Republicans spend significant amounts of time publicly railing against and legislatively restricting abortion -- a procedure that has been around as long as pregnancy. However, abortion is far from their only reproductive health care target. Appointments made and policies already outlined by the incoming Trump-Pence administration indicate a full-scale attack on every aspect of reproductive health, from contraception access to preventative measures against cervical cancer and STI screenings, to measures aimed at addressing our country's already abhorrent maternal mortality rate.
Providers and advocates around the country are preparing for an all-out assault on bodily autonomy. For several of those who spoke with Truthout, a key priority is gearing up to defend against the promised attacks on the Affordable Care Act (ACA). While it does not provide universal health care, the ACA's regulation of the insurance industry has lowered the cost of care for millions and significantly decreased longstanding discrimination against women, transgender individuals and those with pre-existing and chronic conditions. Repealing even parts of the ACA could be devastating for marginalized and low-income people.
"I am very concerned that ideology will supersede a humanitarian approach to governance," Dr. Leah Torres -- a Salt Lake City-based Ob-Gyn specializing in reproductive health -- told Truthout. "I see how having no access to health care affects those of lower income. Health care is a human right, not a privilege. We must, as a society, value everyone. To do otherwise is un-American at its very core."
Torres said her patients and fellow health care providers are already expressing concern about the full or partial repeal of the ACA.
"The nation has been lied to about the ACA and has taken the false rhetoric to heart without understanding to what or why they're opposed," she said. "Another concern is the harm that short-sighted defunding will do for the long-term. This tends to be much more harmful not just public health-wise, but also financially. Short-term cost savings burden much more and for much longer than short-term spending that creates savings and improved public health in the long term."
Jessica González-Rojas, executive director at the National Latina Institute for Reproductive Health, also fears for the future of the ACA.
"The GOP has been steadfast under Obama's leadership with maybe 50 votes -- or more -- to repeal the ACA in Congress," González-Rojas told Truthout. "So, we know with an administration that's hostile to the ACA and two legislative bodies hostile to the ACA it's definitely on the chopping block. And there's so much wrapped up in there!"
González-Rojas pointed out that repealing the ACA wouldn't only raise costs for premiums. Provisions requiring contraception to be fully covered, the recently finalized protections for transgender patients, coverage for breastfeeding supplies, affordable STI testing and care that supports healthy pregnancies would all be eliminated.
"The nondiscrimination clause that includes transgender identity to protect trans people in health situations was one of the most groundbreaking pieces of the ACA," González-Rojas said. "Also, all the things that really support healthy parents, healthy babies, healthy mothers -- all those things are on the chopping block and that seems really, well, mean. And really concerning, especially considering how many Latinas and Latinos are uninsured still. We have more to go and repealing the ACA would set us back."
Monica Simpson, executive director of SisterSong Women of Color Reproductive Justice Collective, worries in particular about southern states that haven't participated in the Medicaid expansion -- a factor in our inexcusably high maternal mortality rate. Pregnant people overall in the US die during and after childbirth at a rate worse than 45 other countries, including double the rate of Canada, more than four times the rate of Finland, and higher than Kazakhstan, Libya and Saudi Arabia. Women of color in the US -- Black women in particular -- fare even worse.
"We've started to put a lot of emphasis on maternal health," Simpson told Truthout. "We try as a reproductive justice organization for our policy work to really expand the full definition of repro justice -- not just the right to not have children, but in order to have children, what do we need? And right now maternal health care is a really scary thing for women of color in this country.... When thinking about a Trump administration and him rolling back or demolishing anything that the ACA has helped us push forward on is a very, very scary thing."
Medicaid is the social program available to low-income people carrying pregnancies, and the lack of expansion in 19 states means pregnant people in those areas receive few or no resources.
"There's a major disconnect that's about to happen between our elected officials sitting at the power table and their effect on our lives. These policies and these things that they're doing -- they never touch them," Simpson said of promises to roll back or repeal the ACA. "Maternal mortality is on the rise and how that's connected to how racism is still very real in our healthcare system [is] something that we don't talk about."
Both Simpson and González-Rojas expressed concern for the safety of their communities in general following the racist and anti-immigrant rhetoric spouted and tolerated during the election cycle.
"Quite frankly, in addition to the health care concerns, we have concerns about the survival of our community because we believe immigrants are going to be the first line of attack," said González-Rojas. "Everything that this administration stands for is opposed to everything that we believe in and fought for for so many years. It's really terrifying. We could see millions of people deported -- most who are working and contributing to this country."
Simpson pointed out that the threat goes beyond policy.
"When thinking about this Trump administration and what just his face and his voice has been able to ignite with very racist folks who think they have righteous reason to wave their bigot flag all day long, those people are in every facet of our lives," Simpson said. "They're in our police forces, they're in our courtroom, they're in our boardrooms and they're in our hospitals and medical facilities as well."
Those who have multiple marginalized identities are facing multiple attacks at once. Reduced access to care is compounded by a daily threat to their ability to live and work in relative peace, as well as additional potential discrimination.
"Women of color, immigrant communities, LGBTQ communities and people who make low income are the [people] who are going to be disproportionately affected -- and we know a lot of people embody all those identities. So, a queer undocumented Latina low-income earner would be one of the most affected," said González-Rojas.
When asked if there has been any indication from the president-elect and his appointees thus far that they plan to address the need for resources for new parents and low-income pregnant people, both González-Rojas and Simpson laughed out loud.
"No. The loudest no. HELL no, actually," said Simpson. "He's going to run this country as if it's a reality show and the people in it are business deals. That's all he cares about; he doesn't care about our lives. Any person that is in the highest power position in this country who does not center the most vulnerable people in the country is the scariest thing for me ever. I don't understand how this country is going to be livable."
Simpson cited Trump's tax plan as another policy that attacks low-income earners and single parents in particular.
"When we think how economic justice is connected to our reproductive lives, we have to think about what [Trump's tax plan] means," she said. "Single parent homes and low-income families are going to suffer the most under this administration."
The appointment of abortion opponent and ACA critic Rep. Tom Price (R-Georgia) to head the Health and Human Services (HHS) Department indicates an overall hostile climate for all manner of reproductive health care.
"This administration has thus far proved extremely hostile to our issues and to the health and well-being of women," said González-Rojas. "They're obviously not holding the needs of women, young parents or young people front and center. And Vice President Pence is, in many ways, scarier [than Trump or Price]. He has a track record of being hostile to Planned Parenthood. He's defunded Planned Parenthood, he literally put a woman in jail in his state for having an abortion, and he's made it OK to discriminate against anyone who is perceived as queer."
González-Rojas called the placement of both Price and Pence -- who has also attacked Planned Parenthood because it provides HIV screenings -- in positions to create federal policy "an all-out assault on our liberties, our rights, our dignity."
Those attacks could be expanded through federal policy and law that mimics or explicitly codifies the Religious Freedom Restoration Act (RFRA), which enables corporations to discriminate against marginalized communities by claiming its religious rights. Indiana and Arkansas both have controversial RFRA laws, but they are not the only ones -- 21 states have their own versions, and 12 more proposed failed laws in 2016. Low-income employees of some churches and religiously affiliated hospitals already face a lack of contraception coverage because of ACA exemptions. Those employees, as well as the LGBTQI community could face additional discriminations and barriers to reproductive health and other care, should emboldened legislators make it a priority.
Pence's state is not just a model for new anti-LGBTQI legislation; Indiana has also been a breeding ground for incremental restrictions on abortion. House Enrolled Act 1337 passed the legislature in March and when Pence signed it into law, Indiana became one of the most dangerous states in the country for pregnant people.
"Pence is the one that scares the shit out of me," said Simpson. "If we look at his state [Indiana] as a model for what he stands for and now he's in the White House? You're doing everything you can to make sure that people can't live self-determined lives. I think that 2017 is going to be a big year; it's going to be hard."
Many people are already preparing for a hard year -- or years -- on the reproductive health front. For example, some are stocking up on emergency contraception and choosing to get long-acting, reversible contraction -- or LARCs -- like an intrauterine device (IUD) while it's covered by their insurance.
"We're hearing people say 'Let me stock up on Plan B', 'Let me go get a LARC,' because we don't know what this administration is going to be about," said Simpson, who expressed the conflict felt by many advocates who find themselves helping people who now must (again) prioritize the most economical choice over their preferred choice. "We want people to be very intentional and mindful about what kind of contraception they use as family planning and we don't want anybody feeling pressured and making a decision from fear about their bodies."
Rollbacks in access are not just possible through repeal or defunding of the ACA. González-Rojas is especially concerned about Title X funding because the program -- which provides basic health care, such as breast and cervical cancer screenings, STI testing, contraception and educational community programs to approximately 4 million low-income people annually -- doesn't discriminate based on immigration status.
"[Title X] is already a program that's underfunded," she said. "We've seen clinics do things like decrease staff pay, reduce hours and even close their doors due to cuts. This is preventative health [care] that's really critical for being able to make decisions about our families and our health and our futures."
Title X covers more than just contraception; it also provides access for low-income people to preventative care.
"We're going to see an uptick in unintended pregnancies, we're going to see an uptick in STIs, and we're going to see an uptick in cervical cancer rates," said González-Rojas. "All these things have real, social implications."
As governor of Indiana, Vice President-elect Pence presided over a degree of Planned Parenthood defunding that resulted in multiple clinics in the middle and southern part of the state closing. With nowhere for low-income residents to access STI testing, Scott County has seen an explosion of HIV diagnoses, with nearly 200 people seeking treatment as of October. Should the policies Pence pushed in the House and as governor be nationalized, the public health concern is very real.
Another public health concern that has real implications for reproductive health is environmental threats, including air and water contamination.
Simpson cited Standing Rock, Flint and southern communities of color who bear a disproportionate burden of industrial air, soil and water pollution. She's concerned that the recent victory at Standing Rock and monetary support heading to Flint could be countered by an administration whose nominee to lead the Environmental Protection Agency is a climate change denier. Reproductive health is, in part, contingent on having clean air to breathe and water to drink -- a seemingly obvious notion, but one that Republican lawmakers seem content to ignore despite their pro-birth policies.
"We've known for decades that we should not be tapping into the soil, into the land," said Simpson. She would prefer we tap a different kind of resource: the growing opposition to the incoming administration and its plans for attacking rights and freedoms.
"What helps me find the ability to get out of the bed and get to work is that we have to be prepared," she said. "This is the time for women of color, for trans folks, for queer folks -- for all those folks who have always been on the periphery; it is time for our leadership and experience to be centered."