A year ago, Margaret Atwood wrote “What ‘The Handmaid’s Tale’ Means in the Age of Trump” for the New York Times. In it, she argues about the importance of women in a society:
Because women are interesting and important in real life. They are not an afterthought of nature, they are not secondary players in human destiny, and every society has always known that. Without women capable of giving birth, human populations would die out. That is why the mass rape and murder of women, girls and children has long been a feature of genocidal wars, and of other campaigns meant to subdue and exploit a population. Kill their babies and replace their babies with yours, as cats do; make women have babies they can’t afford to raise, or babies you will then remove from them for your own purposes, steal babies — it’s been a widespread, age-old motif. The control of women and babies has been a feature of every repressive regime on the planet. Napoleon and his “cannon fodder,” slavery and its ever-renewed human merchandise — they both fit in here. Of those promoting enforced childbirth, it should be asked: Cui bono? Who profits by it? Sometimes this sector, sometimes that. Never no one.
Trump had only been in office a couple of months (and had spent much of that time on a golf course) when Hulu began broadcasting Atwood’s The Handmaid’s Tale, which is a work of fiction. But since then, we have seen repeated attempts to control women and babies as part of his repressive regime. They have not gone unnoticed. From a February 2018 Gutmacher Institute Policy Review:
Coercive intent and practices are at the core of social conservatives’ reproductive health agenda, including virtually every reproductive health–related initiative from the Trump administration and social conservatives in Congress over the past year.
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Social conservatives hold prescriptive views—rooted in both religious doctrine and political ideology—on sexuality and reproductive decision making. Generally speaking, this worldview holds, and seeks to establish as norms for society at large, that people, especially adolescents, must abstain from sexual activity outside of marriage; women’s access to contraception should be limited to certain circumstances, primarily marriage, or that contraceptive options other than fertility awareness methods are unacceptable; women should welcome all pregnancies, including those resulting from rape; and, consequently, abortion should be severely restricted or banned entirely.
The Department of Health and Human Services (what a travesty of a name today) has just issued its new guidelines for Title X family planning grants. They could have come right out of Gilead, the dystopian land of The Handmaid’s Tale.
Title X is another one of those old programs that began when we were a united nation. Originally funded by President Johnson in 1965 as part of his War on Poverty, the Family Planning Services and Population Research Act, Title X of the Public Health Service Act, was signed into law in 1970 by Richard Nixon. He pushed Congress to act in a 1969 message that included his declaration: “It is my view that no American woman should be denied access to family planning assistance because of her economic condition … This we have the capacity to do.”
Title X, as it has become known, passed unanimously in the Senate and by a vote of 298 to 32 in the House where it was sponsored by a Texas Congressman, George H.W. Bush. Yes, bipartisanship was once a thing, as we all recognized the good that could come from providing reproductive health care for women in need. It has been a highly successful program.
As of 2016, the Office of Population Affairs of the Department of Health and Human Services reports that 4 million patients were provided services through Title X-funded clinics. Those clinics administered 6 million sexually transmitted disease tests, including over 1 million tests for HIV. They completed almost 1 million clinical breast exams and 700,000 Pap tests in addition to family planning services.
Title X clinics offer clients a broad range of effective and medically safe family planning methods approved by the U.S. Food and Drug Administration.
- 80% (2.8 million) of all female clients adopted or continued use of a most, moderately, or less effective method of contraception at exit from their last encounter.
- 17% of all female clients are using a most effective contraceptive method: female sterilization, implant, or IUD, or rely on male vasectomy
- 45% used a moderately effective method: injectable contraception, vaginal ring, contraceptive patch, pills, diaphragm, or cervical cap
- 18% used a less effective method: male condom, female condom, sponge, withdrawal, a fertility awareness-based method, or spermicide used alone
- 9% did not use a method because they were pregnant or seeking pregnancy
- Female family planning methods: The pill was the preferred method of 27% of all female clients, followed by male condoms (16%), injectable contraception (15%), IUDs (8%), hormonal implants (6%), the vaginal ring (2%), female sterilization (2%), and the contraceptive patch (1%)
- Male family planning methods: A majority of all male clients used male condoms (65%), followed by reliance on a female method (6%), withdrawal (3%), or vasectomy (1%)
Today, a truly bipartisan 91 percent of the American public still believes that contraception is a morally acceptable form of birth control. With that kind of overwhelming support, conservatives cannot ban contraception—at least, not yet. But that does not mean they will stop trying. And they are not afraid to use coercive methods to control the bodies of women. They have already shown us that.
They have succeeded, in individual states, in reducing a woman to little more than an incubator, as I wrote three years ago, often granting a fetus rights that supersede her own.
In Alabama, a state not known for budget surpluses, a law was passed last year that allows the state to provide legal counsel for a fetus whenever a minor appeals to a court for an abortion. That fetus can then call witnesses against its incubator and even appeal the court's decision should the court allow the minor access to an abortion. I'm not sure how a fetus is made aware that it will not likely win such an appeal, but perhaps it figures the delay will change the status of the host. Who will no doubt love it and treat it kindly, once it has forced itself into residence. Or at least that is probably what its lawyer is telling it.
How far down the rabbit hole does one have to go to make sense of the indefensible?
According to the ACLU:
”The judicial bypass already creates additional and somewhat daunting steps for a minor seeking an abortion. But Alabama's law goes beyond any other state's process judicial bypass by allowing the district attorney, the guardian appointed to represent the fetus, or the teen's parents to call witness to testify against the teen. The teen's teacher, employer, pastor, boyfriend, neighbor, and friends could all be notified of her pregnancy and called to testify against her. Additionally, the law allows the district attorney, guardian or the minor's parents to file an appeal if the bypass is granted, potentially dragging out the process for so long that the teen can no longer get the abortion she needs.”
Last year Trump’s regime tried to force a detained undocumented minor to bear a child against her wishes, even after she came up with the money for the procedure and a judge’s authorization.
Once they limit a woman’s right to control her own body after she becomes pregnant, it is not a big step to decide what methods she is allowed to use, if any, to prevent a pregnancy from occurring.
The first step was to modify and extend the religious exemption of the Affordable Care Act (ACA). According to the Guttmacher Institute, that was done last year.
In October 2017, the Trump administration released new federal regulations governing the ACA’s contraceptive coverage guarantee, which requires insurance plans to cover 18 contraceptive methods without copayments or deductibles, thereby empowering women to choose from the full range of birth control options. The administration’s move creates sweeping new exemptions for employers, universities, individuals and insurers with religious or moral objections to some or all contraceptive methods and services.26 As of early February 2018, the new regulations had been temporarily enjoined by two federal courts.
Restricting full contraceptive method choice in this way is inherently coercive. The new regulations open the door for employers and others to impose their religious or moral beliefs on employees, students and dependents by dictating whether and which contraceptive services are covered in their health insurance plans. This may interfere with women’s ability to afford and choose the contraceptive methods that work best for them, and women may instead be forced to rely on less expensive but, for them, less suitable options.27 The Trump administration’s birth control regulations build on long-standing efforts by social conservatives to misuse federal and state laws intended to protect religious freedom to instead impede access to reproductive health services.28
This should be read as nothing but an all-out declaration of war upon the bodies of women by the far right, using religion as a shield.
However, as long as women have access to organizations that provide the full spectrum of reproductive health care (like Planned Parenthood), they are likely to retain the ability to choose for themselves, with the assistance of their healthcare provider, the method of birth control that best suits their health, lifestyle, and beliefs.
But what happens when we lose Planned Parenthood? Although conservatives have repeatedly failed in their frontal attacks on this broadly popular institution, they have quietly made progress while the nation’s attention has been focused elsewhere. And heaven knows, Trump has provided adequate distraction.
There are two main sources of federal dollars that Planned Parenthood receives. The first, and largest, is Medicaid payments for services rendered to qualified recipients. It was this money stream that some states tried to shut down after the fraudulent videos appeared three years ago.
In 2016, the Obama administration sent a letter to states advising them that this was illegal; states could not bar providers from receiving Medicaid reimbursements unless those providers were unfit to perform medical services or to bill appropriately for those services.
On January 19, 2018, the Centers for Medicare and Medicaid Services, part of the Department of Health and Human Services, issued a short letter rescinding the Obama administration’s 2016 guidance, arguing that it “limited states’ flexibility with regard to establishing reasonable Medicaid provider qualification standards.”
The new letter doesn’t change the law; instead, it explains how the Trump administration plans to interpret and enforce it. Essentially, the Trump administration is signaling that it considers stripping Medicaid funding from Planned Parenthood to be at least potentially legal, and is probably not going to try to stop states from doing it. That opens the door for states to keep Medicaid patients, many of whom are low-income, from using their insurance coverage at Planned Parenthood clinics.
So, we now have the opportunity for states and employers to deny women the right to obtain birth control under their insurance plans or Medicaid. The only option left is the program that was designed to assist those women in financial need, Title X. And gee whiz, guess who Trump has put in charge of Population Affairs over at HHS?
Last May, the Trump administration tapped Teresa Manning, a law professor at George Mason University who is both anti-abortion and anti-contraception, for the position of deputy assistant secretary for Population Affairs at HHS. When she left her post this year, Valerie Huber, who is an advocate for abstinence education, took her place as acting deputy assistant secretary. Last April, the administration tapped Charmaine Yoest, for the position of assistant secretary of public affairs at the Department of Health and Human Services. Yoest is a well-known anti-abortion activist. In February, she left that position for the Office of National Drug Control Policy.
Every year, the office of Population Affairs puts out a Funding Opportunity Announcement (FOA) for grants under Title X. This year, not only was the FOA months late, with some clinics due to run out of funds at the end of this month, but the announcement itself should serve as a red flag for the defenders of women’s rights.
First of all, the announcement fails to include the standard Quality Family Planning recommendations. From a statement of the American College of Obstetricians and Gynecologists:
Title X has historically been grounded in evidence-based practices and has a record of success. However, the new guidelines signal a shift away from this by removing mention of the high, national standard for family planning services, the Quality Family Planning recommendations.
These changes will effectively block Title X patients from the qualified providers of their choice, steering them toward organizations or providers singularly focused on abstinence and fertility awareness methods – political interference at its worst. This will reduce individuals’ options for care and jeopardize their access to the most effective forms of contraception, most notably, long-acting reversible contraception, like the IUD and implant.
For teens, we are back to abstinence only, re-branded as sexual risk avoidance. Not only is abstinence a discredited policy that never did work: it caused actual harm.
In pursuit of that goal, these programs ruthlessly withhold important sexual health knowledge, provide medically inaccurate and incomplete information, and perpetuate stigma around sex, sexual health, and sexuality.
The FOA also seems to favor general practice providers over specialty reproductive health clinics, even though there are not enough of them to replace Planned Parenthood. The favorite conservative, evidence-free talking point has found its way into policy. Oh, and the rhythm method is back—with a vengeance.
The announcement stressed the inclusion of natural family planning methods — also known as fertility awareness — among the broad range of services offered by grantees. Applicants also have to ensure their activities promote “positive family relationships for the purpose of increasing family participation in family planning and health decision-making” and emphasize the social science research on “healthy relationships, to committed, safe, stable, healthy marriages and the benefits of avoiding sexual risk or returning to a sexually risk-free status, especially (but not only) when communicating with adolescents.”
Natural family planning methods have always been a part of Title X services (see blockquote above). Information on the rhythm method has always been provided, alongside information on birth control pills, IUDs, and vasectomies.
But this year’s announcement includes ominous language about “family participation in family planning and health decision-making.” Which family members? Spouses, parents? What happened to the guarantee of confidentiality that minors have been given in the past?
There also seems to be primacy given to providers that specialize in a single form of birth control. For that you can thank religious anti-woman groups. From Stassa Edwards at Jezebel:
The grant program is designed to encourage providers that offer a single method of family planning like the kind of natural family planning offered by religious providers, as well award them points under the new system. The guidelines state that “single providers who have developed expertise in one family planning approach or method may be partners in a broader proposal that offers a broad range of family planning methods.”
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Simply put, the Title X guidelines open the door to crisis pregnancy centers and other faith-based organizations to participate since they are one of the few organizations to meet the new guidelines while simultaneously placing Planned Parenthood at a disadvantage. Indeed, the new rules encourage “cooperation with community-based and faith-based organizations,” even though it’s unlikely that many of these organizations offer the full range of family planning options, like birth control, particularly long-acting reversible contraceptives like IUDs (which have become increasingly popular since Donald Trump’s election).
What’s most disturbing is that it is clear that the right-wing nuts who have been pushing this anti-woman agenda don’t really care about the unborn. Or the newborn. They don’t care enough about children to renew CHIP on a timely basis or to provide a decent free public education for these children as they grow. So why do they want us to bear them?
Could it be that they just want us pregnant and unable to compete? There was a time when jobs were denied to women using the excuse that we would just get pregnant and quit. Modern birth control methods allowed us to determine when to have children, and employers could no longer slam doors of opportunities in our faces. Are they looking for a return to the 1950s? To the time when America was all theirs?
It is hard with a president like Trump to keep an eye on all of the travesties of his administration. Under his chaotic leadership, we have seen attacks on people of color by Nazis (nice people!), on immigrants and on Muslims, on the disabled, on the LGBTQ community, and on women everywhere. As the straight white men who make up the top level of the patriarchal power structure start to realize that their displacement is inevitable, we can only expect to see more attacks on everyone else. In honor of last week’s International Women’s Day, it seems fitting that this attack would be on us.
Although they have never needed a specific day before.