Parenthood and other family planning services that provide

reproductive health services such as abortions. These changes come as a shock following the

Obama presidency which introduced many programs successful in providing accessibility to

reproductive health services. The Affordable Care Act and programs such as Title X have been

extremely successful in improving access across the board. The proposed changes to Title X are

guaranteed to be detrimental in terms of accessibility.

Never in its history has the nation’s family planning safety net been in such

jeopardy as it is today. The policy agendas of the Trump administration,

Congress, and many states are being shaped by leaders adamant in their
 ideological opposition to—and intent to dismantle—the funding streams and

providers that have long constituted the US publicly funded family planning

effort. (1)

The proposed changes threaten lower-income women the most, “If fully implemented,

the proposed changes to Title X would shrink the network of participating providers and have

major repercussions for low-income women across the country that rely on them for their family

planning care.” (Sobel, 1) Effects of the changing political climate are evident in the attack

against Title X and therefore Planned Parenthood. Planned Parenthood and similar programs are

responsible for providing a variety of reproductive health services. These services range from

contraception and abortion to STI testing and mammograms. These services prove themselves

essential to reproductive health, and the accessibility through programs such as Title X remains

essential to low-income individuals. The outcome of improved access to contraception and sex

education shows in a statistic released by the U.S. Department of Health and Human Services

which stated that:

Today the U.S. teen birth rate is at an all-time low. Since 1991, the rates of teen

pregnancy have dropped by half. In 2013, the CDC reported that birth rates for

U.S. teens 15-19 years old dropped to a record low not seen since 1946. This

decline in teen pregnancies crossed all races and ethnicities. (1)

Action has also been taken against an employee's right to contraception through her
religious employer's health insurance plan. The Contraception Mandate concentrates on

legislation that requires employers health insurance to cover their employee's contraception.

Trump’s administration has taken action against the mandate and has since made changes that

allow for religious employers with “moral reservations” to be exempt from the mandate. This

means decreased access for women with religious employers who are exempt. Trump’s claims

and promises to dismantle family planning programs and overall accessibility to reproductive

services has drawn attention across the country and many are joining the fight for rights to all

reproductive health services in a safe, accessible, and affordable way.

Over the last several decades, the historically significant gap between feminists

and family planners on the issue of birth control has been diminished not only by

feminist gains, but the increasing threat to the legality and funding of both

abortion and contraceptive services. (Belinda, 3)

The changing political climate establishes itself as a threat by making modifications to

legislation and by taking aims at grant programs such as Title X.

Legislation on a State-to-State Basis

While there are active changes being made to federal legislation in our given political

climate, more impact has been observed on a state to state level. States and their own legislation
have adjusted to the political climate in a variety of ways, the more conservative states have

taken the change in leadership and legislation as a chance to come down hard on reproductive

health legislation and therefore limiting access. The more progressive states have taken the

shifting political climate as an opportunity to further improve access by reducing costs of

contraception and improving access to safe and affordable abortions. States such as Texas, Iowa,

and Louisiana have taken a hard stance on reproductive health legislation. Changes to legislation

have now made accessing contraception, abortions, and other forms of reproductive services

harder and at times, impossible. An example of these changes is discussed in an article that

reflects on the modifications to legislation on a state-to-state basis in response to the changing

political climate.

But in Texas? There, lawmakers this year have passed a law that bans dilation and

evacuation, the most common method of second-trimester abortions, and requires

tissue from an abortion to be cremated or buried. The Lone Star State is also very

close to approving a law requiring women to buy separate insurance for

non-emergency abortions — what one legislator termed "rape insurance" — for

even private insurance plans. (Milligan 1)

States such as Texas have responded with legislation that limits many forms of

reproductive health services, as well as limitations to insurance plans. This type of response in
legislation demonstrates that the changes in political climate in wake of the Trump presidency

have negatively impacted access and quality of reproductive health care and services.

In contrast, states such as California, Oregon, Vermont, and Maryland are taking a

progressive stance on the new federal legislative changes. Changes and additions to legislation in

relation to health insurance have made accessing reproductive health services far more affordable

and straightforward.

Some states expanded their laws prior to the Trump presidency. California, for

example, in 2014 established the right to free birth control under the ACA; the

law applies to both private plans and Medicaid managed care plans. Maryland's

law, signed in 2016 and effective in 2018, eliminated co-pays for most birth

control as well as vasectomies, covers emergency "Plan B" contraception and

allows women to get six months' worth of birth control pills at once. Vermont's

law, also signed in 2016, codifies the ACA birth control coverage in state law. (2)

While the positive effects of the more progressive states maintaining and improving their

reproductive health services through changes in legislation are clear, concurrently the more

conservative state’s legislation limits access to its residents. Despite the legislative action that

each individual state has taken, the national legislative changes to reproductive care are still

evident through legislative limitations on a state to state basis.

Location, Finances, and Health Insurance

Before and after Trump’s election it has been clear that factors such as location, financial

status, and health insurance make a large impact on accessibility. The current political climate

has decreased accessibility more by implementing legislation that impacts anyone who lives

rurally or in a conservatively legislative state, and threatens financial support on reproductive

health services residing from programs such as the ACA.

As a result of the changes in our political climate, changes to legislation have made it so

that more and more religious employers are able to be exempt from the Contraception Mandate.

While the Trump administration has made efforts to fully roll back the Contraception Mandate,

the efforts have been blocked on a national level. As for now, the Contraception Mandate

remains partly intact and has remained since 2012, when Obama implemented the ACA.

The ACA, the sprawling 2010 health-care law pushed through by a Democratic

Congress, says that people should be insured for preventive services without

paying out-of-pocket fees — and that women’s health-care services must be

included. Under the Obama administration’s interpretation of the law, all Food

and Drug Administration-approved forms of contraception have been covered

since 2012. (1)

Depending on a women’s occupation, she can be denied access to contraception through

her employer's health insurance, due to the changing political climate and legislation which are
evidently limiting access to contraception. The exemptions are explained for different types of

employers:

One of the regulations allows nonprofit or for-profit employers with an objection

to contraceptive coverage based on ​religious​ beliefs to qualify for an exemption

and drop contraceptive coverage from their plans. The other regulation exempts

all but publicly traded employers with ​moral​ objections to contraception from

rule. These new policies, effective immediately, also apply to private institutions

of higher education that issue student health plans. (6)

The new legislation implemented is seen in major companies such as Hobby Lobby, who

took moral and religious reservations having to do with providing contraception to the Supreme

Court. In the case, the argument of whether a religious employer should be obligated to provide

birth control to their employee was debated. Hobby Lobby won, making it so that their 28,000

employees could not access contraception through their health insurance.

Employees of companies such as Hobby Lobby or other morally exempt employers now

have extreme limitations in their access to contraception without health insurance to assist in

paying for contraception or other forms of reproductive health care. While the benefits of the

ACA and the contraception mandate prior to the shift in political climate are clear, the legislative

changes were still implemented.

The owners of these companies objected to having health insurance plans that
 included birth control — a coverage guarantee under the Affordable Care Act

(ACA) that has allowed more than 55 million American women to access

affordable birth control and has saved existing benefit recipients at least $1.4

billion on birth control pills alone since the provision went into effect. (3)

The impact of the modifications to the contraception mandate can be observed by looking

at how many people work at large companies such as Hobby Lobby. By limiting accessibility

fully to that many employees, it is evident that the response in legislation to the changing

political climate is negative and aims to limit access to large numbers of women who require

affordable contraception. For many, paying out of pocket for contraception of any form is

financially unrealistic, not to mention other forms of reproductive health care. Limitations to

accessibility to contraception should not depend on occupation. Factors such as one’s finances,

occupation, and location are often somewhat out of control, but should not dictate whether a

person has available and affordable access to reproductive health services.

Employers can argue that they should not have to cover their employee's contraception

due to “moral exemptions”, yet, the question of whether all of the women without health

insurance coverage will be able to access affordable contraception remains. “The IFR expands

exemptions to the contraceptive mandate to protect certain entities and individuals that object to

coverage of some or all contraceptives based on sincerely held moral convictions.” (1) The

concern is raised when major companies begin to exempt themselves and therefore leave

thousands of people without financial assistance for contraception or others forms of

reproductive health care.

Catholic Hospitals

Catholic hospitals have had limitations concerning reproductive health services for the

longest out of most other institutions and have remained unaffected by the shifting political

climate. Services such as contraception, sterilization, abortions, and in-vitro fertilization have

long since been prohibited based off of moral and religious Catholic limitations in relation to ​The

Ethical and Religious Directives​, set in place by the ​United States Conference of Catholic

Bishops.

While the limitations to reproductive health services in this form are set only in Catholic

hospitals, it raises the question of whether or not a religious institution should have this much

control over the types of procedures and care that an individual can access through a hospital. As

an alternative to contraception, it is stated that the Catholic hospitals should instead prov​ide, “for

married couples and the medical staff who counsel them, instruction both about Church’s

teaching on responsible parenthood and in methods of natural family planning.” (Morris 1)

While teaching responsible parenting is important to parents, providing services such as

contraception or permanent sterilization that prevent unwanted pregnancies is necessary to a

large majority of people who cannot have a child unplanned. It is necessary to be able to obtain

basic reproductive health care from any health provider, with little justification needed besides

the fact that everyone should have access to contraception and other forms of reproductive health
care. Benefits of reproductive health care are demonstrated and established through the

decreased teen pregnancy rate as well as through improved reproductive health services across

the board. The improvements are a positive milestone, but are proven less useful when they do

not apply everywhere, especially in all hospitals.

The health benefits of reproductive care are well established, and Americans’

right to make personal reproductive decisions has been legally affirmed. But legal

rights mean little without practical access, and it remains to be seen if all

Americans will retain the true access to a full array of legal medical procedures,

or if access will be placed in the hands of the Catholic bishops and the institutions

they control. (1)

Besides contraception and abortion, other procedures such as a Tubal Ligation, which is a

surgical procedure that a woman can get that indefinitely prevents pregnancy, is an example of a

routine procedure that requires board review at a Catholic hospital. Despite the simplicity of the

procedure, it can still be denied or extremely difficult to receive. Other procedures such as

in-vitro fertilization are prohibited in Catholic hospitals, while this is a common medical practice

done to compensate if a couple or individual cannot become pregnant for any reason, it remains

prohibited due to the fact that it “separates procreation from the marital act”. Different types of

ways of regulating birth are discussed in the ​Humanae Vitae​ by Pope Paul VI.

Pop​e Paul VI in ​Humanae Vitae​ states:

 Equally to be condemned… is direct sterilization, whether of the man or of the

woman, whether permanent or temporary”. Except when performed for strictly

therapeutic medical reasons, directly intended amputations, mutilations, and

sterilizations performed on innocent persons are against the moral law. (14)

Catholic hospitals have upheld many of the regulations and limitations quoted by the

Humanae Vitae,​ the regulations limit all forms of contraception and many reproductive services.

With these regulations, accessibility to the most common reproductive health services inside of a

hospital is being limited due to these regulations set in place by the United States Conference of

Catholic Bishops.

Part 4: Discussion and Conclusions

It is evident that the current political climate and legislative laws have made an impact on

accessibility to reproductive health services through a variety of factors. On a national level,

these factors are changes and exemptions to the Contraception Mandate, which now makes it

possible for “morally obligated or exempt” employers to not include contraception in their health

insurance plan. Attempts to dismantle the ACA as a whole have been made, but have not made it

through to the Supreme Court yet. Catholic hospitals have long since placed regulations on their

practices and services provided which limit accessibility to reproductive health services in a

variety of ways. Yet, the majority of the changes to legislation have been observed on a

state-to-state basis in regard to accessibility. Conservative states have taken the changes in
national legislation as a chance to implement more strict and conservative ideals into their

reproductive health care system. The more progressive states have taken the changes in national

legislation as an opportunity to take a stand against our current political leader and political

climate by implementing more progressive legislation and keeping old legislation that proved

itself useful to the general public. The changes to the Affordable Care Act have impacted all

legislation to some extent and continues to threaten programs such as Title X in terms of federal

funding.

Moving forward in this time of political climate and leadership it is hard not to be

concerned for on-going accessibility to reproductive health services in both practical and

inexpensive ways. Depending on location, it is easier or more difficult to access all reproductive

health services. States such as California and Oregon suggest that perhaps all lawmakers and

legislation should follow suit in their political approach to contraception and reproductive health

services based off of the success of their implemented legislation and the improvements in terms

of reproductive health it has brought.

Political climate has always impacted controversial topics, one of the most being

reproductive health services. Despite the controversy, evidence points to the fact that

accessibility to these services is beneficial to our country and its citizens. The correlation of an

increase of access to contraception and sex education to a decrease in teen pregnancies shows

that continued improved access to these services has been successful. Location, financial status,

and occupation should not determine someone’s right to contraception or any kind of
reproductive health service.

Setbacks in terms of accessibility throughout Trump’s presidency are evident. It is clear

that with our current political climate accessibility to contraception and other reproductive health

services has been limited, this extends nationwide as well on a state to state basis. Nationally, the

effect is strong but does not extend to every citizen, as it largely depends on the individual's state

of residency and whether their accessibility is either improved or lessened. Overall, through the

country’s recently shifting political climate, accessibility to reproductive health services has been

limited through legislation set in place to further restrict access on a national and state-wide

level. Improvements have been seen nationally, a major one being a dramatic decrease in teen

birth rates. This decrease is linked to improved sexual education as well as improved access to

contraception. The political climate has affected states differently, as some have taken a

proactive stance on the legislation implemented on the national scale.

Despite some of the improvements or achievements made in relation to fair access to

contraception, recent legislation has been set in place with the clear intent to limit accessibility.

This is seen through limitations in health insurance packages, Catholic hospitals, specific state

legislation, and through continued efforts to defund Title X and the Affordable Care Act as a

whole. All of these resources are essential to people’s reproductive health, and with a continued

lack of accessibility, quality of care, and full access to all services the progress made in relation

to reproductive health will be reversed.

 Bibliography

Corbin, Caroline Mala. “The Contraception Mandate.” ​Northwestern University Law

Review,​ vol.
107, no. 3, Spring 2013, pp. 1469–1483. ​EBSCOhost,​
search.ebscohost.com/login.aspx?direct=true&db=aph&AN=89334668&site=ehost-l
ive.

Gold, Rachel Benson, and Kinsey Hasstedt. “Publicly Funded Family Planning Under
Unprecedented Attack.” ​American Journal of Public Health​, vol. 107, no. 12, Dec.
2017, pp. 1895–1897. ​EBSCOhost​, doi:10.2105/AJPH.2017.304124.

Goldstein, Amy. “Judge Blocks Trump Effort to Roll Back Birth Control Mandate
Nationwide.” ​The Washington Post,​ WP Company, 14 Jan. 2019,
www.washingtonpost.com/national/health-science/judge-blocks-trump-effort-to-roll-
back-birth-control-mandate-nationwide/2019/01/14/abba97e4-181f-11e9-8813-cb9de
c761e73_story.html?utm_term=.f7d8be8d93c5.

Milligan, Susan. “Taking It to the States.” ​U.S. News - The Report​, Aug. 2017, pp. C5–C7.
EBSCOhost,​
search.ebscohost.com/login.aspx?direct=true&db=aph&AN=124894532&site=ehost-
live.

Sweeney, Belinda. “The Moral Property of Women: A History of Birth Control Politics in
America.” ​Archives of Sexual Behavior​, vol. 35, no. 3, June 2006, pp. 381–383.
EBSCOhost,​ doi:10.1007/s10508-006-9033-7.

Sobel, Laurie, et al. “Proposed Changes to Title X: Implications for Women and Family
Planning Providers.” ​The Henry J. Kaiser Family Foundation,​ The Henry J. Kaiser
Family Foundation, 21 Nov. 2018,
www.kff.org/womens-health-policy/issue-brief/proposed-changes-to-title-x-implicati
ons-for-women-and-family-planning-providers/.

U.S. Department of Health and Human Services. “Final Rules on Religious and Moral
Exemptions and Accommodation for Coverage of Certain Preventive Services
Under the Affordable Care Act.” ​HHS.gov,​ US Department of Health and Human
Services, 7 Nov. 2018,
www.hhs.gov/about/news/2018/11/07/fact-sheet-final-rules-on-religious-and-moral-e
xemptions-and-accommodation-for-coverage-of-certain-preventive-services-under-a
ffordable-care-act.html.