Attacks on abortion and gender-affirming care dismiss bodily autonomy

Earlier this week, the US Senate once again missed an opportunity to stand up for abortion rights, when the Women’s Health Protection Act went down by a narrow two-vote margin. The vote was called in response to the unprecedented leak from the Supreme Court documenting what many have feared since the Trump administration packed the court with anti-abortion judges. Legally, the draft majority opinion striking down decades of settled law in Roe v. Wade is out of step with the fundamental right to privacy, which underpinned the court’s 1973 decision that the Constitution protects abortion access. But politically, it’s in lockstep with the growing determination of conservative lawmakers to use the power of government to strip away our right to make private decisions about our own bodies.

Privacy is inextricable from the right to bodily autonomy, which the United Nations defines as the right to make decisions about our own lives and futures. Bodily autonomy emphasizes that control over our own bodies is a foundational personal freedom.

America has often struggled to live up to this ideal. Our nation was founded on the presumed right of wealthy white people to buy and sell Black people as slaves. It has taken America most of our 400-year history to even begin to repent, much less repair, the sins of slavery that have stolen futures and fortunes from millions of Black Americans.

In the 1970s, as arguments for abortion rights moved into the center stage in American politics alongside the ongoing Civil Rights movement, Black womanist and queer thinkers at the intersections of these movements articulated a powerful reproductive justice framework explaining that what was at stake was not just abortion : It was each person’s fundamental right to make deeply personal and private decisions about their bodies, their families and their futures.

Now, 50 years later, we still haven’t gotten the message.

As abortion rights teeter on the brink of extinction at the Supreme Court, a gathering wave of laws aimed squarely at transgender people is also sweeping across the US Since Time magazine heralded the “tipping point” of transgender visibility in America in 2014, transgender and nonbinary (trans) Americans have increasingly found ourselves in the crosshairs of legislative crusades to erase us from public life. Early efforts founded, as when North Carolina notoriously lost its battle to keep trans people from using public restrooms in 2015. But over the last two years, many states have seen a barrage of strikes on the ability of trans people — particularly trans young people — to access health care, secure identity documents, play sports and even go to school safely.

The tide rose slowly for a few years, with states like Idaho, South Dakota and Mississippi considering bans on sports participation by young trans athletes beginning in 2020. This spring, however, the tsunami arrived. First Texas directed state agencies to investigate the supportive families of trans youth, claiming that these parents’ care for their children is “child abuse.” Next came Alabama, where legislators gleefully rammed through a law on the last day of the session that prohibits providers from following widely accepted expert standards of care in providing gender-affirming care to trans youth. Florida is the latest to jump on the bandwagon, using its state Health Department to rail against federal guidance on the importance of affirming social support and health care for trans youth. In total, 19 states were considering various versions of these policies in their legislative chambers in spring 2022.

Like efforts to ban abortion, bans on social transition and gender-affirming care for trans youth fly in face of medical guidelines that outline why these services are medically necessary and often lifesaving. The Endocrine Society and the World Professional Association for Transgender Health maintain expert standards that describe the safe and effective provision of care to trans youth. Multiple scientific studies have found that social support, including use of appropriate pronouns and names — which is the primary intervention for trans youth — and gender-affirming care such as puberty delay medications improve mental health and are associated with better health and quality of life in adulthood.

These state laws, by contrast, feed on misinformation and fear mongering rather than actual science. What’s more, bans on abortion and gender-affirming care create a chilling effect on health care professionals by forcing them to violate their oath to promote the health and well-being of their patients.

Attacks on abortion and gender-affirming care are crafted from the same playbook by the same legislators with a single-minded goal: Terrorizing and controlling people by stripping us of any say over what happens to our own bodies, including our private medical decisions.

Protecting and advancing bodily autonomy for all isn’t just about any specific health care service: It’s about every person’s fundamental freedoms. We cannot stay in our silos and think only about ourselves. Regardless of whether we are trans or not, or whether we could ever become pregnant, we cannot allow conservative ideologues to stand between patients and their providers or between parents and their children. No matter where we live or who we are, we must stand together to defend the right of each person to make deeply personal choices about their own bodies. Our lives depend on it.

Drs. Restar and Baker are Robert Wood Johnson Foundation Health Policy Research Scholars. The views expressed by the contributors are their own and not of their employers.

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