Donald Trump's name adorned the first casino in America to have an in-house strip club. He is the first American president to have made a cameo appearance in a soft-core pornography film, and he has called his struggle to avoid sexually transmitted diseases while sleeping around his "personal Vietnam." When Trump the candidate was asked last year whether any of his paramours had had an abortion, he refused to answer.
This is not a man who shares the longtime Republican goal of rolling back the sexual revolution. Nevertheless, after nearly six months in office, Mr. Trump has already surpassed George W. Bush as the American president most hostile to reproductive rights and measures to promote sexual health. There is a deeply insulting irony in this: American women are being stripped of their sexual and reproductive autonomy not by a moralizing puritan but by an erotically incontinent libertine.
This will be true whether or not the Republicans' health care plan ever passes - though that plan, with its multifaceted attack on obstetric and gynecological care, is a particularly bald expression of contempt for women. There are differences between the bill that passed in the House and the one that may or may not make its way through the Senate. But both could be said to accomplish legislatively what Mr. Trump boasted, in the infamous "Access Hollywood" tape, that he likes to do to women physically.
That assault includes blocking Planned Parenthood from collecting Medicaid reimbursements for a year. This would force the more than half of Planned Parenthood clients who rely on the program to seek care elsewhere, whether or not alternatives exist. (In many places, they don't.) Medicaid itself, which pays for half of American births, would be severely cut. States would be allowed to let insurers opt out of guaranteeing coverage for maternity care. Tax penalties would restrict individuals and small businesses from buying private insurance plans that cover abortion. And the Senate bill, which would free some insurance plans to charge co-pays for preventive care, would end Obamacare's guarantee of no-cost birth control.
It's worth noting that even President Bush, a born-again evangelical Christian, never tried to defund Planned Parenthood in the United States (though he did cut off funding for the group's foreign affiliates). This wasn't because Mr. Bush was moderate but because 10 years ago, the idea of ending Medicaid reimbursements for Planned Parenthood was so far from the mainstream that even a very conservative, anti-abortion president would not champion the cause.
No one thinks that Mr. Trump personally disapproves of Planned Parenthood. During the presidential campaign, he defended the organization, even though he also promised to cut off its federal funding. "Millions and millions of women - cervical cancer, breast cancer - are helped by Planned Parenthood," he said at a Republican debate in February. "I would defund it because I'm pro-life, but millions of women are helped by Planned Parenthood."
That statement, combined with his evident acceptance of non-procreative sex, made it possible to imagine that he might be marginally better on issues of sexual and reproductive health than other Republicans. Instead, his presidency is proving that cynicism and indifference can be as damaging as fanaticism.
The first sign of how bad Mr. Trump would be on reproductive health came three days after he was sworn in, when he signed a new, souped-up version of the global gag rule. It was inevitable that a Republican president would reinstate this policy, first enacted by Ronald Reagan, prohibiting foreign aid organizations receiving family planning funding from making abortion referrals or lobbying for abortion law reform.
Mr. Trump, however, dramatically expanded the gag rule's scope, so that it now applies to all foreign health assistance programs - affecting more than $8.8 billion in funding, instead of just $600 million. As Scott Evertz, Mr. Bush's former AIDS czar, told me in January, Mr. Bush didn't do that because he knew it would hamstring Pepfar, the president's signature H.I.V./AIDS initiative.
"It would have been impossible to treat H.I.V./AIDS in the developing world," Mr. Evertz said, "if the global gag rule were to be applied to the thousands of organizations with which those of us involved in Pepfar would be working." Mr. Trump, however, shows no sign of caring about Pepfar. Indeed, his draft budget would cut the program by more than $1 billion, which experts say could lead to a million deaths.
The president appears similarly indifferent to H.I.V./AIDS in the United States. In June, six members of the Presidential Advisory Council on H.I.V./AIDS quit, writing in Newsweek: "The Trump administration has no strategy to address the ongoing H.I.V./AIDS epidemic, seeks zero input from experts to formulate H.I.V. policy, and - most concerning - pushes legislation that will harm people living with H.I.V. and halt or reverse important gains made in the fight against this disease."
Although Mr. Trump has not yet been able to eviscerate Planned Parenthood, he has already taken steps to damage it. On April 13, the president signed a law repealing an Obama-era rule protecting Planned Parenthood from state efforts to withhold money allocated by Title X, the only federal program expressly devoted to family planning. (Planned Parenthood cares for about a third of the four million Americans served by Title X.) Adding insult to injury, the official appointed by Mr. Trump to oversee Title X is an anti-abortion activist named Teresa Manning, who has said that contraception "doesn't work."
Ms. Manning isn't the only anti-abortion, anti-contraception advocate Mr. Trump has brought into the federal government. Another is Charmaine Yoest, the former president of Americans United for Life, who has been made assistant secretary for public affairs at the Department of Health and Human Services. Katy Talento, who has written attacks on birth control pills for a right-wing blog, sits on Mr. Trump's Domestic Policy Council. The Trump administration has also appointed Valerie Huber, a former president of Ascend, an association that promotes abstinence education, to be chief of staff to the assistant secretary for health.
Then there's Mr. Trump's secretary of health and human services, Tom Price, who has claimed that "there's not one" woman in America who is unable to afford contraception. Together, these hires represent a familiar Trump administration strategy: putting people in charge of government programs whose goal is to dismantle them.
The influence of the Trump administration's anti-contraception views is very apparent in a draft regulation, recently leaked to Vox, that would drastically expand the number of employers allowed to opt out of birth control coverage in their insurance plans. If enacted, the rule will allow any employer, even large, publicly traded corporations, to refuse to cover birth control simply by citing a moral objection.
This could result in hundreds of thousands of women losing contraceptive coverage. As the American Civil Liberties Union has pointed out, the rule makes a shamelessly bad-faith argument, asserting that no woman would go without coverage, since she could always rely on Medicaid or Title X - even as both of those programs are being targeted by the administration for funding freezes or cuts.
Poor women will bear the brunt of this administration's policies on sexual and reproductive health, but millions more women will feel the pain as well. Under Republican plans, Americans with private insurance stand to lose coverage for birth control, abortion and maternity care. If Planned Parenthood were to lose the 40 percent of its budget that comes from federal funding, it would result in a rash of clinic closings nationwide, depriving women of access whether or not they're on Medicaid.
And there is the very real possibility that Roe v. Wade could be overturned during Mr. Trump's tenure. The president's first Supreme Court appointee, Neil Gorsuch, has already staked out a place well to the right of the conservative chief justice, John G. Roberts Jr. Should Mr. Trump have the chance to replace one of the five justices committed to upholding Roe - two of whom are in their 80s - we will once again see the widespread criminalization of abortion in this country.
Already, Mr. Trump's administration has ushered in a dangerous new zeal among the most radical anti-abortion groups. Usually, violence and threats of violence against abortion providers crescendo during Democratic administrations, when the anti-abortion movement feels shut out of policy making, and subside when Republicans are in control. (Every assassination of an abortion provider has occurred when a Democrat was in the White House.)
That dynamic has changed. The president of the National Abortion Federation, Vicki Saporta, told me that she has been surprised to see a "dramatic increase" in threats and death wishes directed at abortion providers since the election. She links it to the broader climate of rage in the country. "There seems to be a free-for-all in terms of hate speech against all different kinds of groups," she said.
On May 13, 10 members of the militant anti-abortion group Operation Save America (formerly Operation Rescue National) were arrested as they locked arms to block the door of the last abortion clinic in Kentucky, in Louisville. According to duVergne Gaines, the director of the National Clinic Access Project at the Feminist Majority Foundation, this was the first attempted blockade in 13 years.
Abortion rights activists fear an intensified siege at the same clinic this month, when Operation Save America holds its national conference in Louisville. They suspect that the group might be testing the ground to see whether the Justice Department under Jeff Sessions will enforce the 1994 Freedom of Access to Clinic Entrances Act, which imposes criminal penalties for abortion clinic blockades. The group clearly feels emboldened by the election outcome. "Trump is a tremor compared to the earthquake coming," wrote Operation Save America's director in a recent leadership report.
This cumulative attack on women's ability to control their reproductive lives would be infuriating no matter who presided over it. But there's an extra shudder of degradation in losing reproductive rights at the hands of a lubricious playboy like Mr. Trump. Unlike longtime anti-abortion activists, Mr. Trump doesn't bother pretending he's acting in women's best interests. Hence his frank admission during a town-hall meeting last year that if abortion were banned, women having abortions would have to be subject to "some form of punishment."
There is no veneer in this administration of "compassionate conservatism" or of promoting a "culture of life." There is simply power and convenience: Mr. Trump doesn't care about women's health or rights, and it's easy to outsource policy to the activists of the religious right who helped elect him. When you're the president, they let you do it.
The writer is a columnist for Slate
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