Early on, Biden is likely to take on the global gag rule that bars the federal government from funding foreign NGOS that provide abortions or even discusses them with patients. That rule, originally known as the Mexico City Policy, was first imposed by President Ronald Reagan in 1984, rescinded by President Bill Clinton, reimposed by President George W. Bush, rescinded by President Barack Obama, and reinstated on the first day Donald Trump began squatting in the White House. In his 1993 memorandum on his rescission, Clinton wrote a gentle admonition that the gag rule “undermined efforts to promote safe and efficacious family planning programs in foreign nations.” True enough. But more to the point, the rule maims and kills women.
It is also counterproductive in that it increases the number of abortions. The Guttmacher Institute reported that U.S. aid for overseas family planning in 2015 alone prevented 2.4 million abortions by averting 6 million unintended pregnancies. When Trump imposed the rule, a major family planning operation, Marie Stopes International, said it would lead to an additional 2.2 million abortions globally each year, 2.1 million of which would be unsafe. The World Health Organization estimates that unsafe abortions cause 13% of maternal deaths globally.
On the home front, Biden could return to Obama-era rules that provide narrow religious and moral exemptions for healthcare workers and employers, exemptions that the Trump regime expanded. He could go back to an Obama-era guidance that Trump rescinded barring states from defunding Planned Parenthood from Medicaid programs that serve low-income people, who are disproportionately people of color. He could also get rid of the 2011 requirement that abortion pills must be prescribed in person at a healthcare facility, something doctors and health experts say is medically unnecessary.
Dumping the Trump changes made to the Title X family planning program would arguably make the biggest immediate difference. With heavy bipartisan backing, Congress initiated Title X half a century ago to give low-income women and men contraception, cancer screenings and other health services they would otherwise not be able to access.
As it stands, the Trump rule bars recipients of Title X funds from performing abortions and restricts what they can say to patients about the procedure. Planned Parenthood, a long-standing target of forced-birthers, reluctantly opted out of Title X because of this. Although federal funds cannot be spent for abortions except under limited circumstances, forced-birthers argue that healthcare organizations shouldn’t get any federal funds if they provide abortions or information about the procedure, even if they don’t use Title X money for that purpose.
The American Medical Association sued over the rule, and in a scathing 2019 decision, a federal district judge said, “The gag rule prevents doctors from behaving like informed professionals. At the heart of this rule is the arrogant assumption that government is better suited to direct the health care of women than their medical providers.” Since that ruling in Oregon, two circuit courts of appeal have split over the matter, with the 9th Circuit Court saying it’s not a problem and the 4th Circuit Court saying it is.
The AMA said imposition of the rule meant 800,000 fewer people received care through Title X in 2019, or 3.1 million compared with 3.9 million in 2018. Amy Moy, chief external affairs officer for Essential Access Health, the largest Title X grantee in California and the country, told Hellmann, “The Trump regulations have devastated the Title X network. It’s our hope and expectation that very early in the new administration, there will be swift action to reverse the Trump era regulations and start to reset and address the harm that’s been done.”
Said Jessica Marcella, vice president of advocacy and communications for National Family Planning and Reproductive Health, a membership organization for Title X providers, “It is essential a Biden administration act as expeditiously as possible, on day one or within 100 days, to get money flowing back to providers, particularly to jurisdictions that don’t have Title X services right now.”
The Title X rule is no small restriction on reproductive rights. For some women it’s a matter of life and death. That makes it a prime choice for Biden to include in his Day One actions.