"The cause for heartbreak is still quite high," said Kristin Ford, the national communications director for NARAL Pro-Choice America.
Pro-choice organizations and activists, like those at NARAL and its numerous affiliates across the US, are regrouping, facing a new administration after four years working under the confines of President Donald Trump and Vice President Mike Pence, both of whom were vocally anti-choice during their four years in the White House.
But the time is now for pro-choice advocates to get to work, Ford said. After years of running defense under Trump and his administration, advocates in support of protecting and strengthening access to abortion now find themselves playing offense.
With President Joe Biden and Vice President Kamala Harris in the White House and Democrats firmly in control of both chambers of Congress, pro-choice advocates say they're hopeful about the future.
"Logistically, there's a lot of work afoot and just a ton of really important priorities," Ford told Insider. "The Biden-Harris administration really made their commitment clear on the campaign trail, and we're going to continue to remind them of that and be active partners in whatever we can to help make sure all that needs to happen does happen."
Ford pointed toward the "global gag rule" also known as the "Mexico City policy," which was expanded under Trump and prevents foreign organizations from providing abortion services or counseling if they receive US funding. Biden is expected to reverse the rule in the coming days.
She also said activists were focused on eliminating Trump-era changes made to the Title X family planning program that cut federal funding from providers who offer or refer patients for abortion. Pro-choice activists also hope to relax restrictions on abortion medication, she said. The Supreme Court earlier in January upheld a rule the Trump administration sought to enforce, requiring women to appear in person to obtain abortion pills. The rule had been relaxed due to the pandemic.
State legislatures and conservative judges pose continued threats to abortion access under Biden
There are some potential headwinds for the Biden administration going forward. Trump appointed more than 200 federal judges during his time in office, according to the Pew Research Center. And the Supreme Court now has a majority conservative bench after Trump appointed three justices during his time as president: Justices Neil Gorsuch, Brett Kavanaugh, and most recently, Amy Coney Barrett.
These changes could spell trouble for the pro-choice movement, Ford said, especially as GOP-controlled state legislatures mull over what she called "draconian" restrictions on abortion access with bills that could end up in court. There are already cases in the Supreme Court's pipeline for the current term.
In 2019, following Kavanaugh's appointment, Ford said members of the GOP in state legislatures across the US saw an opportunity to push anti-choice legislation.
According to the Guttmacher Institute, which tracks changes in abortion law, there were 58 new restrictions placed on abortions in 2019, but in the same year, 36 states took action to introduce abortion protections.
"For a long time, the anti-choice movement seemed to publicly adopt a more incrementalist approach and tried to have a more palatable face on their work, and the jig is really up," Ford said. The prominent voices in the anti-choice movement are pretty vocal and unified they want to outlaw abortion period no exceptions. No caveats."
Some, she noted, have also been in favor of restricting access to contraception, which she called an "extraordinarily out-of-the-mainstream position."
Some states attempted to restrict abortion through measures more broadly aimed at curbing the spread of COVID-19. Several states last year enacted such measures declaring abortion procedures nonessential, according to a report from the Ambulatory Surgery Center Association.
But 2021 has already seen a number of anti-choice bills appear across state legislatures. Bills proposed by lawmakers in Arizona and Mississippi, for example, would charge women and their doctors with murder if they carry out an abortion. Lawmakers in South Carolina have proposed what's commonly called a "heartbeat bill," which prohibits abortion after a fetal heartbeat is detected.
"It's really alarming the number of states that are not just trying to roll back access to abortion but are introducing these truly horrifying over-reaches into people's personal decision-making that carry criminal penalties," Ford said.
"You're talking about a scenario in which people are criminalized for the outcome of their pregnancy, and that's not just about abortion," she continued. "You can envision a scenario in which people are interrogated for a miscarriage or for experiencing pregnancy loss."
Despite efforts to restrict abortion access, approximately 79% of Americans support access to abortion, at least in some circumstances, Gallup polling data from May 2020 shows.
Activists also hope Biden will help dismantle the Hyde Amendment
The Hyde Amendment, passed in 1976 — not long after the Supreme Court's landmark 1973 decision in Roe v. Wade, "blocks federal funds from being used to pay for abortion outside of the exceptions for rape, incest, or if the pregnancy is determined to endanger the woman's life," according to the Kaiser Family Foundation.
The law prohibits Medicaid and other federal programs from providing funds for abortion care. In practice, the amendment disproportionately targets low-income women, women of color, and LGBTQ people, said Kelsey Ryland, co-director of the coverage campaign for All* Above All, an organization led by women of color that labels itself a "catalyst for abortion justice."
"I think when we look at the double crisis of a pandemic and the call to racial justice in our country, we see that people who are impacted by the Hyde Amendment are the same folks who are at the center of these double crises," Ryland said, pointing toward the pandemic's adverse impacts on minority communities and the nationwide racial justice protests that grieved the public conscience last summer. "I think the pandemic has really exposed the inequity in our healthcare system."
For years, Biden supported the Hyde Amendment, but while campaigning for president in 2019, he wooed pro-choice activists by pledging to repeal it.
"If I believe health care is a right, as I do, I can no longer support an amendment that makes that right dependent on someone's zip code," Biden said.
His statement came July 7 that year, days after the former vice president had said he still supported the 1976 amendment, prompting an immediate backlash from his opponents in what was a heated race between Democrats for the party's nomination.
"I can't justify leaving millions of women without access to the care they need and the ability to exercise their constitutionally protected right," Biden added, explaining his reversal on the Hyde Amendment.
At a press briefing on January 20, the first day of the Biden administration, White House Press Secretary Jen Psaki avoided a reporter's question about Biden's plan for the amendment, reminding reporters instead that the new president was a "devout Catholic."
Even if Biden does follow through with his campaign promise to oppose the amendment, activists still face hurdles from congressional Republicans, many of whom on Tuesday signed an open letter in support of the amendment.
"If the Biden administration truly wants to address racial inequity and make sure people can get the healthcare they need, we need them to end the Hyde Amendment and also increase access to medication abortion," Ryland said.
Biden is expected to announce executive orders pertaining to abortion on January 28.
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