On June 16, 2015, Donald Trump declared that he would be running for president of the United States of America. From that moment on, gender issues took center stage in U.S. media discourses, either due to Trump’s previous remarks that had been caught on tape, or the derogatory insults that had been thrown at his opponent, Hillary Rodham Clinton. While some pundits and media put the issue down to “locker room talk”— a reflection of his supposed alpha-male dominance and thus capability to govern—the discourse reflects an ongoing struggle in U.S. politics and policies, at home and abroad, about gender roles, rights, and the American family.

Similar to increased tensions driven by Trump’s campaign and subsequent presidency, the political dynamics concerning gender, women, and family planning have become increasingly contentious. Mobilized by conservative Christian religious ideology and Republican party dynamics that are based in a particular moral and ethical reasoning—and often run in contrast to scientific evidence—the Trump administration has sought to systematically dismantle existing domestic and international agreements, commitments, and funding for women’s health services and family planning. 

For context, the environment surrounding gender rights—specifically in relation to U.S. politics—has been a consistent point of political contention. Prior to Trump’s candidacy and subsequent election, the United States had taken, at times, positions on the issue of women’s rights, including reproductive rights, that had been marred in controversy, resulting in regressive domestic and international policies in comparison to other Western states. For example, the United States was part of a globally transforming position to provide legal and safe access to abortion with the 1973 Supreme Court decision on Roe vs. Wade, joining a handful of states globally that had removed a complete ban on abortion. Although the court’s decision should have settled the matter, the decision on Roe vs. Wade has been a continuous point of controversy that haunts U.S. politics until today. 

Because of conflict over the decision, many state legislators have passed laws making it almost impossible for women to access safe abortions. This includes banning some of the safest medical procedures and imposing medically unnecessary requirements on clinics and providers, such as obligating clinics to meet the requirements of ambulatory surgical centers, a costly and unnecessary set of requirements for clinics providing abortions. Although this may seem like a fringe issue, it has affected a wider spectrum of political decisions regarding the role and rights of women, women’s health, and gender.

Bearing the brunt of the political debate on women’s reproductive rights have been Planned Parenthood clinics, which provide information on and access to abortions, among other health services for women. These other services cover a much wider spectrum of women’s health issues, including breast cancer screening and long-term family planning. Still, many social conservative Republican politicians argue for their closure. In support of this point of view, prior to his election, President Trump threatened to defund the organization at a federal level. Yet, in the same speech, he also praised Planned Parenthood clinics for offering essential services to millions of women. Here lies the contradiction: the opposition to abortion, despite Planned Parenthood not even using federal funds for these services, overrides the reality of essential healthcare to women in need. 

Restricting Funding

Partially fulfilling his election promise, Trump implemented a set of new rules in 2019 to limit funding available to the organization. The first rule, tabled in February 2019, barred organizations that provided abortion referrals from receiving family planning money, meaning that doctors cannot refer a patient for abortion, even when medically necessary. This has arguably created barriers between doctors and patients by effectively putting a gag order on a doctor’s ability to advise patients on all available options, even in cases when the patient is in distress or urgently requires such services. Second, in December 2019, a rule was put forward by the Department of Health and Human Services (HHS) and the U.S. Centers for Medicare and Medicaid Services (CMS) that sought to complicate abortion coverage for insurance companies. The Trump administration moved to curb abortion access by increasing the administrative burden on insurance companies, adding to their costs, in order to dissuade insurers—including those offering coverage through the Affordable Care Act—from offering abortion and family planning coverage. Not only have both rules threatened access to care for millions of U.S. citizens, but the most affected have been low-income, African–American, and women of color. This is reflected in existing mortality rates across the United States, with the country having one of the highest rates of pregnancy and childbirth-related deaths among developed countries; that number increasing exponentially among Black, Hispanic, and Native American women. 

With low-income, minority-ethnic women being the most impacted by these rule changes, it is not surprising that international policy under the Trump administration has also impacted similar demographics. That being said, the United States has historically taken a rigid position on funding international programs related to family planning, particularly if abortion is offered. After the Supreme Court decision on Roe vs. Wade in 1973, the U.S. Agency for International Development prohibited the use of U.S. funds for “information, education, training, or communication programs that seek to promote abortion as a method of family planning”. 

Furthermore, the Reagan administration in the 1980s withheld funding to the United Nations Population Fund (UNFPA). Support for this UN body was contentious because of the belief that it supported China’s sterilization and abortion practices concerning its “one child policy”. Similarly, the United States refused to ratify the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) because of the unsupported notion that the convention would bind the United States to policies allowing “abortion on demand”. Here, and as is evident in the domestic policy context, the issue of abortion in the U.S. political landscape has generated an environment that has put additional limitations on the physical autonomy of women, often most severely impacting low-income and minority ethnic demographics, and consequently limiting access to other necessary health services. 

Global Women Impacted

After the election in 2016, U.S. involvement in global women’s rights became even more restrictive. In 2019, U.S. representatives to the United Nations were accused of watering down the language on the Commission on the Status of Women (CSW) and refusing to reaffirm U.S. commitment to the Beijing Declaration which reaffirms equal rights to women and men, to which the United States was a key signatory in 1995. The U.S. delegation had been accused of undermining Western efforts to ensure basic standards for women’s health, requesting that references to “sexual reproductive rights” as a human right be removed. The delegation included anti-abortion conservatives that had previously campaigned for abstinence-only sex education and lobbyists for Evangelical Christian groups. 

In addition to the Trump administration’s attempt to dilute existing international commitments on women’s rights and reproductive health, the United States has cut funding to the UNFPA, pulling $32.5 million, citing the program’s support of abortion practices. In the wake of this decision, UN officials have reiterated that the program does not support abortion and only uses funds to provide women with access to safe childbirth and outreach programs for individuals facing gender-based violence. 

While the issue of women’s reproductive rights has been a consistent point of contention in the United States, the Trump administration’s position on the CSW and Beijing Declaration marks a noted turn from positions of previous U.S. administrations that had been supportive of these international commitments. Previous U.S. administrations have worked with Western allies to advocate for women’s rights, particularly on global health policy. Although these agreements are not legally binding, they have offered a framework for engagement, empowering activists who would point out the tacit support of international powers and thus use by civil society organizations to pressure their governments to advance laws and policies. 

For women’s civil society organizations in the global south, access to reproductive health is an important feature of women’s health, helping to deflect reproduction of social inequalities and increase economic engagement. Where there has been constrained access to reproductive health services, there have been high numbers of preventable deaths. Limited access to health services has also been correlated to increased rates of HIV infection. By curtailing reproductive health services to women, or weakening international agreements concerned with women’s rights and health, the result is increased numbers of premature and preventable mortality rates among women. Yet, it is not only women that are affected by these decisions; the limitations placed on women’s access to health services impacts children and increases rates of stillbirths. 

While the impact on children may not be direct, the negative consequences can be traced back to these policy positions. Studies have shown that, because women are—by and large—the caregivers in a family, they are more likely to reinvest their income into their families. On average, women reinvest 90 percent of their income in maintaining a household; in comparison, men average 30–40 percent. What this means is that children who lose their mothers are more likely to fall into systemic poverty, if they survive past the age of two. When women’s health is prioritized, not only is the quality of family life upgraded, but there are greater systemic benefits overall, including higher levels of GDP and increased opportunities to break cycles of poverty.

While the positives of investing in women’s reproductive health are particularly evident, governments have been reluctant to make the necessary commitments. Governments, globally, have cited, primarily, a mix of ideological, religious, and cultural reasons for being disinclined to invest in women’s reproductive health. These reasons resonate across North–South and West–East divisions, where women tend to engage in invisible forms of labor, leading to assumptions that investment in their bodies and health is considered a frivolous expenditure that risks the moral degradation of society. Although abortion is probably the most controversial aspect of women’s health, reproductive rights, and family planning, it is also a quintessential issue of female agency. Whether one agrees or disagrees with the procedure, the restraints imposed on women remove their bodily autonomy and reproduce gendered social and political disparities, patriarchal values, and paternalist governance. 

In relation to current U.S. political trends that rely on moral reasoning for the curtailing of women’s reproductive rights, it is expected beyond reasonable doubt, that the impact on women’s health and reproductive rights, domestically and globally, would be negatively impacted should President Trump be reelected. Indicative of this future are not only threats to existing domestic programs and attempts to water down language in international agreements and commitments, but the nomination of Amy Coney Barrett to the U.S. Supreme Court. Although female representation in high office of government is important, Barrett’s politics are distinctly patriarchal. Since being nominated by the president, information on Barrett’s ties to a socially conservative religious group that propagates “traditional” gender roles and female subservience poses a potential threat to civil rights legislation related to gender and sexuality, including her support for overturning Roe vs. Wade. Similarly, Trump’s Supreme Court nominee reflects U.S. policy choices on a global stage, particularly with regards to the CSW, where the individuals engaged in global discussions on women’s rights, despite being women, actively sought to dilute existing commitments.  

Funding From Other Countries?

Should Trump be reelected for a second term, and if he continues with the same political agenda as his first term, we can only hope that other countries will step in to support and fund programs related to women’s rights and healthcare. Despite affirmations from other Western states to uphold international agreements and maintain commitments related to women and gender policy, there continues to be a number of problems. First, newly empowered ideologues, working locally in the global south, are lobbying domestic governments against family planning access. Second, there is the issue of a damaged global U.S. reputation. 

With regards to the former, despite appearing far-fetched, the social conservative base that has supported Trump and his vice-president, Mike Pence, has been actively engaged in petitioning governments across Africa to criminalize sexual deviancy based on moral and religious platforms. It therefore would not be surprising if those groups, or groups with similar objectives, actively sought to constrain women’s access to reproductive health for moral and religious reasons. As for the United States’ own domestic policy toward reproductive health and family planning, the most affected will be low-income and minority-ethnic women, who otherwise depend on international advocacy and programs related to women’s health access. In relation to the second point, although one can only speculate how a diminished global reputation will impact international U.S. leadership, we can assume that other governments will effectively undermine established U.S. norms and structures. This could provide opportunities to some governments to withdraw from agreements and treaties, ignore them altogether, or refuse to cooperate with international organizations on the status of women. 

In contrast, running against Trump, former Vice-President Joe Biden has promised to expand healthcare access and tackle inequalities inherent to women’s healthcare. His domestic promises, as stated in his election campaign, would be reflected in renewed international commitments. Biden has promised to curtail U.S. mortality rates among women during pregnancy and childbirth by developing policies that put women’s health at the forefront by investing in preventative care and early support. He has also promised to stop states from violating Roe vs. Wade, restore funding to Planned Parenthood, reverse gag orders that prevent doctors from talking to patients about abortions, and seek to ratify CEDAW. Biden’s promises are wide-ranging: not only do they go beyond domestic and international commitments to women’s health and safety, but they also will actively attempt to rectify economic inequalities in wage gaps, childcare, and access to education. 

While Biden and his running mate, Kamala Harris, have a significant and diverse political platform, the ability to enact these changes will largely depend on the make-up of the U.S. House of Representatives and Senate. Should the Democratic party sweep the elections, maintaining a hold on the House of Representatives and overturning Republican control of the Senate, Biden will be able to follow through on his domestic and international policies unencumbered. This will facilitate reengagement with progressive policies and help the United States rebuild its global reputation, inclusive of areas to do with women’s reproductive health and with reaffirmations and reengagement in the work conducted by international organizations to advocate for and provide assistance to women. In the case that the Democratic party does manage to gain control over the executive and legislative branches of the U.S. government, the United States would be able to reinvest and ratify agreements, but it remains to be seen whether trust in U.S. global leadership can be redeemed.

The best outcome following the 2020 elections is, without doubt, a Biden victory that fulfills the broad political promises on women’s rights; engages in a platform of political pragmatism; and breaks away from an obsession with the politics of abortion. However, a victory that gives way to such a sweeping cultural-political transformation will also depend on an outcome that flips the Senate in favor of a Democratic majority. Most affected by these outcomes, however, are the lives of low-income and minority women in the United States and abroad—particularly those that benefit from public funding and international programs. The myopic focus on abortion has had, and continues to have, a wider impact that diverts attention, not just from issues of female bodily autonomy, but from crucial access to health services and from beneficial political platforms used to engage in advocacy.