Hey Rulers! Happy Friday and welcome to this week’s edition of Women Rule. I don’t know about you all, but my energy seems to be decreasing along with our daily allotment of sunlight post-time change. Let’s get into it before we lose any more daylight. Abortion providers are experiencing deja vu. Immediately after Donald Trump was declared the 47th U.S. president, reproductive health care providers received a deluge of requests for appointments and online prescription orders for medication abortions and contraceptives — a surge reminiscent of the fallout after Trump’s 2016 election. In the first three days after the Nov. 5 election, Hey Jane, an online abortion provider, saw a 25 percent increase in medication abortion prescription orders, a 53 percent increase in birth control prescription orders and a 187 percent increase in emergency contraception orders compared to the previous 30 day average. On Nov. 6 alone, Planned Parenthood saw a 1200 percent increase in scheduled vasectomy appointments, a 760 percent increase in scheduled IUD appointments, a 350 percent increase in scheduled birth control implant appointments — and a 140 percent increase in scheduling gender-affirming care appointments. Experts say the sudden demand for reproductive health care is indicative of a fear among many Americans that their right to access it may be in jeopardy under the incoming Trump administration. And they argue those fears are well-founded, considering the drastic rollback in reproductive health care access that followed Trump’s last term. Karen Stone, Planned Parenthood Action Fund’s vice president of public policy and government relations, tells Women Rule that “44 percent of women of reproductive age now live in a state without access to abortion” — a direct result of the 2022 Dobbs decision made by a conservative-majority Supreme Court with three Trump-appointed justices. “We anticipate that President-elect Trump and his allies will try to make it more difficult for people to access essential reproductive health care — because he has done so before,” Stone says. Joanne Rosen, a professor at Johns Hopkins University’s school of public health, says there are multiple legal pathways for anti-abortion advocates to curtail abortion access in the next four years — including but not limited to the conservative-majority Supreme Court. According to Rosen, one possible route is found in the trail of breadcrumbs in a June Supreme Court decision that, on its surface, struck down an attempt by conservative doctors to curtail access to the abortion drug mifepristone. But the court’s decision didn’t actually address the underlying issue of access to the medication — instead it hinged on “purely procedural grounds,” leaving the possibility open for future legal action on the content of the argument. Another case that could wind its way back in front of the court is the constitutionality of Idaho’s statewide abortion ban. Earlier this year the court heard a case seeking to determine whether a decades-old federal law, the Emergency Medical Treatment & Labor Act or EMTALA — which requires emergency rooms to provide stabilizing treatment to patients experiencing medical crises — supersedes Idaho’s abortion ban. SCOTUS ultimately tossed the case back down to a lower court, once again punting the issue of abortion back to the state level. And while many blue states have “shield laws” that aim to protect providers who prescribe and mail abortion pills into states with bans, the strength of these laws have yet to be tested in the face of legal action. But the most dramatic threat for reproductive health care is the possibility that a new Trump administration could revive the Comstock Act — an 1873 anti-vice statute initially created to curtail mailing information or tools used to facilitate an abortion — to ban the procedure at the federal level. After the Supreme Court overturned federally enshrined abortion rights in its 2022 Dobbs decision, the U.S. Postal Service requested guidance from the DOJ on the legality of mailing abortion medications under the Comstock Act. The DOJ, under the Biden administration at the time, advised that the mailing of abortion medications mifepristone and misoprostol is not illegal under the Comstock Act so long as the sender “lacks the intent that the recipient of the drugs will use them unlawfully.” But a DOJ under the Trump administration could interpret the act differently, using it instead to prosecute senders — and potentially recipients — of abortion medications by mail. As Julie Kay, founder of the Abortion Coalition for Telemedicine, points out: “Comstock enforcement is high on the to-do list of the most anti-abortion politicians and policymakers. We’ve seen that coming out of Project 2025; we’ve heard Justices Alito and Thomas kind of trying to put out the welcome mat at the Supreme Court for resuscitating the Comstock Act.” But she also notes that attempting to resuscitate the “very old and very dead” law, though not outside the realm of possibility, would be an “incredible stretch.” “I think there are enough legal hurdles, but there can always be more,” Kay says, noting that when it comes to abortion cases, the courts have shown a willingness to discard decades of established precedent, as in Dobbs. Planned Parenthood’s Stone says that the organization is prepared to face a Trump administration that could “try to intimidate and bully abortion providers” through threatening a “radical and incorrect interpretation” of the Comstock Act. And that includes through litigation, if necessary. For her part, Kay says her organization is working with clinicians and talking to activists about how to protect reproductive health care rights going into the next four years, including leaning on governors in abortion-friendly states. Before the expected battle starts, Stone says Planned Parenthood is encouraging the Biden administration to shore up reproductive rights and working to push the Senate to confirm as many outstanding judicial nominees as possible to the federal bench, recognizing that federal courts will “continue to be central in the fight for reproductive freedom.” Despite the looming challenges likely to come in the new Trump administration, abortion advocates are cautiously optimistic that any further restriction on reproductive health care access will prompt action not just from voters, but possibly from moderates within the Republican Party. “We’ve seen [Trump] really follow the anti-abortion playbook and we expect that will continue unless … we all stand up and say, ‘No, this isn’t going to happen,’” Kay says. “You’ve got another election at least in the Republican Party in two years and you’ve got ways that people are going to protest — and we expect that we will start to see some Republicans for choice.”
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