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Watchful waiting: Trump and women’s health care in Louisiana 

Women’s wellness groups brace for blowback from the incoming Trump administration.

click to enlarge COURTESY PLANNED PARENTHOOD
  • COURTESY PLANNED PARENTHOOD

In October, a University of New Orleans poll of likely voters suggested a slight edge (44 percent to Hillary Clinton's 41 percent) for then-candidate Donald Trump among Louisiana women. Nationally, women disagreed. As reported by The Washington Post's analysis of exit polls, just 41 percent of women voted to trust Trump with their interests.

  We know how that turned out. Despite women nationwide voting for his opponent, Hillary Clinton (Trump received single-digit support from women who identify as black), President-elect Trump will be responsible for decision-making and appointments, including key Cabinet positions and at least one Supreme Court seat, that will directly affect women and women's health.

  In interviews with Gambit, several Louisiana women's wellness organizations shared concerns about what the coming years may bring for their constituents. Many pointed out that the state already presents a challenging environment for their groups, whose work includes access to health care and abortion, services for sexual assault survivors and safety from harassment. In the next four years, they'll continue their work in the shadow of a presidential administration that, to them, seems particularly ominous for women's health issues.

  Few specific policy proposals have been revealed — but campaign chatter and the political record of Trump appointees and actions of likeminded legislators foretell hostility to issues typically championed by women's wellness advocates. During the third presidential primary debate, Trump implied he'd work to appoint Supreme Court justices who would overturn Roe v. Wade, which made abortion legal. The Ohio Legislature already is heading down that path, last week passing a bill that makes abortion illegal if a doctor detects a heartbeat in the fetus, which can happen as early as six weeks, often before a woman knows she's pregnant. The Planned Parenthood Action Fund has issued multiple statements condemning Vice President-elect Mike Pence. Tom Price, who is poised to become head of the U.S. Department of Health and Human Services, has long expressed the desire to eliminate the Affordable Care Act (ACA), which has many provisions specifically benefiting women.

  Kirby Smith, media relations coordinator for Planned Parenthood Gulf Coast says the potential loss of the ACA could have far-reaching effects on women's health.

  "We know that about 55 million women rely on the Affordable Care Act for health care, for access to no-copay preventative services, for things like birth control, STD screenings, [and] lifesaving preventative screenings including breast cancer screenings and pap tests," she says. "If the Affordable Care Act were repealed ... that landmark access to health care that women are afforded could be jeopardized."

  Some provisions of the ACA have made it easier for a greater number of women to receive Planned Parenthood's services. The ACA's requirement that insurance cover contraceptives without patient cost-sharing has made birth control more affordable and given women more choices as to what form of birth control to use. For example, contraception provisions built into the ACA have helped make long-acting intrauterine devices (IUDs), which can cost between $500 to $1,000 out of pocket, more accessible to women.

  Planned Parenthood also could take a hit on another front in the upcoming years as the ongoing political fight over its federal funding finds support at the top of the ticket. Defunding Planned Parenthood is a favorite cause of Vice President-elect Mike Pence and a common Republican rallying cry, often based on opposition to abortion. (No federal funding of clinics can be used for abortion services, as spelled out in the the Hyde Amendment.)

If the Affordable Care Act were repealed ... that landmark access to health care that women are afforded could be jeopardized.
Kirby Smith Media Relations Coordinator for planned parenthood Gulf Coast

  Smith says limiting health care for women by depriving the organization of funding for basic contraceptive and preventive services could have "devastating" consequences — especially for women who already struggle with access to care, including people of color, rural residents and low-income people.

  "[Planned Parenthood] is often the only place that offers the screening or birth control method [some populations] need and rely on," she says. "Our patients aren't making a political statement when they come here for care."

Though Abortion remains a controversial issue, Smith points out that maintaining women's access to abortion is supported by a majority of Americans. (A 2016 Pew Research Center poll found 56 percent of Americans support abortion rights in all or most circumstances.) A presidential administration that openly opposes the constitutional right to abortion would be a dangerous scenario for women in need of those services, who could be forced to travel hundreds of miles, wait weeks and lose wages as they search for clinics offering abortions.

  The New Orleans Abortion Fund (NOAF) supports abortion access by offering financial assistance for women seeking pregnancy terminations, which can be prohibitively expensive. NOAF executive director Amy Irvin describes the work of abortion rights proponents in the state as difficult — "Louisiana is kind of a petri dish of anti-choice laws," she says — and anticipates continuing challenges in a state that already has some of the country's most restrictive abortion regulations, including the recent implementation of a bill requiring a 72-hour waiting period for abortion services — a bill backed and signed by Democratic Gov. John Bel Edwards.

  NOAF plans to continue helping Louisiana women obtain funding for abortion services, providing clinic escorts and advocating for women's abortion access, especially on the state and local level. Both Irvin and Smith say one positive aspect of the election has been the support Planned Parenthood and NOAF have received from the local community, including donations and interest in volunteering.

  "[We] are certainly thinking about additional programming and advocacy efforts, moving forward in a new sort of landscape," Irvin says.

click to enlarge Members of BreakOUT! at a press conference outside New Orleans City Hall. - KAT STROMQUIST
  • KAT STROMQUIST
  • Members of BreakOUT! at a press conference outside New Orleans City Hall.

Beyond reproductive rights and access to health care, another facet of women's wellness involves safety: protecting women from harassment and violence; advocating for women who have experienced sexual assault, including the provision of hospital advocates and mental health services; and fighting "rape culture," or the normalization and acceptance of sexual assault in society. In this, too, the upcoming administration does not bode well for women. From the dismissal of what many took to be Trump's description of sexual assault as "locker room talk" to Pence's clashes with transgender rights groups, prospects look grim.

  Margaret Reynolds, regional director of Sexual Trauma Awareness and Response (STAR), an organization that provides counseling, medical and legal services to sexual assault survivors and their loved ones, says concerns first rose at the organization during the presidential campaign.

  "Across the nation, when Trump was running in the last weeks and those women were coming out and saying, 'You know, [Trump] sexually assaulted me,' numbers went up on (our) hotlines. ... People were triggered," she says. "It's a scary time, I think, for a lot of survivors."

  An uptick in calls puts pressure on the small organization's resources — it has only five full-time employees and is the only stand-alone sexual assault clinic in Louisiana. Reynolds says STAR is training more advocates, and the organization has increased its fundraising efforts to prepare for ongoing challenges.

  Other organizations are taking a more overt lobbying role. On the Transgender Day of Remembrance (Nov. 20), the LGBT rights group BreakOUT! met on the steps of New Orleans City Hall for a press conference in the wake of the election. Member and organizer Nia Faulk reminded listeners that transgender women face the same issues cisgender women do, including vulnerability to domestic and sexual violence — often in higher percentages than in the cisgender population. (Transgender women also struggle with access to health care; a 2016 Health and Human Services directive moved to mitigate this by barring discrimination by insurers and health care providers based on gender identity — but that provision is contained in the ACA, meaning it's subject to repeal.)

  BreakOUT! will focus on state and local representatives, lobbying for the equal treatment, safety and economic opportunity for trans and gender-non-conforming people.

  "It is a political act to take up space and to be seen," Faulk said. "We'll be doing the same things that we were doing [before], times 10."

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