Biden's plans are bold, but are his promises achievable?
As the world watched on November 7th 2020, Democrat Joe Biden won the U.S. Presidential Election after days of nail-biting and vote counting, denying President Donald Trump a second term in office. As cofounder of fertility startup, ELANZA Wellness, like so many other women and people affected I was watching extra carefully. I’m acutely aware of the impact U.S. politics has on how the world polices reproduction, and the tone of the incoming laws and convictions that govern it. It had become clear the outcome of this election was going to have a massive, direct impact on women’s health issues both in the USA and globally for many years to come.
Politicians, lawmakers and leaders from all walks of life continue to argue over who has jurisdiction over womens’ bodies, including how and when they reproduce. This includes everything from contraception and parental leave, to preventive care like mammograms, access to fertility treatment and maternal mortality rates. Who the President is carries serious implications for who wins those arguments.
Partisan politics tends to reduce the discourse around reproductive health to a single issue: abortion. Biden’s stance on the subject has evolved and liberalized over the decades he has been in politics and now sits in line with the majority of the Democratic Party. But the politics of reproductive health stretch far beyond Roe v. Wade. As Reuters put it, Joe Biden as U.S. president will bring “sweeping changes to women’s reproductive rights globally.” The former Vice President has already voiced a commitment to championing access to sexual and reproductive health care.
Over the last four years, campaigners have claimed that Donald Trump’s deeply divisive leadership has threatened the reach and quality of reproductive health care. He has led efforts to repeal the Affordable Care Act, elevated the religious beliefs of employers over women’s rights to control their own reproductive processes, and limited access to essential health services both domestically and around the world.
The policies and record of President-Elect Biden, in stark contrast, support expanding access to a range of reproductive health care and look likely to bring into law changes that will reshape and strengthen women’s health services. His campaign released The Biden Agenda For Women, a plan that specifically outlined expanded access to health care, how to tackle health inequities and moves he would make to help women navigate work and families. A significant portion of this plan is based on reversing or changing positions taken by the Trump administration.
So what does that mean in practice? What can we expect a Biden administration to change over the next four years? Here are 10 of Biden’s key plan pledges from the women’s agenda around reproductive health and family building in turn:
1. TO HELP WOMEN NAVIGATE WORK AND FAMILY
In the United States, women overwhelmingly take on the day to day responsibilities of caring for their families. While women represent nearly half of the U.S. workforce, they still devote more time than men on average to housework and child care.
Currently 8 in 10 workers don’t have dedicated paid family leave to care for a new child or a loved one. Biden plans to bring the US in line with most other countries in the developed world by guaranteeing up to 12 weeks paid leave for all workers based on the FAMILY Act. This leave can be used to care for newborns, newly adopted or fostered children (as well as for their own or family member’s serious health condition). He also supports the Healthy Families Act, which would allow workers to accrue and use up to seven job-protected days of paid sick leave per year.
As the Biden Agenda points out:
“Only one in six American workers typically has access to paid family leave if they need it...the lack of family friendly policies is causing many women to leave the workforce completely.”
He also has plans to make high-quality child care affordable. For instance, families will get back tax credits for as much as half their spending on child care for children up to age 13, up to a total of $8,000 for one child or $16,000 for two or more children.
There will also be provision for access to affordable, high-quality child care on a sliding scale for low-income and middle-class families who would prefer this option over the tax credit for young children.
Biden also supports expanding the coronavirus emergency paid sick and family leave benefits to include all workers and supports fair and flexible work schedules. Women most often are the ones who adjust their schedules and make compromises when the needs of children and other family members collide with work, Pew Research Center data show.
2. TO END DISCRIMINATION AGAINST PREGNANT AND NURSING WORKERS
Biden has specifically laid out plans to support the Pregnant Workers Fairness Act, making sure that employers offer pregnant and nursing workers reasonable workplace accommodations like short breaks or easy access to water.
3. TO REDUCE MATERNAL MORTALITY
Approximately 700 women die each year in the U.S. because of pregnancy or delivery complications, most of which are preventable. That means the US has one of the highest deaths related to pregnancy and childbirth out of all developed nations. There are also pronounced racial and ethic disparities and gaps in care in rural communities. Horrifyingly, the maternal mortality rate across the US is not falling - in fact, it has risen over the past few decades.
Not so in California, which actually saw maternal mortality decline by 55% between 2006 and 2013 after it implemented a strategy of safety bundles that included implicit bias training for health workers and placing hemorrhage carts (similar to crash carts) in maternity departments. Biden plans to take this California strategy “nationwide.”
4. TO BOLSTER THE AFFORDABLE CARE ACT (ACA) FOR FREE, PREVENTIVE CARE
Biden has pledged to support the The Affordable Care Act’s (ACA) expansion, helping connect more women to contraception and better care before, during, and after childbirth. Research has found that the maternal mortality ratio is lower in states that have adopted Medicaid expansion through the ACA compared to non-expansion states.
Since the Act came into effect in 2012 it has also strengthened access to coverage for millions of women in the U.S. For instance, it expanded birth control with no co-pay to 63 million women. It also made it illegal for insurance plans to discriminate against women (plans are now banned from charging women more for coverage than men) and it also offers protection against discrimination on the basis of pre-existing health conditions, including pregnancy. Additionally, all plans must include certain preventive services, including prenatal and well woman care, and FDA-approved contraceptive services and supplies at no cost.
However, the ACA’s future is uncertain as it is currently the focus of a major Supreme Court case, supported by President Trump, that seeks to overturn the entire law with no plans to replace it. A group of 20 states, led by Texas, have sued the federal government seeking to have the entire ACA struck down. These states are represented by 18 Republican attorneys general and 2 Republican governors. The case could have consequences for nearly every single American.
In reality, expanding the ACA may prove difficult for Biden even if this particular case is not held, as more lawsuits are expected. Several Republican Attorney Generals have pledged to undercut the new administration, and the courts at every level all the way up to the Supreme Court have become more conservative under President Trump’s leadership.
5. TO RESCIND THE GLOBAL GAG RULE
A key anticipated early move by the Biden administration will be to rescind the U.S. “Mexico City” policy banning government-funded aid groups from mentioning abortion. As Biden’s Agenda puts it:
“This rule currently bars the U.S. federal government from supporting important global health efforts — including for malaria and HIV/AIDS — in developing countries simply because the organizations providing that aid also offer information on abortion services.”
Biden also plans to reverse the domestic gag rule, which restricts providers that offer abortion referrals from government funding. The “gag rule” forced the closure of clinics and some studies estimate up to 26 million women and families lost access to contraceptive services. Women’s rights advocates say the policy has led to unwanted pregnancies, unsafe abortions and preventable deaths.
Campaigners also hope that under Biden, the Global Health, Empowerment and Rights (HER) Act, which was introduced in Congress in 2019, will be passed. This law would repeal the Global Gag Rule and prevent a future president from unilaterally reinstating it.
Under Biden, we can also anticipate further global impact through the restoration of U.S. funding to the United Nations Population Fund (UNFPA), which exists to protect and promote the reproductive health and rights of women and girls.
6. TO STOP STATE LAWS VIOLATING ROE V. WADE
President Trump nominated Judge Amy Coney Barrett to fill the Supreme Court vacancy left by the death of progressive Justice Ruth Bader Ginsburg. Judge Barrett has gone on record criticizing the Roe v. Wade decision and opposes abortion. More than 20 states are poised to ban abortion if the central legal precedent case Roe v. Wade is overturned.
Biden, in contrast, has called abortion procedures an “essential health service.” As president, he may codify Roe v. Wade, in line with Democratic Party policy. It is not currently included in the Constitution. Asked for his plan, Biden responded:
"Number one, we don't know exactly what she [Amy Coney Barrett] will do, although the expectation is that she very well may overrule Roe, and the only responsible response to that would be to pass legislation to make Roe the law of the land.”
7. REPEAL THE HYDE AMENDMENT
The Biden campaign’s plan also stated his administration will “do everything in its power to stop the rash of state laws that so blatantly violate the constitutional right to an abortion, such as so-called TRAP laws [or targeted restrictions on abortion providers], parental notification requirements, mandatory waiting periods, and ultrasound requirements.”
The Hyde Amendment is a legislative provision that bans the use of federal funds to pay for abortion except to save the life of the woman, or if the pregnancy arises from incest or rape. Biden declares that he will repeal it “because health care is a right that should not be dependent on one’s zip code or income.”
Although the Supreme Court ruling in 1973 made abortion legal in the United States, states are still able to place restrictions on the procedure. And in practice, in 2020, some states such as Florida, Missouri and Texas, have implemented hundreds of abortion limitations.
A study published in Lancet Global Health shows that more than half of unintended pregnancies (61%) currently end in abortion, that abortions occur in all countries, even in those with restrictive abortion laws, and abortion rates are actually lowest in high-income countries where abortion is broadly legal. The higher number of abortions in low- and middle-income countries is likely explained by a lack of access to a range of contraceptive options that are affordable and acceptable.
8. RESTORE FUNDING FOR PLANNED PARENTHOOD
Biden’s plan declares that he aims to restore federal funding for Planned Parenthood and reissue guidance specifying that states cannot refuse Medicaid funding for Planned Parenthood and other providers.
He wants to reverse the Trump Administration’s rule preventing these organizations from obtaining Title X funds. Access to and funding for contraception via the federal Title X family planning program - which supports the delivery of reproductive health services, including contraception, to low-income people - had suffered significant financial cutbacks.
9. TO DEFEND ACCESS TO QUALITY, AFFORDABLE HEALTHCARE FREE FROM DISCRIMINATION
Whilst the Obama-Biden Administration made it illegal for insurance companies to increase premiums based on gender, sexual orientation or gender identity, this was repealed by President Trump.
Biden plans to try to ensure comprehensive care coverage, including for care relating to gender confirmation surgery. He additionally plans to ban controversial homosexual “conversion therapy.”
10. ENSURE PROVISION OF GYNECOLOGICAL CARE FOR INCARCERATED WOMEN
Biden’s Agenda also states that federal criminal justice grants will be conditional on adequate provision of primary and gynecological care for inmates, including for pregnant women.
So, can President-Elect Biden achieve these goals?
When he takes office in January, Biden has a lot of work on his plate, especially considering he is likely to face a very divided Congress and potentially a Republican Senate. Depending on the outcome of the Georgia runoff at the beginning of 2021, as NBC points out, Senate Majority Leader Mitch McConnell would have power over Biden’s “legislative agenda, cabinet picks and judicial nominees.” Republicans are campaigning hard to keep control of the Senate to keep Biden’s progressive plans in check, and he could be the first president since 1989 to enter office without full control of Congress. Given the pressing need for bipartisan support on issues around COVID-19, Biden may potentially need to redirect his energies away from healthcare issues like those set out in his women’s agenda in order to gather support to tackle the pandemic.
There is also the question of the Supreme Court, which is now dominated by conservatives who can rule on reproductive health issues that go beyond Roe v. Wade. Justice Amy Coney Barrett’s nomination even saw top doctors and the editors of leading specialist journal Fertility and Sterility publish a letter in protest, for the first time in the journal's 70-year history. The authors Craig Niederberger, M.D., Eve Feinberg, M.D. and Antonio Pellicer, M.D. called Barrett’s nomination "an enduring step backwards for womens' individual liberty" that could lead to changes to legislation that could mean greater health risks to women and lower pregnancy rates and that Barrett’s appointment “threatens those who seek to build a family through in-vitro fertilization," whilst “scientific advances in the field would come to an immediate and devastating halt without the ability to continue reproductive research.”
In addition to lawmakers and Supreme Court judges, the fundamentally conservative beliefs of what may be half the US population have also been heard and made clear throughout President Trump’s tenure, and that is something any politician will need to take note of. President-Elect Biden has already declared that his presidency is a time to “heal” and come together, which may require compromise and careful consideration of which progressive battles to fight.
November 7th 2020 also happened to be my 35th birthday. As the TV news blared increasingly angry, elated, and divided voices, as memes spread like wildfire, as the world turned its curious, cautious gaze once more to America and its politics that seem to symbolize the best and the worst of us all, and as once again two men and their contrasting beliefs stood centre stage, I blew out my candles with a simple wish.
Progress.
Biden’s Agenda for Women contains many promises of it, but promises aren’t enough.
Perhaps it’s a sign of his commitment to action rather than simple rhetoric that Biden selected a woman as Vice-President, one who not only shares his positions on women’s health ("Are we going to go back to the days of back-alley abortions?" Vice President-Elect Kamala Harris has said. “Women died before we had Roe v. Wade in place.”) but is willing to challenge him and has previously set her own confident vision for future policy direction.
Back in 2018 during Brett Kavanaugh’s Supreme Court hearings, Harris questioned him specifically around women’s reproductive rights.
"Can you think of any laws that give government the power to make decisions about the male body?" she asked.
"I'm not thinking of any right now, Senator," Kavanaugh replied, after an awkward pause.
Indeed.
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Catherine Hendy is co-founder of ELANZA Wellness and co-author of Everything Egg Freezing (available on Amazon). ELANZA Wellness is a reproductive healthtech company on a mission to revolutionize reproductive healthcare. By combining technology with high touch care, ELANZA works with patients and clinics to help reduce the gender data gap, reduce the psychological burden of fertility treatment, and increase outcomes for people worldwide. Learn more about ELANZA Wellness at www.elanzawellness.com and on Twitter, Instagram and LinkedIn.