Opinion | How the Biden administration should stand up for abortion rights

Publish date: 2024-07-08

Herminia Palacio, MD, is president and chief executive of the Guttmacher Institute. Daniel Grossman, MD, is the director of Advancing New Standards in Reproductive Health (ANSIRH) at UC San Francisco.

As physicians and researchers with experience in using evidence to inform policymaking, we are thrilled with the return of facts and science to the White House.

In the first days of the Biden-Harris administration, we have witnessed the prioritization of bold, evidence-based action to address the covid-19 crisis and to confront racial injustice. We applaud these strong stances, and now urge the new administration to also step up to protect and expand abortion access.

This issue is relevant to racial and social injustice. Black, Hispanic and other people of color, as well as those living on low incomes, make up the majority of abortion patients. They bear the brunt of restrictive policies and disproportionately suffer the consequences.

Six in 10 U.S. women of reproductive age live in states that are, to varying degrees, hostile to abortion rights. They have to navigate an ever-denser thicket of abortion restrictions to get care. Those who are already facing other barriers — which in addition to structural racism, include immigration status, lack of economic opportunity or rural location — are hit the hardest.

The Biden-Harris administration is expected to announce several actions on Thursday to roll back some of the previous administration’s attacks on sexual and reproductive health, rights and justice, including repealing the “global gag rule” and starting the process of restoring the Title X national family planning network.

These steps are important but not nearly sufficient — more are needed. Members of the new administration have said they will defer to experts on public health, and we are happy to oblige them here by making a clear and compelling case for these further policy changes.

Most immediately, the administration should suspend the in-person dispensing requirement for mifepristone (also known as medication abortion or the “abortion pill”) for the duration of the covid-19 pandemic, so that people do not have to risk their health to access needed care.

Medication abortion accounts for almost 4 in 10 abortions in the United States. The science overwhelmingly demonstrates that the abortion pill is safe and effective, can be prescribed via telemedicine and can be provided by mail. This has become the norm in several countries, including the United Kingdom. However, outdated and unnecessary FDA restrictions require abortion pills to be dispensed in specific settings. That requirement was suspended last year during the coronavirus emergency after physicians and advocates sued, but it was reinstated just this month by the Supreme Court.

In this moment, when the country is looking to the administration to heed public health experts, it must suspend this requirement for the duration of the public health emergency and direct the FDA to ensure its medication abortion policies are aligned with the scientific evidence.

Another urgent leadership priority for the administration should be to eliminate abortion coverage bans such as the Hyde Amendment. Hyde targets low-income people for harmful and discriminatory treatment by blocking abortion coverage for those insured by Medicaid, except in the 16 states that specifically require it.

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Because of social and economic inequality linked to systemic racism and discrimination, women of color are disproportionately likely to be insured through Medicaid. In fact, half of the 7 million women potentially affected by the Hyde Amendment are women of color. The administration should set a marker for congressional action by omitting Hyde from its first budget request.

Lastly, the administration is poised to announce an executive action to repeal the “global gag rule” (also known as the Mexico City Policy), which prevents foreign nongovernmental organizations from using their own, non-U.S. funds to support abortion related activities. That’s a crucial first step but the administration must go further by also tackling the harmful Helms Amendment.

Helms is a 1973 policy that in effect prohibits the use of U.S. foreign assistance to support abortion services. Worldwide, there are 35 million unsafe abortions each year, and repealing the Helms Amendment would allow the United States to promote access to safe, dignified abortion services in other countries. Now is the moment to challenge Congress to address the vast disparities and dangerous outcomes produced by this global two-tiered system of legal and restricted abortion access.

Facts matter, and the facts couldn’t be clearer: Abortion is essential health care and plays a critical role in reducing health and social inequities in the United States and globally. As part of righting racial and social wrongs, the administration should immediately suspend the in-person requirement to obtain abortion pills and work with Congress to repeal the Hyde and Helms amendments.

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Opinion | How the Biden administration should stand up for abortion rights