How Biden Can Rebuild America's Reproductive Services, Decimated by Trump | Opinion

The U.S. just passed the somber milestone of 4 million COVID-19 cases in a single month (November). With the holiday season upon us, experts warn that gatherings of family and friends will accelerate the spread. Trump's policies and rhetoric aren't helping.

The virus also has a secondary effect on reproductive health, which the Trump administration has also exacerbated. The pandemic impacts reproductive decisions, with many people preferring to delay pregnancy and/or have fewer children. That makes reproductive health services all the more crucial, but they're harder to access because of Trump's policies.

Restricting access to reproductive health services is especially damaging in the midst of a pandemic, but that's exactly what the outgoing administration and its allies in statehouses have done. To help restore it, the Biden administration could facilitate access to reproductive telemedicine.

In the U.S., the fertility rate (the number of children a person has in their lifetime) has been declining for decades. In fact, the U.S. fertility rate pre-pandemic was the lowest it has been since 1985. COVID-19 has accelerated this trend. Childbirth can be expensive and medically risky for many Americans, and the pandemic has heightened those concerns.

The social and financial situations of American women are a major factor. The U.S. is the only developed country that doesn't guarantee paid family leave for new parents and does not offer universal childcare or pre-K, which puts pressure on working parents. School closures in the pandemic are disproportionately affecting women, who bear the lion's share of childcare, making moms twice as likely as dads to leave their jobs in 2020. These job losses have long-term effects on women's financial stability, and consequently, long-term effects on their reproductive decisions.

At the beginning of the pandemic, many conservative politicians used the crisis to ramp up attacks on reproductive health and rights. Pressed by anti-choice advocates, state officials included procedural abortions in their bans on non-essential surgeries. Pro-choice groups fought back in court. As the grip of the virus loosened over the summer, so did restrictions on elective medical procedures. But as cases rise again, and shortages of ICU beds in some hospitals recur, conservatives will no doubt use it again as a pretext for restricting abortion access.

The pandemic disproportionately affects people according to class, race, ethnicity, and sexuality. That includes its impact on sexual and reproductive health. Because of COVID-19, Black and Hispanic people, queer people, and low-income people are more likely to want fewer children or delay having children compared to their white, straight, and higher-income counterparts. They are also more likely to worry about affording or obtaining contraception during the pandemic. Trump and GOP-dominated states' policies cut reproductive health services, disproportionately affecting people of color, queer people, and lower-income people.

To reduce those disparities and restore availability of comprehensive reproductive health services for everyone, telemedicine could help. Since the beginning of the pandemic, online health clinics are reporting an increase in patient requests for birth control, as well as an increased demand for emergency contraception. Telemedicine can also offer significant advantages for those seeking medication abortions (i.e. mifepristone, known as the "abortion pill"). It eliminates the risk of spreading COVID-19 and lowers the barriers of needing to travel long distances to an abortion clinic and the associated costs.

But anti-choice politicians are trying to shut down online delivery of these services. Despite its track record of safety and effectiveness, GOP Senators are urging the FDA to ban mifepristone. The Trump administration even asked the Supreme Court to reinstate the FDA requirement of in-person dispensing of the medication, something reproductive health advocates say should be waived during the pandemic.

The incoming Biden administration can and should move to expand access to reproductive telemedicine. In the pandemic and in its aftermath, we have an obligation to meet reproductive health needs and respect reproductive rights. We can't exercise those rights without effective access to reproductive services. It will take time to rebuild the physical capacity of reproductive health clinics lost during the Trump years. Meanwhile, telemedicine could let Americans exercise their rights online.

Vina Smith-Ramakrishnan is a Werner Fornos Fellow with the Population Institute, a nonprofit based in Washington, D.C. that supports reproductive health and rights.

The views expressed in this article are the author's own.