In the midst of the tariff forest, or conflagration to switch the metaphor, we cannot lose sight of the trees – Administration’s devastating attack on reproductive, and general, health of people here and abroad. And the attacks are just beginning.

The Administration has suspended Title X funding for family planning clinics in this country but also USAID grants for reproductive and other health around the world. Title X supports the provision of reproductive healthcare, including family planning and the treatment and prevention of sexually transmitted diseases in family planning clinics in this country. Many of those clinics are operated by Planned Parenthood. None of the funds can be used for abortion services. A total of $66 Million in Title X funding has been suspended, including $21M for Planned Parenthood clinics. These programs have been audited repeatedly to make sure that this does not happen, yet this administration under the guise of fiscal probity has suspended the funds to do yet another investigation. The effect of this suspension will be that clinics will be turning away low-income patients who will have nowhere else to go and will lead to increases in sexually transmitted infections, cervical cancer and pregnancy rates, and therefore abortion rates.

The next shoe to drop is probably Medicaid funding going to Planned Parenthood and other reproductive healthcare clinics. Medicaid funding reimburses clinics for reproductive healthcare visits, including family planning and sexually transmitted disease provision for clients who are eligible for Medicaid. If and when these cuts are enacted, and there are sure to be challenges because these funds are budgetary provisions, enacted by Congress, and it will lead to the closure of many family planning clinics nationwide. Patients will have nowhere else to go. On top of this, the Supreme Court this week heard arguments about whether or not states can prohibit Medicaid recipients from using clinics which also provide abortion services, i.e Planned Parenthoods. Planned Parenthood receives about one-third of its revenue from Medicaid and Title X.

Planned Parenthoods nationwide are facing huge budgetary pressures, as are many healthcare providers, with rising costs, especially salaries for nurses, doctors and other trained personnel. My old affiliate, Planned Parenthood of Greater New York (PPGNY), recently announced that they were putting up for sale the building that houses its Manhattan clinic and would be closing the clinic. They said they hoped to open in Manhattan clinic at another site, but there are no definite plans. The affiliate, along with many other Planned Parenthood affiliates nationwide, have been closing under-performing clinics because they cannot be subsidized in the current climate. PPGNY and PP Illinois have recently closed four clinics each. This has led to greater travel, and other costs, being imposed on rural patients, as well as delay and forgoing of health care.

Planned Parenthoods around the country that provide abortion services are inundated by patients from states where abortion has been criminalized. The resulting subsidy that patients need, including travel costs and accommodations, as well as the fees that they are unable to pay are devastating the finances of Planned Parenthood. This is a human and public health crisis, and states that keep abortion legal must do more to make abortion as safe and accessible as possible. Women are going to resort to do-it-yourself abortion and not under a doctor’s care which could lead to injury and death. Those doctors who are mailing abortion pills internationally and across state lines are not reaching every woman who needs an abortion. About half of women coming to Planned Parenthoods nationwide are using abortion pills, but many are opting for surgery because the procedure can be done in the same day and the woman can return home without delay or risk of needed a followup visit in a state where abortion is criminal.

There is a curious intersection, and disconnect I believe, with much of the conservative ideology about white supremacy. The attacks on Planned Parenthood will reduce reproductive healthcare as well as abortion services in areas with large white populations. If the conservatives hope as a result the white birth rates will go up, that might happen (preliminary data shows an increase in births in criminalized states – the abortion rate has also gone up!). But these attacks will also end up resulting in the closure of clinics serving minority populations, so those birth rates will also go up. In all cases, there will be an increase in sexually transmitted diseases (and illegal abortions), which in many cases cause infertility, thereby decreasing the nation’s ability to increase the birth rate. Talk about counterproductive.

The middle of all this chaos, families have to sort out whether and when to have children. One of the factors that men and women will take into account is how they view the future. Certainly the tariff chaos will give financial pause to many in every state and of every political persuasion. People are now poorer than they were a month ago, and one can question whether they see any light at the end of the Trump tunnel. Some conservatives are beginning to see that they should offer incentives for married couples to have children, though incentives offered in various countries around the world have done little or nothing to increase birth rates.

The intersection of the tariff policy with the anti-immigration policy gives political concern. Many areas of this country have seen population growth and economic vitality from immigration. If these areas are depopulated through deportations, the economies there will stagnate and decline. One US study called it, “Depopulation, Deaths, Diversity and Deprivation: the Four D’s of Rural Population Change.” This scenario played out in the former East Germany recently, an area where people of ability left for greater opportunity in the former West Germany, leaving behind people with fewer opportunities and social services, who were full of resentment, and therefore voted for far right political parties. This would naturally buoy the Trump party even though he was the cause of it all.