(CNN) -
President Joe Biden signed a presidential memorandum Thursday to reverse restrictions on access to abortion at home and abroad imposed and expanded by the Trump administration.
The memorandum "will reverse my predecessor's attack on access to women's health," Biden told reporters during a signing ceremony in the Oval Office.
She added that the measure "relates to protecting women's health at home and abroad, and reestablishes the changes that were made to Title X and other things that make it difficult for women to have access to affordable health care in terms of regarding their reproductive rights.
Biden's move fulfilled a campaign promise to rescind the so-called Mexico City Policy, a ban on U.S. government funding for foreign nonprofit organizations that perform or promote abortions.
The Trump administration reinstated the restriction in 2017 through a presidential memorandum and then extended it to cover all applicable U.S. global health funds that generated about $ 9.5 billion in aid for everything from HIV treatment to drinking water projects and child immunizations, depending on the groups agreeing not to discuss or perform abortions.
The memorandum also directs the Department of Health and Human Services to immediately proceed to consider repealing the Trump administration rule that blocks health care providers in the federally funded Title X family planning program from referring patients for abortions, according to the Biden administration.
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Taken together, the actions show a government receptive at least to initial requests from advocates eager to codify a new era of abortion protections after the previous administration pushed restrictions on the procedure to unprecedented levels.
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Proponents of abortion restrictions criticized Biden for the announcement, which coincides with the eve of anti-abortion activists hosting the annual March for Life event on Friday, although this year it will be virtual.
Former President Donald Trump made history in 2020 by being the first sitting president to participate in the event, which for decades has drawn huge crowds of supporters each year to the National Mall.
The measures come as healthcare providers, reproductive rights groups and progressive legislators seek a more permanent end to long-standing barriers to the procedure.
Access to abortion abroad
Beyond US borders, the impact of Trump's expanded policy, formally called "Protecting Life in Global Healthcare," has been "truly devastating," said Melvine Ouyo, a Nairobi-based reproductive health nurse and former director. from the Family Health Options clinic.
Kenya.
"So many lives were lost."
The policy, also known as the "global gag rule," has been instituted by Republican governments since President Ronald Reagan and repealed by Democrats.
A State Department review published last year of the Trump administration's policy to ban funding of foreign nonprofit organizations that perform or promote abortions found that it has also affected efforts to treat tuberculosis and HIV / AIDS, as well as to provide nutritional assistance, among other programs, and has had a significant impact in sub-Saharan Africa.
Advocates and practitioners like Ouyo say the deaths are the result of cuts to health care of all kinds for women, including access to contraception, which sends them seeking illegal, often unsafe and deadly abortions.
"This global gag rule has been one of the most damaging policies in the lives of women, especially women who come from underserved communities," Ouyu told CNN.
"Biden really has a lot to do."
Seema Jalan, executive director of the United Nations Foundation Universal Access Policy and Project, said advocates see an opportunity for the Biden administration to work with Congress to make comprehensive change.
He cited the Helms Amendment, which prohibits U.S. foreign aid to perform or promote abortion, not only to foreign nonprofits, but to U.S. governments, multilateral organizations, and nonprofits, and the Hyde Amendment, which imposes similar restrictions on groups within the country.
Currently, the policies allow abortions in cases of rape, incest or threat to the life of the pregnant woman.
"There was the government's hard work working with Congress to implement permanent solutions to harmful policies - addressing the global gag, Helms, Hyde and other technical fixes that are very important," said Jalan.
Anti-abortion advocates, however, criticized the pushback, arguing that it runs counter to Biden's stated efforts to unite the country.
"Funneling US tax dollars to abortion groups abroad is an abominable practice that goes against the 'unity' that Joe Biden and Kamala Harris promised to inspire," said SBA List President Marjorie Dannenfelser.
"Resigning the Mexico City Policy on the eve of the March for Life is a deeply disturbing measure, especially when the president says he wants national unity," said the president of the March for Life, Jeanne Mancini, on Thursday. He added that the government "must work to protect the inherent dignity of all people, born and unborn."
Access to abortion in the US
Biden's memorandum also addresses Title X, a federally funded program that served approximately 4 million people a year before the abortion referral rule was implemented, according to HHS.
The program provides resources including contraception, breast and cervical cancer screenings, preventive education, and HIV and sexually transmitted disease screenings, but not abortions.
In 2019, Trump's HHS issued a rule to prohibit health care providers participating in the program from offering referrals for abortions, a policy that opponents say would most affect low-income individuals, rural residents, communities of color and the uninsured.
The rule sparked multiple challenges in federal court and was ultimately blocked in federal court.
But in July of that year, the US Court of Appeals for the Ninth Circuit allowed the rule to go into effect despite ongoing defiance against it.
The effects of the rule have been severe.
Planned Parenthood, which previously covered 40% of Title X patients and had been involved in the program since it began, according to the organization, withdrew from the program shortly after the Ninth Circuit's decision.
Additional clinics have left the program since the rule took effect, leaving six states without Title X providers, according to data from the nonpartisan Kaiser Family Foundation.
More than 1,000 Title X subrecipients and sites - roughly 25% of the 4,000 clinics in the program before the rule - have withdrawn from the program, according to Kaiser.
National Right to Life President Carol Tobias regretted Biden's memo on Thursday.
"During the presidential campaign, Joe Biden made it clear that promoting abortion would be a priority in his administration and would be done at the expense of taxpayers," Tobias said, accusing him of dismantling "internal protections that have saved countless lives - and putting money away. of taxpayers in the pockets of abortionists.
Biden's memorandum, while representing a significant change in direction, represents only the beginning of the advocates' goals to restore the program.
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"We look forward to some commitment to repair the program, rescind the rule, and get long-standing providers back on the grid so that services can be restored in parts of the country that have been without Title X funding for so long," said Audrey Sandusky. , Communications director.
for the National Family Planning and Reproductive Health Association (NFPRHA).
About 1.5 million people lost access to Title X coverage after the rule was implemented, according to Sandusky.
The group counts nearly three-quarters of Title X recipients among its membership of providers and administrators and worked with Biden's transition team and HHS staff on the future of Title X, he said.
In light of how some 'patients have been in the dark' after they were no longer able to get free or low-cost health care from their regular providers, 'I would say that it would take a long time for providers to regain the trust and confidence that patients have had in them, "Sandusky said, as well as" to regain confidence in the federal government and assure providers that they have the support they need from this government and from Congress. "
In a call with reporters Wednesday, Planned Parenthood President and CEO Alexis McGill Johnson said that reversing the Mexico City Policy and Title X abortion referral restriction is "a great start, which will increase the access and it will have a significant impact on people's lives, but I emphasize again, this is a start.
When asked about the conversations between Planned Parenthood and the Biden administration on Title X, McGill Johnson described “very strong, and I would say, exciting conversations, not only about the domestic gag rule, but also about how they can be invest more in access to family planning and contraception, how to be more inclusive, how we can use politics to also involve men, to involve other populations.
"We need to improve and modernize Title X," said McGill Johnson, then added, "making sure it meaningfully reflects the sexual and reproductive health care needs of all patients."
Beyond Biden's actions
Lawmakers, pointing to data showing the policies result in more unsafe abortions, more unwanted pregnancies, more maternal deaths and have a disproportionate impact on black and brown women, say they are seizing the moment as well.
Democratic Rep. Rosa DeLauro of Connecticut, chair of the House Appropriations Commission that oversees Title X funding, told CNN in an interview Wednesday that while she had not been in contact with the Biden administration about Title X, is focused on returning the program to its previous form.
“What I'm committed to in Assignments, because we have jurisdiction over Title X funds, is working with the administration and the providers, those who were forced out of the program, to make sure the funds are there for them. get it back, ”he said.
"Or work in that legislative direction and make sure there are safeguards in place to make sure we can't have what the Trump administration tried to do here."
When asked if he would seek to increase funding in this legislative session, DeLauro replied, "I'm going to take a look at what we have by way of allocation and so forth and if I can, I will work to increase funding."
Democratic Sen. Jeanne Shaheen of New Hampshire is set to reintroduce the Global HER Act on Thursday, which would permanently repeal the Mexico City Policy.
He said it was "shameful" that the Trump administration not only implemented it, but expanded it.
"I am so relieved that President Biden has made rescission of this policy an early priority," Shaheen told CNN.
The data does not lie.
We know how damaging this policy has been, how it likely contributed to the rise in maternal deaths, unsafe abortions, and compromised access to critical care.
Breaking this rule is the beginning, but it is not enough, it must be a permanent solution.
And in the House, Democratic Rep. Jan Schakowsky of Illinois and others will re-introduce a bill to repeal the Helms Amendment.
They are also targeting the Hyde Amendment.
Access to reproductive health care and abortion, in addition to being necessary, "is fundamental to the independence, success and bodily autonomy of women," Schakowsky told CNN.
"If you can't control reproduction yourself, you can never really plan your life."
And some lawmakers, along with reproductive rights groups, are pushing Biden and Vice President Kamala Harris to go further.
Congressional Pro-Choice group calls on Biden to take immediate action on multiple fronts beyond repealing Mexico City's policy and reconsidering the Title X rule, including expanding support for US foreign assistance. .for abortion care, rescinding a decree restricting access to abortion under the Affordable Care Act and ordering the Secretary of Health and Human Services to lift the Food and Drug Administration's decision that it cannot be shipped an over-the-counter medicine by mail to safely end pregnancy early during the pandemic.
More than 90 advocacy groups, including NFPRHA and Planned Parenthood, have presented the Biden administration with a "Plan for Sexual and Reproductive Health, Rights and Justice" calling for such actions and others, such as repeal of the Hyde Amendment.
Marcela Howell, president of In Our Own Voice: Black Women's National Reproductive Justice Agenda, which is one of the groups, told reporters Wednesday that lawmakers who freely discussed access to abortion were contributing to their goals.
"The reality is that we have all fought against the stigma around abortion, and if we cannot get the government and members of Congress to use the term abortion care, that increases the stigma," he said.
"And we believe that it is a safe and legal procedure that women have accessed at various times in their lives and the stigma that surrounds it must be removed."
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