Advocates of sexual and reproductive health and rights are celebrating Joe Biden and Kamala Harris’s historic victory. As the country looks toward the start of this new administration, it is still gripped by three related crises: the COVID-19 pandemic, an economic recession, and deep-seated racial and social inequities. In order to successfully tackle these challenges, the Biden-Harris administration must center sexual and reproductive health, rights and justice at the heart of its responses. Though there is much work to do over the next four years, there are several issues that require immediate attention. Advocates have laid out an ambitious agenda on this front and now must hold leaders in the White House accountable to ensure that harmful policies passed under the Trump-Pence administration are dismantled and replaced with evidence-based ones that ensure sexual and reproductive health and rights for all.
The Biden-Harris administration should use its electoral mandate decisively and make 2021 a turning point, starting in the first 100 days in office. To do this, it must focus on helping as many people as possible achieve reproductive autonomy, with a particular focus on those who are facing the steepest barriers to care, such as Black and Indigenous people, other people of color, people with disabilities, immigrants, people with low incomes and young people.
Three National Crises
The COVID-19 pandemic is exacerbating sexual and reproductive health inequities in the United States and around the world and threatening to undo decades of progress on access to care. One in three U.S. women have experienced pandemic-related delays or cancellations of sexual and reproductive health care, and rates are significantly higher for Black women (38%), Hispanic women (45%) and queer women (46%) than for White women and straight women. Globally, lockdowns, curfews and other necessary responses to the pandemic have caused disruptions in reproductive health care supply chains and services—potentially leading to millions of unintended pregnancies, untreated complications for over one million pregnant and postpartum women, and three million unsafe abortions. By prioritizing and safeguarding access to sexual and reproductive health services, the incoming administration can mitigate some of the most insidious and longest lasting impacts of the pandemic.
Advancing sexual and reproductive health and rights is also core to economic recovery from one of the worst recessions in living memory, and one that has disproportionately affected women and their employment opportunities. Access to contraception increases women’s education levels, workforce participation and income, and reduces their probability of experiencing poverty. Further, in U.S. states with policies that support women’s bodily autonomy, women have the greatest opportunities in the labor market. Women’s participation in the workforce drove recovery from the 2008 recession and will likely be key to the restoration of the U.S. economy in 2021 and beyond.
The social and racial inequities that the United States is grappling with manifest in sexual and reproductive health, where the racial disparities in maternal health care and outcomes are a stark example. Black women are more likely to be uninsured and face financial barriers to obtaining medical care and are less likely to access prenatal care than White women. Further, Black women are more than three times as likely to experience a pregnancy-related death as White women. To eliminate social and racial inequities, policymakers must prioritize the needs of people facing the greatest barriers to care.
The First 100 Days
The Biden-Harris administration is markedly more friendly to sexual and reproductive health and rights than the current one, but new leadership does not guarantee progress on these issues. The Trump-Pence administration launched an aggressive attack on sexual and reproductive health and rights on multiple fronts, and the response to it must be equally aggressive and multifaceted. There is no silver bullet, no single click of the "undo" button that can address all the harm the current administration has caused. Both in the United States and globally, the situation requires not just reverting to how things were "before" (i.e., before the Trump-Pence administration and before COVID-19), but making true, equitable progress and—in the Biden-Harris campaign’s own words—"build back better."
There are several steps that the Biden-Harris administration can take in its first months in office to support sexual and reproductive health and rights. These recommendations are detailed in First Priorities: Executive and Agency Actions, a document developed and endorsed by over 90 sexual and reproductive health, rights and justice organizations, including the Guttmacher Institute.
- The first priority must be to reverse Trump-era policies that target sexual and reproductive health, including the Title X "domestic gag rule," the "public charge" rule for immigrants and the expanded "global gag rule," all of which are actively harming millions of people in the United States and around the world. The Biden-Harris administration must immediately reverse these policies through executive orders (where possible) and work to mitigate the damage they have caused.
- The new administration must also halt any anti-reproductive health care regulations that are not yet finalized and reverse those that are in effect. These include the expansion of religious and moral exemptions from the federal contraceptive coverage requirement, the sweeping "refusal of care" rule, and the exclusion of Deferred Action for Childhood Arrivals recipients from Affordable Care Act benefits. Special attention should be given to the Trump-Pence administration’s actions during the period between the election and inauguration day, when it may feel emboldened to put forth especially dangerous policies.
- The Biden-Harris administration should push for positive changes within federal agencies that focus on domestic and international policy issues. In its first few months in office, the new administration should issue guidance related to medication abortion, patients’ choice of reproductive health care provider, Medicaid coverage, use of foreign assistance funds, and protections for immigrants’ sexual and reproductive health, among others.
- President-Elect Biden can strengthen the much-weakened executive branch by appointing experienced and dedicated agency leaders with positive reproductive health, rights and justice records. Key in this effort is the inclusion of people with diverse professional and life experiences. These teams can help craft the Biden-Harris administration’s first budget request, to be released in March 2021, and include calls for increased investment in domestic and global reproductive health programs and the end of harmful policies like the Hyde Amendment and the Helms Amendment.
- The Biden-Harris administration should also reestablish the United States’ place in global decision-making spaces by reengaging with the United Nations, rejoining the World Health Organization and restoring funding to the United Nations Population Fund. These actions would directly counter the Trump-Pence administration’s strategic efforts to dismantle the United States’ leadership in global public health institutions.
The Path Forward
The results of the 2020 presidential election reflect a public demand for change, including on sexual and reproductive health and rights. The Biden-Harris administration must use its electoral mandate, largely driven by women of color, to chart a new course forward through our overlapping crises. Every single person in the United States and around the world is impacted by sexual and reproductive health policy, and the Biden-Harris administration has an opportunity and responsibility to address their needs.