How Trump administration undermines reproductive and LGBTQ rights in California

By Lori Freedman and Rebecca Griffin, Special to CALmatters

A pregnant woman arrives at a Catholic hospital with vaginal bleeding. The  doctor determines that she has a rare condition that means her pregnancy will not survive and is a threat to her life. The standard treatment is to terminate the pregnancy.

Treating her in a hospital would be the safest option because she could be at risk for hemorrhage. However, the hospital ethics board that enforces the Catholic Church’s religious principles refuses the doctor’s request. A clergy member on the board Googled the condition and decided his judgment trumped the doctor’s.

This story is sadly not unique. A Catholic hospital in California refused to perform a tubal ligation after Cesarean delivery, even though that’s the medical standard, forcing the patient to go in for a second surgical procedure. Another canceled a transgender man’s hysterectomy the day before it was scheduled because it doesn’t view gender affirming care as legitimate.

A new Trump administration regulation puts the full force of the government behind individuals and institutions that refuse to provide care in the name of religious beliefs. This unnecessary overreach emboldens people to discriminate and has dangerous implications for people’s health.

We’re facing an unprecedented sweep of abortion bans across the country, a frontal attack that we must fight back. At the same time, we must keep on our eyes on this insidious undermining of reproductive rights that can compromise your care even if you live in one of the dozens of pro-choice states and cities that sued to block the rule.

The rule empowers hospitals, doctors, nurses, pharmacists, and even support staff to refuse to provide care. It broadens the definition of what kind of actions people can deem unacceptable.

The Trump administration’s move invites people to file complaints, especially against abortion providers or people who provide LGBTQ care, knowing they have a sympathetic ear in the White House. It sets up the government to aggressively enforce these rules, up to and including blocking federal funding to states or institutions they feel are violating the rights of people refusing to provide care.

Years of research at the intersection of religion and health care provide a window into just how damaging this move could be. At their best, religious refusals stigmatize patients and subject them to emotional and financial burdens. At their worst, they can be dangerous and even deadly.

More than half of ob-gyns who work in Catholic hospitals have found themselves in conflict with hospital policies that deny patients standard care based on evidence and cause undue suffering.

For instance, to treat an inevitable miscarriage, doctors often have to wait for the women to show symptoms like a fever, infection or blood loss. If patients don’t have those symptoms, some physicians encourage women to check themselves out of the hospital and drive to another institution since an ambulance ride is so costly. These women have little choice in the matter, and face risks to their health and future fertility by delaying treatment.

In response, doctors sometimes find themselves bending the truth and creating workarounds. But those workarounds are still subject to the whims of religious leaders.

Restricting reproductive health care has wider implications than many people would think. Counseling and referrals for abortion and birth control often come up in the context of treating conditions like diabetes, cancer or heart disease. People need access to emergency contraception after sexual assault.

Because individual providers or institutions aren’t required to be up front about what they do and don’t provide, patients often won’t know about restrictions until they’re dealing with an emergency. More than a third of women  surveyed didn’t know that their primary hospital is Catholic.

Less than a third of these hospitals have information on their websites about how religious directives cause them to restrict care. By creating an environment that encourages people to deny treatment with impunity, the administration leaves people to gamble that the person standing over their gurney in a moment of crisis will give them the care they need.

Trump’s reasons for pursuing this new rule are transparent. This is another volley in Trump’s relentless war on women’s and LGBTQ rights. It fits squarely with his attempts to dismantle the Title X family planning program and his inflammatory lies about abortion.

Institutions around the country have already found ways to balance respect for individuals’ beliefs with providing patients the care they want and need. All this unnecessary regulation does is embolden health care providers to discriminate and endanger people’s health.


Lori Freedman is a sociologist in the Department of Obstetrics, Gynecology & Reproductive Sciences at UCSF, [email protected] Rebecca Griffin is a communications specialist at the Bixby Center for Global Reproductive Health at UCSF, [email protected]

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