The Evolving Regulatory Framework for Contraceptive Care
Clinical implications of administrative policy changes affecting reproductive health services | Kimberly Chernoby, MD, JD
In 8th grade civics class, students learn that the legislative branch (Congress) is responsible for making federal laws. While that is true, this explanation ignores the entire field of administrative law. Administrative law is how rules and regulations are promulgated by the executive branch, the branch of government headed by the President. This means that when there is a new President, a significant portion of the rules that govern this country are subject to revision.
Laws regarding reproductive health are part of this category of policy that can change with administrations. One example is the Mexico City policy, sometimes called the “Global Gag Rule.” This policy, which has been enacted and rescinded by different administrations over several decades, affects U.S. federal funding to international organizations. When the policy is in effect, it prevents federal funding from going to organizations that promote abortion as a form of family planning. This week, the Trump Administration expanded the rule to include a ban on funding organizations that engage in DEI or “gender ideology.”
Why this matters is because two months ago, Dara was standing in front of an inflatable IUD to protest the fact that this administration is poised to destroy nearly $10 million of birth control in Belgium. Why? Because, pointing to policy that prohibits U.S. funding going to abortion, the Administration described this stock pile as abortifacients and said that funding could not support the distribution of this contraception.
If you are confused, you’re not alone. As I discussed in a recent New England Journal of Medicine article, there is ongoing misinformation about the classification of certain contraceptive methods. Opponents of birth control have argued that certain forms of birth control should be classified as abortifacients, a term referring to drugs or devices that cause abortion. This represents a shift from the longstanding medical and federal government definition, which, along with the American College of Obstetricians and Gynecologists, defines pregnancy as beginning at implantation. Under the currently accepted framework, interventions before implantation are contraception (preventing pregnancy), while interventions after implantation are considered abortions. The purpose of trying to label some forms of birth control as abortifacient is to ensnare these forms of birth control in the laws that govern abortion.
The Mexico City policy isn’t the only policy affected by the change in Administration. Other rules that change with administrations include funding levels for Title X clinics (the only federally funded program focused on family planning) and access to reproductive health care through the Department of Defense and the VA. For example, on New Year’s Eve, the Administration released a rule that is a near total ban on abortion access at the VA, including in cases of rape or incest. Given these attempts to label certain types of birth control as abortifacient, it’s possible these restrictions could eventually extend to certain contraceptive methods.
As physicians, our responsibility is to ensure patients have access to accurate medical information so that they can make informed decisions about their health care. When patients confuse Plan B emergency contraception and abortion, we should take time to provide clear, evidence-based education. This helps patients navigate an increasingly complex landscape where politicians are intentionally muddling facts, evidence, and science.