Criminalizing Abortion and Gender-Affirming Care Marks Political Invasion of Evidence-Based Healthcare

A Bans Off Our Bodies march in New York City on May 14, 2022. (Rhododendrites / Wikimedia Commons)

I am a physician. Every day, I apply my training and my experience to improve the lives of my patients in deeply personal ways. Unfortunately, this work is increasingly stymied by others’ ideology and the strangled influence that policies and legislation place on the care I am able to offer my patients—and in the world of both transgender care and abortion care, it is only getting worse.

Abortion care is no stranger to the oppressive weight of political ideology, and the current furor over transgender youth healthcare, emblemized by a slew of attacks in state capitals across the country exemplifies a resurgent threat to evidence-based medical practice, patients’ health and lives, and physicians’ consciences and careers.

Government interference is not new, as the lengthy battle for access to comprehensive reproductive care reminds us. State legislatures have built their decades-long assault on abortion access on false and distorted scientific premises. We have seen states ban abortion by misusing the complexities of early pregnancy, misrepresenting early embryonic development, and flat out ignoring the mountains of data demonstrating the safety of abortion. The U.S. Supreme Court appears ready to upend the right to access abortion all together in response to a Mississippi abortion ban legislated on such false premises, with implications for millions of women, people and families across the country. 

It is dismaying, but unfortunately nothing new that reproductive healthcare is the target of and ideological machinations—but seeing these attacks extended to other areas of healthcare is bone-chilling. In real time we are seeing the political invasion of evidence-based healthcare spread to other areas of healthcare such as gender-affirming care for transgender adolescents. Misrepresenting this life-saving care as child abuse and passing bills seeking to bar or criminalize healthcare for transgender children will disrupt families and cost lives.

These bills, like those restricting abortion, are extreme and without scientific or medical rationale. They are in lockstep with lawmakers’ ongoing campaign to deny science and disregard the health of patients by placing themselves in the middle of healthcare professionals and their patients. Through these laws, politicians are inserting themselves into practices and clinics, controlling what physicians can say about topics from pregnancy termination to firearm safety to vaccines, or forcing them to deny appropriate care.

Ideologically motivated politicians are widely mischaracterizing the healthcare that transgender individuals need, repurposing it as a cultural bludgeon rather than the compassionate, complex and family based process it is. Studies have found that gender-affirming care improves the well-being and mental health of transgender youth and is linked to a lower risk of suicide attempts. This healthcare, like abortion care, is lifesaving. Across the board, major medical organizations endorse gender-affirming healthcare, reflecting decades of research and best practices in supporting transgender people’s health and minimizing harm and suffering.

The likely consequences of barring gender-affirming care mirror those of other unscientific bans on essential healthcare like abortion. The impact of being unable to obtain needed care reaches beyond a person’s medical record. We know that those who are denied abortions they need are more likely to be living in poverty, unable to fully engage in their lives as desired. We also know from studies that more than 45,000 transgender youth aged 13 and older could be denied medical care as a result of the above-mentioned restrictions, according to the Williams Institute at UCLA School of Law. Moreover, patients are not the only targets—caregivers, parents, clinicians and others who “aid and abet” are threatened with persecution when it comes to abortion care or transgender care. 

Assaults on science-based medicine invariably have implications for health equity and justice. Criminalizing needed medical care has ramifications not only for the individuals seeking care in those states, but for entire communities. When so much of a person’s health depends on the zip code they live in, their exposure to environmental pollution and hazards, their local infrastructure and social safety net, the historical injustices that continue to ripple through generations of families, bans on evidence-based healthcare only multiply the impact of social determinants of health. 

To be a doctor and have to tell the people seeking my help that I cannot help them, is heart-wrenching. It is my duty as a physician and an imperative of my conscience to provide evidence based, compassionate, healthcare to anyone in need. Broad and persistent health inequities, and ongoing assaults on evidence-based care, point to how much work lies ahead of us in safeguarding and advancing the health of all Americans, including transgender youth and people in need of abortion care. It should not be a pipe dream that our lawmakers share that priority and collaborate with us to achieve it by following the science, rather than the bias. 

Sign and share Ms.’s relaunched “We Have Had Abortions” petition—whether you yourself have had an abortion, or simply stand in solidarity with those who have—to let the Supreme Court, Congress and the White House know: We will not give up the right to safe, legal, accessible abortion.

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Jennifer Villavicencio, MD, MPP, is a Cuban American obstetrician-gynecologist. She is an expert in complex family planning, health policy and strategic communication of socially complex subjects. In addition to clinical caregiving, her passions include reproductive justice-informed health policy, structural equity and anti-racism, and effective messaging around abortion. She serves as the lead for equity transformation at the American College of Obstetricians and Gynecologists.