Abortion in the Presidential Debate: Trump Defends State Bans, Harris Vows National Protections

During the presidential debate between former President Donald Trump and Vice President Kamala Harris, moderator Linsey Davis asked Trump why the country should trust him on the issue of abortion, pointing out that his stance has changed as quickly as overnight.

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“In your home state of Florida, you surprised many with regard to your 6-week abortion ban because you initially had said that it was too short and you said, 'I'm going to be voting that we need more than 6 weeks.' But then the very next day, you reversed course and said you would vote to support the 6-week ban," Davis said.

Trump defended his actions, stating that his support for the 6-week abortion ban in Florida was motivated by his opposition to what he called "radical" abortion policies of the Democrats. He claimed that Democratic leaders have advocated for extreme measures, including allowing abortion in the ninth month or even after birth. Davis clarified that it isn’t legal in any state in the US “to kill a baby after it’s born.”

Trump credited his administration for overturning Roe v Wade, arguing that this decision brought the abortion debate back to the states, allowing citizens to vote on the matter. "For 52 years, this issue has torn our country apart," Trump said, adding that the Supreme Court's ruling fulfilled a long-standing wish from both Republicans and Democrats to have abortion rights decided at the state level.

He also affirmed his belief in exceptions for rape, incest, and the life of the mother, emphasizing that 85% of Republicans share this view. Trump touted his role in the appointment of 3 conservative justices to the Supreme Court, which was instrumental in overturning Roe v Wade.

Harris criticized Trump, calling his statements "lies" and accusing him of misleading the public on the realities of abortion laws in the United States. She argued that Trump had deliberately appointed Supreme Court justices with the aim of overturning Roe v Wade and imposing restrictive abortion bans across the country.

Harris described the impact of these bans, sharing stories of women denied care during miscarriages or forced to carry pregnancies resulting from rape or incest. She condemned the criminalization of health care providers. “Now in over 20 states there are Trump abortion bans which make it criminal for a doctor or nurse to provide health care,” she said. “In one state it provides prison for life.”

Harris pledged that, if elected president, she would sign a law reinstating the protections of Roe v Wade, arguing that the government should not interfere with a woman's right to make decisions about her own body.

Trump repeatedly refuted Harris' claims, insisting he is not in favor of a national abortion ban and that the issue has been resolved at the state level. He also dismissed Harris' assertion that he would support a federal ban as “another lie,” claiming that he had no intention of reversing a state's autonomy on this matter.

When pressed by Davis on whether he would veto a national abortion ban if it came to his desk, Trump deflected, arguing that such a bill would never pass Congress given the current political landscape. Harris, on the other hand, maintained that Trump's policies are part of a broader agenda to limit reproductive rights, referencing the “Project 2025” plan as a potential pathway to a national abortion ban. She emphasized her commitment to restoring Roe v Wade and challenged Trump on his stance regarding restrictions on late-term abortions.

“The majority of Americans believe in a woman's right to make decisions about her own body,” Harris said. “And that is why in every state where this issue has been on the ballot, in red and blue states both, the people of America have voted for freedom.”

Maternal Health Post Dobbs

In July, a state-by-state scorecard by The Commonwealth Fund revealed significant disparities in women’s health care across the US, highlighting significant contrasts in access, quality, and outcomes.¹ Mississippi, Texas, Nevada, and Oklahoma rank among the worst-performing states for women’s health, while Massachusetts, Vermont, and Rhode Island lead the rankings. The scorecard evaluated 32 measures of health care access, affordability, quality, and outcomes, showing that states with abortion restrictions tend to have fewer maternity care providers and higher maternal mortality rates.

Earlier this year, during a Senate hearing led by the US Senate Committee on Health, Education, Labor, and Pensions, discussing the national physician shortage, Sen Laphonza Butler (D, California) emphasized the need to address gaps in maternal health care, especially among minority populations.²

“Our health care system and the state of maternal health in this country is at an inflection point that requires the urgent attention of this committee; the numbers should alarm all of us,” she said. “The United States has the highest rate of maternal mortality among high-income nations; within recent years, thousands of women have lost their lives due to pregnancy-related causes. And over the past decade, while the birth rate in this country has declined by roughly 20%, maternal mortality rates have steadily risen. The crisis is exacerbated in communities grappling with the lack of access to essential maternal health care.”

The scorecard findings indicate the ripple effects of the 2022 Supreme Court decision overturning Roe v Wade, which has exacerbated disparities in reproductive health care.¹ States with restricted abortion access, particularly in the Mississippi Delta region, face the highest rates of maternal death, especially among women of color.

Pregnancy complications entail a range of risks, and they are even more complex for patients with existing health conditions.³ "Even without chronic health issues, pregnancy is inherently more dangerous than not being pregnant," Michael M. Aziz, MD, MPH, maternal-fetal medicine specialist and member of the State Liaison Network for the Society for Maternal-Fetal Medicine (SMFM), said in an interview with HCPLive in 2022.

"The risk of death from an abortion is the same as your risk of death from tooth extraction," he said, "and it's a shame that abortion has become so highly politicized that the facts aren't just left to speak for themselves."

According to a CDC report that analyzed the maternal mortality rates in 2021, 32.9 per 100,000 of those who were pregnant and gave birth in the US died.⁴ This number has dramatically increased within the US in the past few years (from 20.1 to 23.8 in 2019 and 2020, respectively) and is the highest among developed nations.

The maternal mortality rate is multiplied by 2.6 when removing White (26.6) and Hispanic (26.0) women from the equation: 69.9 deaths occurred for every 100,000 Black women who gave birth in 2021.

"Of all the developed nations in the world, the United States has the highest maternal mortality rate," Aziz said.³ "That's only gone up with the current COVID-19 pandemic."

Access to Contraception

Trump's stance on abortion is not the only aspect of women's health he's swiftly flipped on, leaving Americans unsure about their access to contraception.

In May, Trump suggested he was considering policy changes regarding birth control restrictions, stating he would release a policy soon, during an interview on KDKA-TV of Pittsburgh.⁵ When asked if he supported restrictions on contraception, Trump responded that the issue is under review and emphasized that states may adopt different policies, according to NBC News.⁵ However, later Trump clarified on his Truth Social platform that he does not support any restrictions on birth control and has never advocated for such measures, adding that the Republican Party does not support a ban either.

However, there are current issues in accessing contraception. Earlier this year, over 150 Democratic lawmakers, led by key members of the Democratic Women's Caucus and Senate leaders, urged health insurers to comply with the Affordable Care Act (ACA) contraception coverage requirement.⁶ They called for the adoption of a "therapeutic equivalence standard," ensuring coverage without cost sharing for all FDA-approved birth control methods that lack a generic alternative.

Pro-Choice Caucus Contraception & Family Planning Task Force Chair Judy Chu (CA-28) explained to The American Journal of Managed Care that instead of covering contraception at no cost, insurers often impose significant cost sharing and deny coverage for many women requesting contraception. The exceptions process, intended to help women access needed contraception, is also deeply flawed, with most patients unaware of how to apply, and delays of up to 14 to 15 days are common, according to an investigation by the Oversight Committee.

Despite the ACA’s protections, investigations have revealed widespread noncompliance, with insurers often denying coverage and imposing administrative hurdles. The lawmakers, backed by reproductive health advocates, pressed insurers to follow recent guidance from the Biden administration to rectify these violations and provide full contraceptive access.

"It is more important now that the Dobbs decision has been passed by the US Supreme Court, that we have contraception available to every woman," Chu said in the interview. "Now there are 21 states that have almost near or all total bans on abortion, which means that. So a woman will have to do even more than ever to make sure that she can maintain her reproductive freedom, so that she can control when she is going to have a baby or not, and so having easily available and affordable birth control methods is very, very critical to this, and having these 17 methods is very important."

References

1. Grossi G. New report shows worsening health outcomes for women in states with abortion bans. AJMC^®. July 18, 2024. Accessed September 13, 2024. https://www.ajmc.com/view/new-report-shows-worsening-health-outcomes-for-women-in-states-with-abortion-bans

2. Grossi G. Panel addresses minority physician shortage, maternal health at Senate committee hearing. AJMC. May 15, 2024. Accessed September 13, 2024. https://www.ajmc.com/view/panel-addresses-minority-physician-shortage-maternal-health-at-senate-committee-hearing

3. Grossi G. Micahel Aziz, MD: abortion reduces risk of death. HCPLive. June 24, 2022. Accessed September 13, 2024. https://www.hcplive.com/view/michael-aziz-md-abortion-reduces-risk-of-death

4. Grossi G. Confronting deadly maternal health disparities, part 1: US implements doula support. The American Journal of Accountable Care. 2024;12(2):50-53. https://doi.org/10.37765/ajac.2024.89573

5. Shabad R. Trump says he's 'looking at' policies that would restrict birth control access. NBC News. May 21, 2024. Accessed September 13, 2024. https://www.nbcnews.com/politics/2024-election/trump-says-looking-policies-restrict-birth-control-access-rcna153323

6. Dem Women's Caucus leads house and senate democrats in demanding health insurers fully cover birth control, as required by the ACA. News release. Democratic Women's Caucus. February 22, 2024. https://democraticwomenscaucus.house.gov/media/press-releases/dem-womens-caucus-leads-house-and-senate-democrats-demanding-health-insurers