Where all the candidates stand on reproductive rights.
Reproductive rights have taken center stage at the Democratic National Convention and are a key element of Vice President Kamala Harris’s campaign platform. The first night of the DNC featured several women sharing stories of how restrictions on abortion put their lives at risk — from being turned away at emergency rooms despite bleeding and pain to being denied a medically necessary abortion until becoming septic and nearly dying. These stories bring into sharp relief the personal stakes of the battle over reproductive rights that will be decided in the November elections. As a practicing gynecologist, a vocal proponent of reproductive rights, and author of the book It’s Not Hysteria: Everything You Need to Know About Your Reproductive Health (But Were Never Told), I’m passionate about making sure voters have all the information needed on these issues and where the candidates stand before election day.
Abortion
Most Americans support abortion rights in some form. An Associated Press/NORC poll from June 2024 showed that 79 percent of voters polled oppose a national ban on abortion, and 61 percent supported access to abortion for any reason. In most cases where abortion has appeared on state ballots in the past several years, voters have protected access to legal abortion, including in traditionally red states such as Kentucky.
Former President Donald Trump appointed three of the Supreme Court Justices who voted to overturn Roe v. Wade in 2022 and has said he would leave abortion rights up to the states. Since Roe was overturned and federal protections for abortion were lifted, 14 states have initiated a total abortion ban, and three now ban abortion after six weeks, a gestational age when most women do not yet know they’re pregnant. Trump’s running mate, Senator JD Vance, has said that he would like “abortion to be illegal nationally” and has flip-flopped on his stance on exceptions for rape or incest.
Vice President Harris has stated that she would fight to protect abortion rights, including working with Congress to codify federal protections for abortion. Her running mate, Tim Walz, is Governor of Minnesota, which was the first state in the U.S. after the fall of Roe to pass a law protecting an individual’s access to abortion. The law, titled the Protect Reproductive Options (PRO) Act, safeguarded the right to make decisions not just about abortion, but also contraception, sterilization, and fertility treatments. Walz also signed a bill protecting people who travel to Minnesota to seek abortion care, even if they are residents of a state with an abortion ban.
The stories shared by women like Amanda Zurawski on the first day of the DNC illustrate why voting against abortion access may actually put pregnant women’s lives at risk rather than “protecting life” as intended. Zurawski was 18 weeks pregnant with a much-desired pregnancy when she broke her water early. Because she resides in Texas, where a strict abortion ban is in place, she was denied an abortion until she became septic and nearly died, suffering significant damage to her fallopian tubes and uterus as a result. In 2012, this same scenario led to the death of Savita Halappanavar in Ireland, shocking the public and leading to the legalization of abortion in that country. The reason that exceptions “for the life of the mother” are nearly meaningless when abortion bans are in place is that there is no mechanism for them to specify how close to death a patient must be before a doctor is allowed to intervene without risking being charged with a felony or losing their license. A woman may break her water early, start to bleed, or develop high blood pressure, and go from being completely stable to septic, hemorrhaging, or near death in hours or days — and by the time the risk is clear enough to satisfy lawyers or judges, the damage may be done.
Abortion bans have had other unexpected consequences for entire health systems. Fear of prosecution and restrictions on reproductive care has led many OB/Gyns to leave or avoid moving to states with strict abortion bans, such as Idaho and Tennessee, resulting in “maternity deserts” where entire counties may lack OB/GYN care. Infant mortality has also risen significantly in states with strict abortion bans, in part because of a rise in births of babies with fatal congenital or chromosomal anomalies. And as we know from from data prior to Roe in the U.S. and in other countries with laws outlawing abortion, simply banning abortion has never significantly decreased rates of abortion — it merely increases the number of women traveling across borders to seek abortion or the rates of unsafe abortion, which is a major cause of maternal mortality worldwide.
IVF and Assisted Reproductive Technologies
The rhetoric around abortion and the protection of life starting at conception has extended to in-vitro fertilization, or IVF, which is an assisted reproductive technology (ART) used for the treatment of infertility. IVF involves the creation of embryos by fertilizing eggs in a lab, and unused embryos may be discarded. In February 2024, the Alabama Supreme Court ruled that embryos in an IVF lab were considered children and warranted legal protection against “wrongful death” if destroyed (which is common practice after someone has successfully conceived and has extra embryos or has embryos that are genetically abnormal and dangerous to implant). This put access to IVF at risk and temporarily halted IVF services for couples at the largest health system in Alabama.
Both former President Trump and Senator Vance have publicly supported access to IVF. However, Senator Vance voted against codifying protection for IVF nationwide, as did all but two Senate Republicans, when the Right to IVF Act failed to pass in June.
Governor Walz has been open about the fertility struggles that he and his wife Gwen faced for several years before conceiving their children with the use of another form of ART, intrauterine insemination (IUI). He has been a vocal supporter of protecting the right to assisted reproductive technologies such as IVF. Of note, Senator Vance recently accused Walz of “lying” about having undergone IVF. However, Governor Walz has not directly said that he and his wife used IVF, rather that they “have two beautiful children because of reproductive health care like IVF.” Walz has also supported a bill in the Minnesota House of Representatives that would require health plans that offer maternity coverage to also cover fertility treatment.
Reproductive Autonomy
Decisions about pregnancy and fertility are extremely medically and emotionally complex. This is why health experts and reproductive rights advocates argue that lawmakers and judges with no medical expertise should not regulate medical care, particularly based on their own religious or moral beliefs, and that the decisions should be left to the individual in consultation with their doctors. No other area of healthcare besides abortion and gender-affirming care is regulated by non-medical professionals, sometimes in direct opposition to standards of medical care or the evidence-based guidelines of professional organizations such as the AMA, the WHO, and ACOG (American College of Obstetricians and Gynecologists).
In this upcoming election, voters will choose not only a President and Vice President but future Supreme Court Justices, Governors, Senators, Congresspeople, and local government leaders who will, in turn, decide on their rights to bodily autonomy and healthcare decision-making. It’s critically important that we understand the issues at hand, and the potentially unexpected ramifications, before heading to the polls in November.
Karen Tang, MD, MPH, is a board-certified gynecologist and minimally invasive gynecologic surgeon based outside of Philadelphia. She’s the author of It’s Not Hysteria: Everything You Need to Know About Your Reproductive Health (But Were Never Told). As @KarenTangMD on Instagram, TikTok, and YouTube, she reaches millions of viewers with her educational videos about gynecologic health topics.
