Women, transgender and gender-nonconforming people, and people who identify as LGBTQIA2+ face significant disparities in accessing fundamental healthcare. In its ruling on Dobbs v. Jackson Women’s Health Organization, the US Supreme Court overturned Roe v. Wade, removing constitutional protections for reproductive rights and empowering states to roll back access to abortion. Many states are also legislating restrictions on gender-affirming healthcare for gender-diverse youth and transgender adults, with both groups experiencing discrimination and numerous barriers throughout the healthcare system. We believe these attacks on fundamental healthcare devalue the basic health, well-being, and dignity of individuals, families, and communities.
Among medical and public health communities, experts recognize access to abortion and transgender healthcare are necessary for individual well-being. Additionally, a growing majority of Americans support reproductive and gender-affirming rights. The ability of a person to make fundamental decisions about their body, health, and family status is an unconditional human right (see International Covenant on Civil and Political Rights; see also UN experts denounce Supreme Court decision to strike down Roe v. Wade, urge action to mitigate consequences). Healthcare bans, whether through legislation or practical barriers to access, are an egregious violation of this right.
As practitioners of Diversity, Equity, Inclusion, and Belonging, the members of the Ethos team oppose these bans on healthcare and believe organizations have an important role to play in ensuring employees and their families have access to these rights.
Women, people of color, people with disabilities, and people limited by the compounding effects of poverty have been subject to coercion and restrictions on bodily autonomy as a result of White male supremacy history and culture in the United States. Today’s bans on healthcare access continue to have an adverse impact on people living in the intersecting spaces of racism, ableism, genderism, and poverty.
For example, race, ethnicity, and immigration status influence healthcare access and outcomes. Healthcare inequities based on race and immigration status have been thoroughly documented to reveal the many ways White-identified US nationals experience better healthcare overall compared to Black and Indigenous people of color and immigrants. Among comparable wealthy nations, women in the United States have the highest rates of death from pregnancy-related complications. Racism in healthcare widens this disparity, resulting in maternal mortality rates three times higher for Black women compared to White women. Among immigrants seeking abortion care, a majority are young adults living at or near the poverty level, many of whom are uninsured due to ineligibility for public health insurance. With continued restrictions on reproductive and gender-affirming healthcare, people who are already experiencing systemic disadvantages to health and well-being will continue to suffer compounding hardships.
In addition, issues of bodily autonomy, medical access, and parenting rights have been central to disability advocacy for decades. Individuals with disabilities are more likely to face systemic barriers to healthcare access, stigma from providers, and higher healthcare costs. Pregnancy is more likely to be a high-risk health event for people with complex medical needs, and restrictions on reproductive healthcare put these individuals at even greater risk. Rates of sexual violence and assault are three times higher for people with disabilities compared to non-disabled people and seven times higher for people with intellectual disabilities, making access to inclusive sexual and reproductive healthcare particularly vital for people in these communities.
Gender-nonconforming people also experience systemic barriers to accessing appropriate medical care, which often includes addressing mental health and medical transition holistically. Lack of appropriate healthcare worsens the debilitating mental health effects that trans people can experience as a result of transphobia and trans exclusion in society. For transgender people with disabilities like autism, access to medical and mental healthcare is unjustly restricted.
Across social identities, people with low incomes will experience substantial harm due to healthcare restrictions, most acutely in states with existing barriers to healthcare access and insufficient financial assistance for those in need. While healthcare bans are a human rights violation for all individuals, systemic inequities mean some individuals (with means and privileges) will still be able to obtain care by traveling across state borders and paying more for services. For people who are economically disadvantaged, a population in which BIPOC and LBGTQIA2+ people are over-represented, essential healthcare services will be virtually unavailable.
Bans on abortions and gender-inclusive healthcare will have adverse implications that reach far beyond individuals in immediate need of these essential services. Lack of access to safe and affordable healthcare contributes to widening racial and gender equity gaps. It also creates trauma that spans generations and presents a dangerous precedent for the continued violation of human rights.
In the United States, employer-based healthcare covers half of the population. Bans on healthcare are matters of human rights that have a direct impact on workplaces, given employers’ unique role in healthcare access. Reproductive and sexual medical services are standard aspects of health. Therefore, it is incumbent upon employers to ensure these services remain accessible.
Companies like Microsoft, Yelp, Citigroup, and Levi Strauss & Co. recently pledged to improve their abortion-related benefits, including offering financial assistance for employees who need to travel out of state to obtain legal abortion services. Additionally, while transgender people are entitled to basic legal and healthcare protections in the workplace, a growing number of organizations are supporting transgender employees by expanding healthcare benefits to include mental health services, gender affirmation surgery, and hormone replacement therapy. In 2020, approximately 20% of US companies provided transgender-inclusive benefits, up from 12% in 2016.
Employees are humans first. They exist in employer communities and entrust their health and safety to the organizational leaders who create policy, decide on benefits, and build workplace culture. Just as organizations have a responsibility to honor the rights of their employees when it comes to anti-harassment and anti-violence, they must consider their employees’ health needs and the precarious social factors influencing employees’ access to healthcare. Organizations must build into their work culture inclusive support for existing or potential parents, and pregnant and LGBTQIA2+ people. In addition to offering comprehensive healthcare benefits, this also means providing supportive paid family leave, compassion leave for abortion care, and trans-inclusive workplace conduct policies; ensuring privacy for people who access these benefits; and promoting a culture that does not stigmatize these fundamental healthcare needs.
Many employees are making difficult life decisions as a result of these changing laws, and being responsive to vital employee needs can position your organization as an employer of choice, support a healthy workplace culture and, importantly, honor the dignity of the people who work in your organization.
Access to safe, affordable, and legal healthcare is not an abstract issue that organizations can ignore. Healthcare is a deeply personal matter, and the grief caused by recent and ongoing healthcare restrictions will affect employees, their loved ones, and their workplaces. Organizations are only as healthy as the individuals who comprise them, so it is employers’ responsibility to engage with these issues in our current socio-economic and political landscape and take action.