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JAMA Forum Archive, 2012-2019: Health policy commentary from leaders in the field
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Reproductive Rights and the 2016 Presidential Election

Although overshadowed by economic, immigration, and security-related concerns, abortion rights have emerged as an important theme of the 2016 election cycle. Other elements of reproductive rights received remarkably little attention. Where do the Democratic and Republican presidential and vice presidential nominees stand on these issues?

Clinton vs Trump

Hillary Rodham Clinton, a staunch abortion-rights advocate of long standing, has described the Roe v Wade decision as “the touchstone of our reproductive freedom, the embodiment of our most fundamental rights.” During the second presidential debate in October, she said she wants “a Supreme Court that will stick with Roe v Wade and a woman’s right to choose.

Donald Trump, for his part, self-described as “very pro-choice” in 1999, has transitioned to view the case as “wrongly decided” and ushering in a “culture of death.” In keeping with this new outlook, Trump committed to nominating antiabortion justices to the US Supreme Court. Listings of 21 potential nominees followed suit.

Equally polarized positions have come into view regarding the contentious Hyde Amendment, which bars the public funding of abortion. Speaking at a campaign rally, Clinton pledged to repeal the 4-decade-old budget rider which is “making it harder for low-income women to exercise their full rights.” Trump in turn committed to “making the Hyde Amendment permanent law to protect taxpayers from having to pay for abortions.”

Referring to congressional efforts to defund Planned Parenthood, Clinton left little doubt as to where she stood. Addressing the Planned Parenthood Action Fund, Clinton assured attendees that “as president, I will always have your back.” In keeping with the Republican Party platform, Trump committed to “defunding Planned Parenthood as long as they continue to perform abortions, and reallocating their funding to community health centers that provide comprehensive health care for women.”

Far less attention has been afforded to controversies surrounding the conduct of abortions during the second trimester of gestation. In 2003, then then-Senator Clinton (D, NY) voted against the passage of The Partial-Birth Abortion Ban Act of 2003, which became law in November 2003. She likewise denounced a subsequent Supreme Court decision to uphold the constitutionality of the statute. Trump has taken the opposing view. Similarly, the 2 could not be further apart on The Pain-Capable Unborn Child Protection Act of 2015 (contentious legislation that passed in the House but then stalled in the Senate in September 2015), which would ban most abortions after 20 weeks of pregnancy.

Armed with a perfect senatorial prochoice voting record in the US Senate from the prochoice advocacy group NARAL Pro-Choice America, Clinton doesn’t need to burnish her prochoice credentials. Trump, as a recent convert to the prolife outlook, is working to assure wary social conservatives of the authenticity of his convictions, through endorsements from leading members of the prolife community and a significant effort to reach out to prolife constituencies has been under way. Guided by long-time conservative congressional aide John Mashburn, Trump unveiled an advisory Evangelical Executive Board. Shortly thereafter, Trump rolled out a “Pro-Life Coalition under the leadership of Marjorie J. Dannenfelser, president of the antiabortion organization Susan B. Anthony List, who until recently denounced the Trump candidacy. Lastly, Trump announced the formation of an expansive Catholic Advisory Board whose designated leader, Joseph Cella, founder of the National Catholic Prayer Breakfast, has previously declared Trump “manifestly unfit to be president.” Whether or not these late-stage initiatives will suffice to dispel perceptions of inauthenticity remains to be seen.

Kaine vs Pence

The Democratic vice presidential nominee, former Virginia Gov Tim M. Kaine, negotiated a complex set of competing convictions. Although an ardent supporter of Roe vs Wade, Kaine held on to his personal Catholic-based opposition to abortion. Derivative positions included but were not limited to supporting abstinence-focused sex education, adoption as an alternative to abortion, parental consent for minors seeking an abortion, and a partial-birth abortion statute. As US Senator, Kaine modified his positions to a point earning him a perfect voting score from NARAL. Notably, Kaine voted against The Pain-Capable Unborn Child Protection Act of 2015 and cosponsored the yet-to-be enacted “right-to-choose” bill known as TheWomen’s Health Protection Act of 2015. Kaine’s current outlook on the Hyde Amendment, which he previously supported, is less clear.

The Republican vice presidential nominee, Indiana Gov Mike Pence has been a fervent abortion-rights opponent throughout his political career. Pence predicted that “we'll see Roe v. Wade consigned to the ash heap of history where it belongs.” As a 6-term congressman, Pence earned a perfect voting score from the National Right to Life for his support of The Partial-Birth Abortion Ban Act of 2003 and for his sponsorship in 2011 of the first-ever amendment to defund Planned Parenthood. As governor, he signed a measure prohibiting abortion on the grounds of race, gender, or disability, the knowing violation of which would hold clinicians liable for wrongful death.

In the upcoming presidential election, the right to choose has once again moved front and center, and voters could not be presented with a starker choice. Regrettably, however, little attention has been paid to other reproductive rights of consequence, and this represents a missed opportunity. At the very least, consideration could have been given to sex education, family planning, unintended pregnancies, sexual assaults, and domestic violence. The same holds true for the promising, if nascent, discussion about enhancing family leave.

Although Clinton has addressed these and related issues, Trump has yet to do so, and because of that, how he will handle the assortment of reproductive rights remains a matter of pure conjecture. Will he abide by the conservative party line if elected, or Will ideology take a back seat? The answers, of course, are unknowable.

As has always been the case, voters are left to cast their votes based on the best information available, plus a good measure of conjecture.

About the Authors:
Christy Gandhi is a third year medical student at Warren Alpert Medical School of Brown University in Providence, Rhode Island, with an interest in health policy and economics. (Image: Christy Ghandi/Brown University)
Eli Y. Adashi, MD, MS, is a professor of Medical Science and the former dean of Medicine and Biological Sciences at the Warren Alpert Medical School of Brown University in Providence, Rhode Island. (Image: Brown University)
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