Women’s Reproductive Health


I’d like to begin this essay with the definition of a medical procedure commonly called a D & C, which was developed in the late 19th century. This procedure—a dilation and curettage—involves dilating a woman’s cervix using medication and then scraping the lining of the uterus using a spoon-shaped instrument called a curette. A D & C can be used to diagnose and treat uterine conditions such as heavy bleeding; it can be used to clear the uterine lining after a miscarriage; it can be used to evaluate the endometrial cavity by obtaining tissue for analysis in order to check for a precancerous condition called endometrial intraepithelial hyperplasia in which the lining of the uterus becomes too thick; it can be used to check for uterine polyps; it can be used to diagnose uterine cancer.

Now that the procedure has been defined, you might also want to know that a D & C is also the procedure that is used for a medical abortion.

You no doubt have heard about “women bleeding to death in parking lots” or in emergency rooms after the US Supreme Court overturned Roe V Wade. You might not have heard why this has happened. First, it’s happening in states with strict abortion laws or with laws preventing abortion altogether. Second, it’s happening because emergency room doctors, OB/GYNs, nurses, and practitioners in those states are afraid that, if they are involved in performing a necessary D & C, they will be arrested “performing an abortion.” So when a pregnant woman in one of those states presents in an emergency room with excessive bleeding that signals a miscarriage, there is a very good chance she will not be treated because the hospital personnel wishes to avoid arrest. The woman will then bleed to death.

This being the case, I want to take a look at where the two political parties’ platforms stand on the issue of women’s reproductive health. Lately, the GOP Platform has been a bit of a moving target regarding this issue. The “right to life” has been part of their platform for 40 years. But the overturning of Roe v Wade—while a nominal victory for the GOP—changed the climate since the result sent decision-making on the subject of women’s reproductive health to the individual states. The outcome was something of a mishmash as 20 states quickly drew up draconian laws regarding women’s reproductive rights. Thus what had previously been a fairly straightforward “pro-life” position ultimately became a statement in the platform that the GOP “will protect and defend a vote of the people within a state on the issue of life.” The party will “oppose late term abortion while supporting mothers and policies that advance prenatal care, access to birth control, and IVF.” Additionally, for the moment, everything else appears rather vague, especially when it comes to vetoing or not vetoing a federal ban on abortion should the legislature pass such a law for the President’s signature.

The Democrat Platform calls for a mandate on abortion access up to fetal viability (22 weeks). It calls for rolling back the filibuster (which over the years has morphed into something that is not a filibuster but rather an anvil held over the collective head of the minority party…but more on that in another essay) so that Roe v Wade could be reinstated and made into the law of the land. The Democrats’ candidate has stated that, if elected, she would ensure that women’s reproductive health rights would become the law of the land. Indeed, as a Senator she co-sponsored legislation that would have prohibited states from imposing restrictions on access to abortion.

Aside from the platforms of both parties, there is further information available that explains the position of Project 2025. Although the GOP candidate has indicated that he knows very little about Project 2025, it’s important for us to note that his running mate is fully versed in—and supportive of—the details of its recommendations, and 140 former staffers of the 45th President were actually involved in its creation, so perhaps the voter ought to be skeptical when the GOP candidate disavows knowledge of the project.

Project 2025 makes 7 main propositions. They are:

1.Revoking the Food and Drug Administration’s approval of a drug called mifepristone which is currently provided by clinicians in medical abortions. This would remove the drug from the market. Failing this, the Project proposes reinstating restrictions that limit who can prescribe and receive the medication and forbidding access to it by any method other than the patient’s appearance at a brick-and-mortar clinic, thus ending access to those who receive telehealth care.

2. Codifying into law the Hyde and Weldon Amendments. These are policies that limit abortion care in the US by restricting the use of federal funds (such as Medicaid) to cover abortion care under circumstances in which Medicaid coverage is currently mandated.

3. Denying access to abortion care in emergency situations by dismantling the protections currently in place through the Department of Health and Human Services. (This is the Emergency Medical Treatment and Labor Act). These protections entitle women to abortion care under federal law as part of an emergency treatment. Refusal to enforce the EMTALA’s protections forces care providers to risk criminal charges if they perform lifesaving abortion care. (Hence, the aforementioned bleeding out in parking lots).

4. Implementing a broad anti-sexual and anti-reproductive rights agenda across government by
a. Changing the Dept of Health and Human Services to the Dept of life, with an anti-abortion task force replacing the current Healthcare Task Force and including a “special representative for domestic women’s health” to lead anti-abortion policy efforts across agencies;

b. Deleting all terms related to gender, gender equality, reproductive health, reproductive rights, sexual orientation, and gender identity from all legislation, federal rules, agency regulations, contracts, agency websites, and grants

c. Using US influence at the United Nations to remove language “promoting abortion” from UN documents, policy statements and technical literature.

d. Proposing to increase pregnancy and abortion surveillance at the federal level, including mandating the reporting of abortions, miscarriages, and still births by all states

e. Seeking to redefine sex education as pornography and to replace it with abstinence-only curricula.

5. Encouraging the states to eliminate all Planned Parenthood facilities from their state Medicaid programs while also withdrawing partial Medicaid funding from those states.

6. Undermining two cornerstones of access to contraception by

a. Reinstating the “domestic gag rule” which would prohibit health care providers who receive Title X funding from providing abortion referrals (before this rule was rescinded, it had eliminated reproductive services for 2.4 million patients.

7. Leveraging US influence to undermine sexual and reproductive health and rights globally by

a. Preventing NGOs (non-governmental organizations) from receiving US global health assistance if they use their own non-US funds to provide abortion services, counseling, information, or referrals

b. Applying this aforementioned policy further to include all US foreign assistance, including humanitarian aid.

c. Blocking funding to the UN Population Fund which provides sexual and reproductive health services to women and girls globally

d. Expanding the Trump-Pence administration’s Geneva Consensus Declaration on Women’s Health and Protection of the Family which is anti-rights, anti-abortion, and anti-gender.

Those are the facts as I’ve been able to gather them. Thank you for reading through this.

To conclude, let me say that at this point in the election cycle, I imagine other voters are as exhausted as I am. I imagine there are times when, like me, other voters “just want it all to go away.” The difficulty we face, however, is that not a single critical issue in this election is going to do that. Older people like me can think that nothing the GOP proposes and nothing the Democrats propose is going to hurt them anyway, unless Medicare and/or Social Security are meddled with. But even older people like me do not exist in a vacuum. We have children, grandchildren, and great-grandchildren, and the votes we cast now will reverberate through their lives. I think this is why we have to think carefully and vote carefully so that our vote reflects the future we want to see for those we leave behind when our lives are over.

Elizabeth George
Seattle, Washington
October 13, 2024