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Trump’s Plan to Punish Abortion Providers Is Deadly, Horrific, and Totally Predictable

We already know that a domestic gag rule will be catastrophic for women

Photo by Andy Katz/Pacific Press/LightRocket via Getty Images

When President Trump revived the so-called global gag rule — a plan to strip U.S. funding from any clinics abroad that provided or even mentioned abortions; it has been enacted by every Republican president since Reagan in 1984 and overturned by every Democrat — health providers called it a “death sentence.”

Melvine Ouyo, a clinic director in Kenya, said the abortions she has provided to young women have saved them from ruin or worse. Of one such patient, Ouyo said, “[When] she came, she was so suicidal, and she is 20 years old, lives with a family of three [where] living standards are very poor — an open sewer and no access to safe water. She cannot afford to carry a pregnancy to term. And she says, ‘I will die if I cannot [get] assistance or services to terminate the pregnancy.’”

Under the gag rule, Ouyo would be required to send the girl home or risk losing her own funding.

Feminists and health care organizations, such as Doctors Without Borders and the International Planned Parenthood Federation, warned the policy would kill pregnant people without preventing abortions — ironically, since the gag rule works to shut down clinics that provide birth control, abortion rates spike in the affected countries, even as more people die in back-alley procedures. Family planning organization Marie Stopes International predicted that, in Nigeria alone, “there will be an additional 660,000 abortions…with 10,000 women dying as a result.”

And yet, back when the gag rule was first reinstated, it flew almost under the radar — one more piece of bad news in the torrent of awfulness that characterized Donald Trump’s first days. It was perceived, when people noticed at all, as one of Trump’s more conventional and staid decisions. After all, any Republican president would have done the same thing.

Now the gag rule finally comes home to roost on American shores. On May 18, multiple outlets reported that the Trump administration plans to revive and update a domestic rule that penalizes domestic abortion providers, including longtime GOP target Planned Parenthood. Like the global gag rule, the domestic gag order was first put in place by Reagan, in 1987. It works much the same way as the global policy: If an organization recommends abortion to a patient or even mentions abortion as an option, its Title X funding will be stripped. For an organization like Planned Parenthood — which, as of 2015, received more than 40 percent of its funding through the federal government — the effect stands to be catastrophic.

Like the global gag rule, the domestic gag order will almost certainly kill women. Abortions are health care; doctors have to be able to recommend them for health reasons, including complications that endanger the life of the pregnant person or unsurvivable defects in the fetus. No one wants to be told that their much-desired pregnancy isn’t viable or that they can’t carry a pregnancy to term without risking heart failure, but it happens, and when it happens, abortion is often the only ethical choice. Under this rule, federally funded doctors cannot recommend the treatment their patients need to survive.

But in some ways, it’s a cheat to focus on abortions that happen for (physical) health reasons. Even if the pregnant person is perfectly healthy and their pregnancy proceeds without a hitch, the physical and emotional strain of bearing a child against your will has been classified as a form of torture by the UN. Giving a child up for adoption is often traumatic. Raising one against your will is no easier. That this is even a subject of debate demonstrates how little we value the female lives that will be ruined.

There will always be girls, like the one who came to Ouyo, who say they would rather die than continue their pregnancies — and they mean it. We know this because of how many women and pregnant people killed or harmed themselves through common means of trying to self-induce abortion before Roe v. Wade.

This is the cruelty of the rule: Every doctor swears an oath to do no harm. The gag rule requires doctors who are dependent on federal funding to torture their own patients — or to just stand by, knowing they have the power to heal them, and let them die.

Not every health care provider will obey the gag rule. Ouyo ultimately chose to defy it, losing $2 million of funding in the process. But that financial loss meant she had to start charging patients, and some of the poorest could no longer afford help. “It feels painful knowing that someone would benefit from your education, your passion, your career, and you cannot do that,” Ouyo told NPR. “It kills your morale.”

Domestic providers will have to make similarly painful decisions. Under the terms of the Hyde amendment, none of Planned Parenthood’s federal funding could be used to cover abortion services — but what it did cover, including birth control pills, emergency contraception, STD and breast cancer screenings, and hormones for transgender patients, was often life-saving in its own right. Under the gag rule, keeping those services available will mean killing patients — and refusing to kill or traumatize patients who need abortions will mean losing the funds to provide all those other services.

Again, this policy won’t end abortion. Shutting down Planned Parenthood or any other family planning clinic will increase abortions; it’s just that more abortions will be self-induced, unsafe, and fatal. And even if some clinics do find a way to operate without federal funding, it will likely impinge on their ability to treat working-class and poor patients, just as it did in Kenya. So, either Planned Parenthood can start failing its most vulnerable patients or it can just plain fail.

If I seem particularly grim, it’s because we already know how this will work. We’ve been watching it work since 1987. Any American feminist processing her shock or rage or terror has to face the queasy but undeniable fact that this cruelty was road-tested on women in developing nations for decades before the GOP tried it on us.

We also know that, in time, any public outrage greeting this decision will fade. It took three decades, but by the time Trump signed the global gag rule into effect in 2017, it had started to seem almost normal. The U.S. gag rule may inspire visions of a dystopian future, but none more dystopian than the one we live in now, where forbidding doctors from saving their patients’ lives is just business as usual, enacted by one president and repealed by the next, one more dull political football that gets kicked up and down the field, while women and other pregnant patients suffer and die with every changing of the guard.

The Trump administration has never been anything less than clear and explicit about its intent to return the United States to the days before Roe v. Wade — Trump has advocated “punishment” for abortion patients, Vice President Mike Pence has promised that legal abortion will end “in our time.” The domestic gag rule is one of the most sweeping steps the administration has taken toward that end.

Yet it’s not hard to see that other, quieter, more apathetic future barrelling toward us, even now. When the domestic gag rule was announced, it was greeted with a handful of op-eds (including this one), a few hours of social media outrage. And then we moved on: to yet another misogynist spree killer shooting up a school, to a New York Times profile of a man who’s made a fortune arguing that women are innately inferior, to the royal wedding, to the weekend, to our lives. There was barely time to feel what we’d lost, or how limited our lives might now be. And this is horror, too, in a world where the suffering and death of women is normal.

Author of “Trainwreck” (Melville House, ‘16) and “Dead Blondes and Bad Mothers” (Melville House, ‘19). Columns published far and wide across the Internet.

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