Update 4/20/18: The final strategic plan does indeed define life as starting at conception by saying "HHS accomplishes its mission through programs and initiatives that cover a wide spectrum of activities, serving and protecting Americans at every stage of life, from conception." It is also reiterated in strategic goal 3, which states that "a core component of the HHS mission is the dedication to serve all Americans from conception to natural death."
The Department of Health and Human Services (HHS), the branch of the government tasked with enhancing the health and well-being of Americans, has released its draft strategic plan for 2018 to 2022, and that plan defines life as beginning at conception. Gynecologist Jen Gunter explained on her blog how the Trump administration could use this language as a way to attack contraception, abortion, and IVF, and how additional language about religious freedom could let religious healthcare providers discriminate against their patients. This document was apparently published before HHS Secretary Tom Price (himself a staunch anti-choice legislator) resigned over his use of private planes. It's a lot to unpack.
First, the definition of life stuff. The current HHS strategic plan for 2014 to 2018 says:
HHS accomplishes its mission through programs and initiatives that cover a wide spectrum of activities, serving Americans at every stage of life.
The new draft says (emphasis added):
HHS accomplishes its mission through programs and initiatives that cover a wide spectrum of activities, serving and protecting Americans at every stage of life, beginning at conception.
Conception as the start of life is mentioned again in goal #3, which also seems to reflect the anti-euthanasia views of former Americans United for Life president and current HHS assistant secretary of public affairs, Charmaine Yoest:
"A core component of the HHS mission is our dedication to serve all Americans from conception to natural death."
This science-defying, anti-choice language shouldn't surprise anyone. In a September 2016 letter, Donald Trump said he'd enlisted the president of anti-choice group Susan B. Anthony List as the president of his campaign's "Pro Life Coalition" and promised to do several things: nominate pro-life justices to the Supreme Court, sign a 20-week abortion ban into law, "defund" Planned Parenthood, and make permanent an amendment that prohibits taxpayer funding from being used to pay for abortions.
Both Americans United for Life and Susan B. Anthony List believe that copper IUDs and emergency contraception cause abortions, which medical experts say is not the case; they can prevent ovulation, prevent fertilization, and, in some cases, the copper IUD can prevent a fertilized egg from implanting in the uterine lining. Implantation is the medical definition of when pregnancy begins.
Gunter points out that if life begins at conception as far as HHS is concerned, it means the department could label these forms of contraception as abortifacients and no longer cover them for low-income people with Medicaid. (Medicaid falls under the Centers for Medicare & Medicaid Services, which is an agency of HHS.) This, of course, would be in addition to private employers being able to opt out of birth control coverage for religious or moral reasons, per a rule issued on Friday.
Redefining the start of life is also a step toward even more restrictions on abortion if HHS says a fetus is no longer a fetus, but rather an unborn child, to use another phrase popular among anti-choicers. Objective 3.3 says HHS will "Protect women and their unborn children from harm."
Reproductive medicine physician Kristen Cain pointed out that this kind of language reflects the personhood movement, where even embryos created for in-vitro fertilization would be considered people with full legal protection under the Constitution. Roe v. Wade protects women's right to abortion until a fetus is viable outside the womb; only after that can states enact restrictions. If HHS says that life begins at conception, it could lend legitimacy to personhood bills like HR 586, The Sanctity of Human Life Act, introduced in January.
But wait, there's more! The document is also littered with references to faith-based care and objective 1.3 includes a subsection devoted to "removing barriers for faith-based and other community-based providers." It basically means that doctors in HHS programs would be able to discriminate based on their religious beliefs. This section promises that HHS will:
Implement Executive Order 13798 of May 4, 2017, Promoting Free Speech and Religious Liberty, and identify and remove barriers to, or burdens imposed on, the exercise of religious beliefs and/or moral convictions by persons or organizations partnering with, or served by HHS, and affirmatively accommodate such beliefs and convictions, to ensure full and active engagement of persons of faith or moral conviction and of faith-based organizations in the work of HHS
Gunter writes, "Yes, the agency tasked with enhancing the 'health and well-being of Americans' now believes that certain religious beliefs are more important than health care. This could apply to contraception, abortion, vaccines, addiction medicine, sexually transmitted infection screening, and transgender care just to name a few."
Politico reported on this draft strategic plan on October 3 in explaining how Price's conservative vision will likely remain in place at HHS, but the story failed to capture much attention. They noted:
A "draft strategic plan" for HHS, published before Price resigned last week, references "faith" or "faith-based" organizations more than 40 times in its five-year statement of priorities. The Obama administration's last strategic plan contained only three such references.
During his tenure, Price was a big proponent of faith-based care, notoriously touting faith-based programs for addiction while showing less support for proven treatments like medication-assisted therapy. Doctors ripped him a new one over those comments.
Gunter concludes that this draft plan is a draft: People can make comments online for every section where it says "share your thoughts."
Update 10/16/17: People can also email, fax, and mail comments on the draft plan to HHS.