By Eli Y. Adashi, MD, MS, and I. Glenn Cohen, JD
It is commonly assumed that the economy will constitute the key, if not sole, battleground of the 2012 presidential election. That may well be the case. In the past several months, however, both parties have paid ever-growing attention to the possibility that the candidates’ positions on issues involving reproductive freedom could affect the leanings of women voters and thereby the final outcome. In conducting intense monitoring—not to mention targeted messaging—in this area, both presidential campaigns have acknowledged that for many women, especially women of reproductive age, reproductive health is as much an economic issue as it is a health care issue.
In a departure from past campaigns, the 2012 presidential election ventures beyond the confines of the abortion issue to incorporate a tapestry of competing ideologies on related questions. Given the interest in these issues, the positions articulated by President Obama and Governor Romney in the domain of reproductive freedom may well be a factor in the 2012 election, because an analysis reveals 2 very different points of view.
The matter of contraception reveals significant differences in the policies of the presidential contenders. The contrast is particularly evident when it comes to access to and funding of family planning services. By enacting the Affordable Care Act (ACA), President Obama enhanced private funding for family planning services by extending dependent coverage to age 26 years, ensuring no-cost contraceptives to women enrolled in workplace health plans, and enabling the purchase of federally subsidized commercial insurance through health exchanges. Concurrently, the ACA expanded public funding for family planning services by extending Medicaid coverage to many uninsured individuals and by eliminating requirements for burdensome state Medicaid family planning “waivers.”
However, should a Romney administration follow through on its pledge to “repeal and replace” the ACA, the aforementioned provisions will be rendered null and void. Under such a scenario, further funding constraints can be anticipated from Governor Romney’s proposals to “block-grant and cap” Medicaid and to eliminate the federal support of Planned Parenthood through the Title X family planning program. Indeed, Governor Romney is the first Republican presidential candidate to pledge to defund Planned Parenthood. Taken together, the policies espoused by Governor Romney will curtail access to family planning services; drive up the incidence of unintended pregnancies; and, in so doing, increase the prevalence of abortions.
On the subject of abortion, the presidential contenders could not be further apart. President Obama supports abortion rights as affirmed by Roe v Wade. Although he opposes the Hyde amendment—a ban on the use of federal funds for abortions—President Obama has not attempted to repeal it. Indeed, President Obama affirmed the amendment as the law of the land to secure the support of pro-life House Democrats for the passage of the ACA.
By contrast, Governor Romney supports the Hyde Amendment and opposes Roe v Wade, which he would like to see overturned, enabling individual states to legislate on abortion. In addition, he has enunciated his belief that “life begins at conception” and his desire that the “laws of our nation reflected that view.” Finally, Governor Romney has pledged support for a law “to protect unborn children who are capable of feeling pain from abortion.”
For his part, Republican Vice Presidential nominee Rep Paul Ryan (R, Wis), was a cosponsor of the Sanctity of Human Life Act, which provides that human life “be deemed to begin with fertilization” and that the embryo have the “legal and constitutional attributes and privileges of personhood.” Rep Ryan also cosponsored the Protect Life Act, which would amend the ACA to more clearly limit the use of federal funds for abortion.
All told, the positions taken by Governor Romney and Rep Ryan could well enable individual states to render abortion illegal, or bar abortions beyond 20 weeks of gestation, or further jeopardize exceptions to protect the mother’s life. Moreover, the assignment of rights associated with personhood to the embryo could well constrain, if not criminalize, human embryonic stem cell research as well as the clinical practice of in vitro fertilization (IVF).
Addressing the issue of women’s health on the global stage, President Obama restored US funding to the United Nations Population Fund during his first week in office, thereby ending a 7-year funding hiatus rationalized by allegations of forced abortions and coercive sterilizations. President Obama also rescinded the Mexico City Policy (also known as the “global gag rule”), which requires federally funded nongovernmental organizations to “refrain from performing or promoting abortion services as a method of family planning in other countries.” By contrast, Governor Romney has pledged to end US funding to any United Nations program “that promotes or performs abortions on women around the world” and to reinstate the Mexico City Policy.
Stem Cell Research
On March 9, 2009, President Obama signed an executive order designed to expand federal support for the exploration of human stem cell research and charged the National Institutes of Health with formulating revised guidelines for the federal funding of such research. To date, federal funding is available for research involving human embryonic stem cells derived from parent-donated excess embryos formed in the course of IVF. For his part, Governor Romney opposes creation of a human embryo through “cloning” or “farming” for the purpose of research—that is, “when the sole purpose of its creation is its sure destruction.” However, Governor Romney is on record in support of the parental right to guide the disposition of excess IVF-derived embryos. It is not known whether he supports or opposes the use of federal funds for human embryonic stem cell research.
With the 2012 presidential election just weeks away, there can be little doubt that reproductive freedom hangs in the balance. For one, the next president will be selecting ideologically compatible nominees to a Supreme Court that has repeatedly restricted abortion rights in the last few years. For another, the next president, working with the legislative branch, could well reorder the status quo. President Obama has spoken through his actions over the last 4 years. Far less clarity exists as to Governor Romney’s positions, in light of lingering ambiguities and influence from a resurgent Tea Party.
Still, the voting public will face a clear choice between a Democratic sitting president and a conservative Republican aspirant, and voters in general and women in particular will have something to say about who the next occupant of the White House will be.
About the authors:
Eli Y. Adashi, MD, MS, is Professor of Medical Science at the Warren Alpert Medical School of Brown University in Providence, RI. A member of the Institute of Medicine, the Council on Foreign Relations, the Association of American Physicians, and the American Association for the Advancement of Science, Dr Adashi has focused his writing on domestic and global health policy at the nexus of medicine, law, and ethics. A former Franklin fellow, Dr Adashi served as a senior advisor on Global Women’s Health to the Secretary of State office of Global Women’s Issues during the Obama Administration. Eli_Adashi@brown.edu
I. Glenn Cohen, JD, is Professor of Law and Codirector of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, Cambridge, Mass. His work has appeared in the Harvard, Stanford, Cornell, and Georgetown Law Reviews; the New England Journal of Medicine; the American Journal of Public Health; the Hastings Center Report; and elsewhere.
Financial Disclosures: Professors Adashi and Cohen declare no conflict of interest. Dr Adashi is a member of the Board of Directors of Alere.
About The JAMA Forum: To provide ongoing coverage throughout this election year, JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide insight about the political aspects of health care. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.