By Jeni Klugman, The Lancet, October 13, 2020
Women are increasingly recognised as a major force in the US electorate—they represented 53% of voters in the 2018 mid-term national elections. White suburban women helped to secure the victory of US President Donald Trump in the 2016 election, whereas African American women voted overwhelmingly (94%) for candidate Hillary Clinton in that election.
In the upcoming 2020 election, the role of the national government in ensuring women's reproductive rights and justice should be a central concern for all Americans. 4 years of the Trump administration have resulted in major reversals of women's rights and deepened injustices. National protection of women's rights has been systematically eroded, and a series of roll-backs at national and state levels have exacerbated gender and racial inequalities. For example, the current administration's new Title IX regulations narrow the definition of sexual assault and permit direct cross-examination of assault survivors on college campus. The 2019 so-called domestic Gag Rule bars Planned Parenthood and other abortion providers from receiving Title X federal funding, which also pays for family planning services, thereby restricting access to reproductive health services for more than 1·6 million women in the USA. These are among the deliberate actions to limit and reverse women's reproductive rights in a country where the rates of unintended pregnancy are higher than in many other high-income countries: nearly half of pregnancies were unplanned in 2011, the most recent year for which data are available.
Principles of fairness and justice are frequent refrains in US political discourse. Yet women's reproductive health access and outcomes are associated with huge disparities on the basis of race, geography, and income, as documented in a Georgetown Institute for Women, Peace and Security report that ranks the performance of 50 states in terms of women's inclusion, justice, and security. The current US system is characterised by injustice, affecting women of colour worst, especially if they are poor and live in states such as Louisiana, where maternal mortality rates are highest in the country—72 deaths per 100 000 livebirths overall and 112 deaths per 100 000 livebirths for Black women—and there are major constraints on the exercise of reproductive rights. Moreover, 18% of women in Louisiana live in poverty, compared with 12% nationally, rising to 45% among female-headed households in this state. In Mississippi, doctors are mandated to give patients medically inaccurate information when they seek an abortion, such as that abortion might cause breast cancer. More than 90% of women in Mississippi live in a county without an abortion provider; access is even more scarce in Wyoming, where over 95% of women live in counties without access. These are among the key injustices plaguing women's reproductive health that are at stake in the upcoming election. Urgent action is needed to restore and advance women's rights.
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