Women’s healthcare under Trump

Iona Jenkins

Whilst the previous system determined financial aid for medical needs on family income, local cost of health insurance, age and smoking status, the new Republican plan tax credits on age, without taking other crucial considerations into account.

One of the key changes to the American healthcare system set out by the Patient Protection and Affordable Care Act, nicknamed Obamacare, is to the prohibition on charging women more than men for the same health plan, and the compulsory provision of maternity care and contraceptives. The basic Republican plan essentially sets out the grounds to allow waivers for health insurers to drop coverage for both of these necessities. Moreover, the bill bans women from obtaining plans that cover abortion, even in medically advised cases, as well as ending non-abortion Medicaid reimbursement to the non-profit group Planned Parenthood, which provides abortion services in some clinics.

Trump’s election sparked a boom in the number of women obtaining IUDs. IUDs are a long-term form of birth control, proven to be more than 99% effective. According to data from Athenahealth, fluctuations in such rates mirror the actions and attempts of the Trump administration to repeal Obamacare, and such actions have induced a 16% increase between 2016 and 2017, showing that at least 134,285 women have had an appointment with a doctor for IUD prescription/insertion since Trump’s election. In fact, the sharpest increase of 38% and 1.5 million patients receiving a form of contraceptive management was in January 2017, Trump’s inauguration month.

The nominal fee for an IUD is $1000, which, as an up-front fee for contraception, is large. However, it is extremely beneficial to women who do not wish to have children for a foreseeable duration of time, and is one of the more effective forms of contraception on offer, as well as being highly recommended by doctors.

On January 18th, the Trump administration moved to protect healthcare workers who refused to perform abortions and other related medical procedures on religious or moral grounds. This has been seen as a violation of civil rights and has caused fear among medical groups that this will generate unlawful discrimination.

A new division, the Conscience and Religious Freedom Division, was created by the U.S. Department of Health and Human Services to contemplate such matters. Whilst the move has been praised by conservationist Christian advocacy groups in support of President Trump, critics of the move fear that it will cause discrimination against gay and transgender patients in the name of religious grounds, as well as abortion or contraception requests. Louise Melling, the American Civil Liberties Union’s deputy legal director, has stated that this will mean ‘they prioritise religious liberty over women, transgender people and others’, further emphasising the suggestion that the new division’s move will encourage a broader range of objections to certain groups of patients who already face discrimination on religious grounds outside of the healthcare sector. Trump’s Justice Department has stated that sexual orientation is not a protected category.

One of Trump’s first acts has been to reinstate a ‘global gag rule’ policy which prevents the US government from funding family-planning organisations or groups such as Planned Parenthood which offer abortion or contraception-related services. Trump has also spoken in support of defunding Planned Parenthood and has signed legislation that set in motion the ability of state and local governments to block abortion clinics from receiving federal funds.

Most of those who disapprove of abortions on religious or moral grounds fail to appreciate that abortions are often medically necessary in terms of both the mental health and physical health of the mother and the foetus. For example, abnormalities may affect the normal course of pregnancy thus a doctor may recommend an abortion. Such abnormalities may include, but are not limited to, chromosomal defects or abnormal implantation. Often, though not always, cases like these would cause the foetus to be spontaneously aborted without the discretion of the mother or doctor. Some examples of medical issues that are likely to require abortion to protect those involved are:

  • Intrauterine foetal death– abortion is recommended if death occurs before 24 weeks gestation; otherwise, the patient must undergo labour induction instead
  • Premature rupture of membranes– if the foetal membranes rupture before the foetus can survive outside the uterus; normally this will cause a miscarriage
  • Placental separation– placental separation from the wall of the uterus can cause heavy bleeding and blood loss which can be life threateningPicture1
  • Foetal congenital birth defects- some are incompatible with life, meaning the newborn dies shortly after birth or causes a vastly shortened life expectancy or disability e.g. anencephaly, spina bifida

 

Maternal medical conditions that cause an abortion to be medically necessary include:

  • Cardiovascular diseases– heart and lung function can deteriorate due to physiological changes during pregnancy; this can cause organs to fail
  • Preeclampsia– this is a direct result of pregnancy difficulty, and can cause liver dysfunction or failure, blood clotting and haemorrhage, strokes or death
  • Renal disease– abortion is necessary if complications from such diseases worsen during pregnancy and put a woman’s life at risk
  • Cancer– cervical, breast or uterine cancers may be found during screening during pregnancy; treatment requires chemotherapy or radiotherapy which can severely harm the foetus

If the mother may be put in a life-threatening situation as a result of continuing with a pregnancy, which would likely result in the death of the foetus also, then it would seem prudent to value the life of the mother rather than resting the decision solely on the situation of the foetus. This, of course, comes to a matter of moral discretion; however, it should be the discretion of the woman whose body and health is in question rather than that of the laws of an administration run by men.

According to the NHS, one in three women will have an abortion in their lifetime, thus proving that this is a common, normal procedure required by many women. Moreover, this statistic shows that it is not a procedure to be condemned or banned. All women should have the right to be able to decide when they want to have a child and the circumstances in which they choose to do so.

 

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