US Health Services Nominee Alex Azar’s Reproductive Health Dilemma

Alex Azar, the Trump Administration’s nominee to serve as Secretary of Health and Human Services (HHS), is making headlines during nomination hearings focused largely on his views regarding the cost of drugs. However, Azar’s nomination provides a vital opportunity to distinguish himself from his disgraced predecessor, Tom Price, and oversee US and global health policy with respect for science and evidence.

Price’s parting gift, and Azar’s incoming challenge, lies in a draft strategic plan for the Department of Health and Human Services, that represents yet another egregious effort to roll back women’s and girls’ human rights. The document, which covers the next four years, lays out the agency’s strategic goals and objectives as well as the means for measuring progress. Among other deviations from previous US law and policy, the draft strategic plan bases policy on a claim that life begins at conception. Such a policy flies in the face of both established legal precedent and scientific fact, and would threaten women’s rights in the United States and around the world.

In an effort to restrict women’s right to abortion, anti-choice organizations and advocates have long tried to insert provisions into laws and policies that would recognize the fetus as a person with rights that are distinct from the person who is carrying it.  Not only do scientific and medical experts repeatedly emphasize that there is no evidence to support claims of life beginning at conception, but that perspective is deeply embedded in US legal precedent. From the landmark Roe v. Wade decision, which found that “that the word ‘person,’ as used in the Fourteenth Amendment, does not include the unborn,” courts have consistently refused to assign the rights of personhood to fetuses. Instead, they upheld women’s rights to make decisions about their own bodies and lives.

Embedding this language into the strategic plan of the agency charged with protecting public health would have major consequences for women’s lives. First, it would give HHS a stronger mandate to issue regulations further restricting women’s rights to make decisions about their bodies in the United States, such as those regulating contraceptives, emergency contraception, and access to abortion.

It could also provide an opening for regulation of women’s behaviors during pregnancy, accelerating the trend towards punishing women for negative pregnancy outcomes. The plan, as drafted, could also give cover to actions like those of Scott Lloyd, who as director of the HHS Office of Refugee Resettlement has personally intervened to obstruct young women currently in HHS custody from receiving the legal abortions they want and have a right to, most notably in the recent case of Jane Doe.

On a global level, we are already seeing HHS officials obstructing critical agreements on sexual and reproductive health. The draft HHS plan would further strengthen their hand, and embolden other conservative governments that are attempting to use international negotiations at the United Nations and other multilateral bodies to erode commitments on women’s human rights. Very recently, for example, the US blocked commitments to sexual and reproductive health and rights at a meeting of the health ministers of the G7, a group of industrialized democracies that also includes Canada, France, Germany, Italy, Japan and the United Kingdom.

The HHS represents the US on the World Health Assembly, the governance body of the World Health Organization, charged with responding to global health emergencies and providing evidence-based health guidance. The new HHS strategy would firmly establish the United States as a profoundly regressive force on women’s health and rights in this and other such bodies, threatening to erode decades of progress on improving women’s health and undercut previous US investment in evidence-based international development policy.

The draft HHS strategy sends a clear message: this Administration is not interested in facts and science. It is not interested in best practices or collected evidence. It has no intention to pursue programs based on what is known to work and improve the lives of women. Instead, the Trump Administration is yet again allowing conservative ideological and religious voices to dictate policy. If confirmed as head of HHS, Alex Azar will have to decide whether he is on the side of science and justice or if he will proceed blindly with a strategic plan and other ideologically driven tactics that subject millions of women to dire consequences.

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