The Biggest Women’s Health Issues of the 2020 Presidential Election

Elections have the ability to impact birth control access and affordability, abortion rights, maternal health and mortality, sexually transmitted infection testing, and more. In the 2020 presidential election, especially, this couldn’t be more true. The current Trump-Pence administration has already rolled back access to reproductive services for women, while the Biden-Harris ticket has promised comprehensive coverage for women moving forward. But there’s no way to talk about what’s currently at stake on November 3 without also talking about the Supreme Court — something that’s of the utmost importance right now as the Senate is considering the confirmation of Judge Amy Coney Barrett — President Trump’s third Supreme Court nominee. There’s evidence that she personally opposes abortion (she’s been linked with anti-abortion-rights faculty groups, for example) and has a record of conservative rulings. And while she hasn’t yet ruled specifically on the legality of abortion, when she’s reviewed cases around abortion restriction, she has voted in favor of those regulations. 

One of the looming consequences: Barrett represents a possible vote to overturn Roe v. Wade, the landmark 1973 decision deeming access to abortion a constitutional right. (In the past, she’s added her name to a letter that criticized the “barbaric legacy” of the decision.)

And if Roe is overturned, your ability to seek an abortion for any reason would depend dramatically on where you live, since abortion rights would fall under under state law. Twenty-four states could ban abortion outright if the ruling is weakened or overturned by the Supreme Court, according to The Center for Reproductive Rights’ What If Roe Fell tool. And as that Guttmacher report points out, increased abortion restrictions would harm those with lower income, women of color, young people, and the LGBTQ+ community the most.

“Denying access to abortion has very serious, long-standing implications and this idea that somehow women will find a way may be true of wealthy women, but it definitely isn’t true for poorer women,” explains Diana Greene Foster, Ph.D., director of research at the University of California San Francisco’s Advancing New Standards in Reproductive Health. Foster says her own research has found those who were denied an abortion were less likely to be able to care for existing children as well as have another child later, and fared worse in terms of physical and mental health and economic well-being.

Abortion is something that has already been limited greatly during the Trump administration, too, from restricting funding to places such as Planned Parenthood to signing a bill to overturn regulations that prohibited states from defunding abortion service providers. (It’s also worth noting that abortion only accounts for a small percentage of Planned Parenthood services. Mostly, the women’s health organization provides STI testing, contraceptive services, well-woman exams, and cancer screenings to young and low-income women.)

Conversely, Vice President Biden is pledging to protect abortion rights under his Biden Agenda for Women. The longtime U.S. senator from Delaware has pledged to “stop the rash of state laws that so blatantly violate Roe v. Wade” and restore federal funding in Planned Parenthood.

Yet, access to safe abortions is far from a stand-alone issue. If Roe is overturned, a lot of other things women have relied on could be in jeopardy, says Mary Ziegler, a professor at Florida State University College of Law, who specializes in the legal history of reproduction. For example, anti-abortion lawmakers have been known to pull birth control pills and IUDs (which prevent implantation of an embryo) and some aspects of in-vitro fertilization (i.e. destruction of unused embryos) into conversations about abortion. (Just recently, Republican Senator Ted Cruz referred to birth control as “abortion-inducing drugs.”)

The Supreme Court also has the potential to further limit the ability to get free contraception for some 43 million women in this country who are sexually active and don’t want to become pregnant as it is hearing arguments against the ACA following the election. If it were to be repealed, you might be forced to think about adding birth control back to your monthly budget.

Of course, Republicans have made attempts to repeal Obamacare since the Trump administration came into office, slowly limiting access to things such as birth control. Case in point: In July 2020, the Supreme Court voted to uphold the Trump administration’s authority to enact moral and religious exemptions to the ACA’s contraceptive coverage guarantee, which would ultimately make it easier for employers to deny women coverage. While these exceptions are not yet in effect — pending lawsuits against them are currently being reviewed in lower courts — it’s one example of the current administration’s attempt to limit access.

The Biden administration says it will allow women at such organizations, including those with religious missions, to access contraceptive coverage through their insurance company or a third-party administrator.

“Traditionally, women have always paid more for health insurance, essentially because of reproductive health care,” explains Elisabeth Smith, chief counsel for state policy and advocacy at The Center for Reproductive Rights. “If the ACA was to go away, we could be back to that former state of affairs and that would be really detrimental for both women’s health and finances.”

The ACA also offers further financial and reproductive protections to women, such as no longer counting pregnancy as a pre-existing condition that health care providers could deny you coverage over. It also requires health insurances to cover breast pumps, oftentimes a necessary first step to help women breastfeed, which the American Academy of Pediatrics recommends exclusively for the first six months of a newborn’s life.

The Guttmacher Institute also notes that the federal government hasn’t offered a “comprehensive response to the growing maternal health crisis.” And while Biden’s site does include an agenda for both women and the Black community, specifically addressing maternal mortality, there doesn’t appear to be any maternal mortality policy provided by the Trump campaign at all. 

Every one of these reproductive health issues also plays a role in racial inequality across America. That’s why the 2020 election and the Supreme Court’s rulings are crucially important for women of color. In fact, Black women experience a higher burden of some STIs and are two to three times more likely to die from pregnancy-related causes than white women. Plus, Black babies experience higher infant mortality rates than white infants. Racism remains a fundamental determinant of health status, contributing to everything from access to care to interactions with doctors.

Now, it’s worth noting that even if Barrett is confirmed and if the Supreme Court does roll back access to reproductive health services, the president still has a lot of sway, says Ziegler. And that’s why this election is historical. In a Biden-Harris administration, using federal or state legislatures to try to guarantee rights to health care (something that already exists in progressive states) could provide protection, she says. Bottom line: If you’re a womxn in this country, who you vote for matters — perhaps in this election more than any in your lifetime.

But apart from all the deaths, ravaged property, and economic carnage, there’s another, weighty consequence: Extreme, volatile weather patterns — plus the polluted air and barriers to access food and safe drinking water due to the impacted infrastructure that often follows these events — can lead to acute and long-term mental health issues. Most commonly, these include trauma and shock, post-traumatic stress disorder, compounded stress, anxiety, substance abuse, and depression, according to the American Psychological Association. Still, this reality is often viewed as a minor consequence of these events, says Sarah Lowe, Ph.D., a clinical psychologist and Yale professor, who studies the effects of natural disasters on mental health.

By diminishing the significance of these impacts, however, society may not be equipped with the resilience needed to deal with the next round of natural disasters, warns Lowe. That’s why it’s necessary to recognize that how the nation — and the world — proceeds on combating climate change, will not only impact your own future and physical safety, but also the country’s collective mental health. 

Since President Trump took office, his administration has taken 74 actions to weaken environmental protections, according to the Brookings Institution, a nonprofit public policy organization. Most notably, he spearheaded the country’s withdrawal from the Paris Agreement, which aims to substantially reduce global greenhouse gas emissions to limit the Earth’s total temperature increase. Earlier this year, Trump also weakened auto emissions standards, which critics say will cause nearly a billion additional metric tons of carbon dioxide to be emitted into the atmosphere, according to NPR. And in June 2019, the current administration, under the Environment Protection Agency, established the Affordable Clean Energy Rule, replacing the Clean Power Plan, which aimed to cut existing power plants’ CO2 emissions 32 percent below 2005 levels by 2030. By comparison, ACE would reduce these emissions by just 0.7 to 1.5 percent, according to a study in Environmental Research Letters. After analyzing the ACE Rule and its probable results, Harvard researchers reported that it does “little to address climate change and is likely to have even greater adverse air quality and health effects in some states compared to no policy.”

Vice President Joe Biden, President Trump’s Democratic opponent in the 2020 election, has pledged a more progressive approach to address the global climate emergency. If elected, he says he’ll rejoin the Paris Agreement, as well as fight for legislation that’ll help the U.S. reach net-zero emissions by 2050. (Net-zero emissions means human-caused greenhouse gases released into the atmosphere are balanced by practices that remove them, such as by restoring forests or using technology to capture CO2 from the air.) Biden also promises to invest in and incentivize clean energy innovations (think: solar and wind power tech), which would reduce the nation’s environmental footprint and create jobs, according to Biden’s climate plan on his campaign website. To curtail greenhouse gas emissions — the primary driver of global warming — from vehicles, the vice president plans to develop new fuel economy standards that seek to ensure all new light- and medium-duty vehicles are electric and heavy-duty vehicles cut down on emissions every year.

Hitting net-zero by 2050 is no easy task — the U.S. will need to transition to a largely electric economy, clean energy technologies will need to be developed, and new regulations will need to be enacted — but all of this is possible, according to an article in the journal Joule. And considering how significant the mental health impacts of climate change can be, there’s even more motivation to make that happen.

Just look at the facts: Two months after Hurricane Katrina — an event that helped expand climate change research, which has since found a link between global warming and intensifying hurricanes — a CDC survey found that more than half of the survivors who responded showed signs of a possible need for mental health treatment. Likewise, a Journal of Clinical Nursing survey found that roughly half of survivors continued to experience poor mental health 15 months after the tragedy. “You survive the storm, but then it’s so stressful to have to cope with the consequences after it’s over and you’re trying to get your life back to normal,” says Susan Clayton, Ph.D., a professor of psychology at the College of Wooster and a fellow of the APA.

That’s not to say the burden is equally distributed. “How strong the [mental health] effect is will depend on what other sources of stress you have in your life, whether you’ve learned good coping skills, and whether you have economic resources and access to mental health services that can sometimes really help you cope with the effects of natural disasters,” says Clayton. People who are prone to depression and anxiety may also be more vulnerable to the mental health effects of natural disasters and climate change, adds Lowe.

And it’s not just the catastrophic, isolated events you see in the news that cause all this damage either. The slowly eroding effects of climate change can wreak just as much havoc on your mental health. Thanks in large part to global warming, heat waves are becoming the norm, with the number per year tripling since the 1960s. Though climate change’s impact on air pollution isn’t fully understood, researchers do know that the practices that contribute to global warming (think: burning fossil fuels at power plants or driving gas-fueled cars) also degrade air quality by releasing small particles of chemicals into the atmosphere. “There’s emerging research on heat waves that show they’re related to increases in aggression, depressive episodes, and things of that nature,” explains Lowe. “There’s also a body of literature showing air pollution is associated with increased inflammation and also increases in reports of depression and emergency visits for a range of psychological conditions.”

Even if you live somewhere that’s relatively safe from natural disasters and changing temperatures, you can still bear some of climate change’s mental health effects just by being aware of the devastation — a condition known as eco-anxiety or climate anxiety. “[With eco-anxiety,] even if you haven’t experienced the direct physical impacts of climate change yourself, there’s sort of a worry about what the future might hold in the sense that things are changing in ways that we’re losing control of,” says Clayton. “It’s one thing to be aware of what’s going on and to get the facts, but I think it’s very different to be exposed to images of climate change effects over and over and over again,” adds Lowe.

For some individuals, simply feeling as if they can’t make a difference in stopping climate change can stir up eco-anxiety, which, in turn, makes them “deeply affected” by feelings of loss, helplessness, and frustration, according to the APA. The good news is that even small, individual actions can make a difference: Those who trade the drive to work for walking or biking reduce their emissions, boost their physical health, and experience lower stress levels than car commuters, according to the APA.

But one of the simplest ways to create the biggest impact is available to you on or before November 3 — vote. No proposed policy can act as a magic bullet guaranteed to stop climate change, but what can? Making an informed decision and taking action.

That’s why Biden plans to expand the ACA, says campaign policy director Stef Feldman. “There are so many fundamental improvements to women’s access to health care that are provided by the Affordable Care Act,” says Feldman. “Without the ACA, insurers could offer health plans but not cover maternity care, which was a practice before the ACA. Women could lose preventive health benefits, such as annual physicals or essential benefits like a breast pump, both of which are now free.” (Insurance companies are also currently required to cover necessary support and counseling related to breastfeeding.)

For the Trump campaign, the president recently announced the America First Health Plan. The plan’s website incorrectly states that the ACA didn’t protect pre-existing conditions and claims that those protections had already been in place for years. This not only conflicts with information presented by insurance companies, such as Cigna, but also information reported by the U.S. Department of Health & Human Services. The president has stated that he’ll protect pre-existing conditions, though he has not detailed how his health care plan would do so if the ACA is repealed.

Covering preventative measures is vital for closing the health care inequality gap that disproportionately affects low-income families. Prior to the ACA, BIPOC were more likely to be uninsured than white Americans — specifically, 18 percent of Asian Americans, 20 percent of African Americans, and one-third of all Hispanics — according to the American Community Survey by the U.S. Census Bureau. Comparatively, the survey found 13 percent of white Americans were uninsured. A major factor in closing this gap has been the ACA’s Medicaid expansion, which increased the income threshold so that more Americans were eligible to receive state-funded insurance. That expansion, as well as the Health Care Rights Law, prevents discrimination for minorities and the LGBTQ+ community and provides access to mental health and substance abuse services. Prior to the ACA, you could be denied coverage for these services, or be subject to a spending cap.

“My wife and I were married in 2013 after waiting more than 30 years for that right and the ability to gain federal benefits,” says Laurie Gemmel of Houston, whose partner is the same sex. “That meant that I could put my wife on my health insurance and claim her on my taxes. We fought for a very long time for that right and younger generations shouldn’t have to go through that all over again.” 

Research from the Center for American Progress shows that members of the LGBTQ+ community are more likely to be diagnosed with chronic conditions, as well as experience mental health and substance abuse issues. The report also showed that LGBTQ+ adults were less likely to work in fields that provided health insurance, and prior to marriage equality, civil union partners were often not covered by each other’s employer-funded health care — if either had coverage at all. That same research found that in 2009, prior to the passing of the ACA, 82 percent of heterosexual adults had health insurance in the U.S., while only 77 percent of lesbian, gay, and bisexual adults were covered. Worse yet, transgender adults were far less likely to be covered at all, with only 57 percent having health insurance.

Insurance agent Jeanie Frederic of Baton Rouge, Louisiana says she’s seen firsthand how extreme denials for health care coverage could be prior to the ACA. Women have been denied due to previous breast implant removal surgery and even migraines, as some insurances considered these to be pre-existing conditions, explains Fredric. “Prior to the ACA, diabetes and sickle cell anemia were an automatic decline,” she says. “Someone taking multiple anxiety meds was often declined as well. Underwriters use standardized guidelines for things like obesity, and they examine medical records to determine risk.”

Now, Frederic says the ACA has changed her industry and empowered consumers. “Wellness testing is covered, mental health care coverage is assured, and most of all the limitations on coverage for pre-existing conditions are gone.”

No matter who wins the presidency this election, Warren says that the mental and physical well-being of Americans — not insurance companies — needs to be front and center for the administration. “We need a president who believes that reproductive health care is health care,” she says. “We need members of Congress and lawmakers up and down the ballot who believe that, too. For millions of women, access to health care is not just about being and staying healthy, but also financial security and the chance to go to school, get jobs, and create businesses.”