Donald Trump vs. Women’s Health

Nicholas Kristof


When video surfaced last fall of Donald Trump boasting about sexual assault, outrage erupted. But if Trump’s words about women were offensive, his policies are incomparably more consequential — and may cost more lives than in any other area of his governance.

Yes, the phrase “war on women” may seem hyperbolic, but it also reflects the devastating impact of Trump’s policies on women’s health. One danger is that we’re so focused on the battles at the White House that we neglect the administration’s policy impact at the grass roots — on, say, women who will die unnecessarily all over the world from cervical cancer.

Cervical cancer, an excruciating way to die, is a prime example of how Trump’s policies weaken efforts against a disease we know how to defeat.

In Tulsa, Okla., a woman named Betty Richardson, 45, told me that because she lacked health insurance she had put off going to a doctor even as she felt something was wrong. Finally, after she could wait no longer, doctors found a tumor the size of a golf ball on her cervix.

Betty Richardson put off seeking medical attention because she didn’t have health insurance. When she decided she could delay no more, doctors found a large tumor on her cervix. 

Photo: Andrea Morales for The New York Times

It’s because of delayed detection like this that the U.S. has one of the lowest cervical cancer survival rates in the developed world. It’s also why Richardson is speaking up. “I had to think about doing this interview, but if one person doesn’t get cancer because I talked to you, it’s worth it,” she explained.

No one should die of cervical cancer in 2017, for it’s highly preventable. Yet because of a lack of resources and political will, one woman still dies every two hours of cervical cancer in America, and worldwide, it will kill two or three women in the time it takes you to read this column.

At home, Trump is undermining the fight against cervical cancer by seeking to defund Planned Parenthood, which performs some 270,000 cervical cancer screenings annually.

A second way Trump is hobbling the battle against cervical cancer is his “global gag rule,” halting funding abroad for organizations linked in some way to abortion, including counseling about abortion. A third is his cutoff of funds for the United Nations Population Fund, which is a major international player in reducing deaths from cervical cancer.

In Haiti, the U.N. Population Fund is working with an outstanding nonprofit, Innovating Health International, to save the lives of women like Mariliene Yéyé, 36, a widow with three children. Yéyé had no education and is illiterate, but her brilliant 13-year-old daughter, Fedline, rose to be No. 1 in her class of 64 students — and then Yéyé developed cervical cancer.

  Yéyé, who is a widow, has three children, including Fedline, left, and Fednor, right.

 Photo: Chery Dieu-Nalio for The New York Times

Now Yéyé is fighting for her life, and she can no longer earn money by taking in clothes to wash. This means that she can’t pay school fees of $30 per child, and Fedline has had to drop out. The girl is trying to keep up with her schoolwork on her own, partly to distract herself from hunger.

This is the simplest and cheapest kind of tragedy to avert. Cervical cancer can usually be prevented with vaccination or an approach that begins with an inexpensive screening used in poor countries called the “vinegar test.” A nurse dabs vinegar on the cervix, and any precancerous lesion turns white. For treatment, a nurse freezes the lesion off with what looks like a plastic gun — and the woman’s life is saved for a total cost of about $3.

I’ve seen Marie Stopes International apply this lifesaving method in Vietnam — but the Trump administration is cutting off all assistance to Marie Stopes under the global gag rule. I watched in Haiti as a nurse, Holdie Fleurilus, administered the vinegar test at a hospital and then removed a precancerous lesion from a 33-year-old health worker, perhaps saving her life. It took 15 minutes.

Holdie Fleurilus, a nurse at a hospital in Port-au-Prince, Haiti, treating Mariliene Yéyé, who has cervical cancer. “If she had come a few years ago,” Fleurilus said, “I could have saved her life with a bit of vinegar.”

Photo: Dieu-Nalio for The New York Times

Fleurilus said that she regularly admits women with Stage 4 cervical cancer and thinks, “If she had come a few years ago, I could have saved her life with a bit of vinegar.”

The U.N. Population Fund had hoped to scale up the vinegar test in Haiti to save more lives, but Trump has cut off all American funds to make that happen.

“I can’t tell you how frustrating it is, to see these women come in with Stage 4 cervical cancer,” said Dr. Vincent DeGennaro Jr. of Innovating Health International. “They will die a slow and painful death. And that could have been prevented for $3.”

Bravo to the Netherlands, Canada, Sweden and other countries for providing more money for women’s health to try to make up for what Trump is doing.

This shouldn’t be a partisan issue. To his great credit, George W. Bush has made cervical cancer an important thread of his post-presidency, calling for funding and bringing much-needed visibility to the issue.

Why am I as a man writing about cervical cancer? Because reproductive health is always in peril of being marginalized as a “women’s issue.” Because men and women alike have a stake in saving lives. Because when President Trump embraces “pro-life” policies that are in fact “pro-death,” that should galvanize us all.

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