While repealing Roe v. Wade was in the anti-abortion Right’s playbook, for decades attempts to restrict abortion didn’t target Roe directly: instead, they targeted access in a sideways fashion, through means such as mandatory waiting periods and parental consent laws. The surface logic of parental consent laws is similar to the logic barring childhood transition: abortion is a serious, irreversible medical procedure for which youth under 18 are too young to give informed consent. Like opponents of transition, anti-abortion ideologues emphasize hypothetical damage to fertility and the possibility of regret.
To respond to the Right’s strategy, we need to see the shared logic, and their two-pronged assault as part of a shared, larger strategy with compounding implications for people who might want abortions, and all trans people.
Months before the Dobbs v. Jackson Women’s Health ruling, which overturned 49 years of precedent establishing a legal right to abortion, a series of U.S. states considered or passed legislation aimed at preventing childhood transition. Florida bill H1557, nicknamed “Don’t Say Gay” in the popular press, targeted discussion of gender identity or sexual orientation by K-12 teachers as an attempt to interrupt the social reproduction of queer identities outside the home. Conversely, the recent executive order in Texas targeted trans youth’s parents and legal guardians, through an expansive reinterpretation of existing child abuse law that would render all technologies of medical transition “abusive” under the law.
Right-wing offensives against abortion, transition, and queer sociality aim to enforce the bourgeois family by any means necessary. To fight them, we must look beyond NGO models of pro-LGBT and pro-choice organization, and towards independent workers’ struggle for the means of reproduction.
Despite a majority at the federal level, the Democratic Party response to both of these attacks on bodily autonomy has been predictably spineless, at best offering symbolic support of “a woman’s right to choose” alongside perfunctory social media posts of trans pride flags outside congressional offices. For decades, Democratic leadership has treated abortion as a cudgel for electoral gains (“vote blue or lose Roe”): in more recent, post-Obergefell years, “LGBT issues” have been similarly weaponized.
The LGBT and reproductive rights NGOs have similarly betrayed us, with Planned Parenthood, the Guttmacher Institute, and the National Center for Transgender Equality all engaged in union-busting and abusive management practices. With each round of reaction comes another reminder to vote blue, and then more workers bullied into unpaid overtime.
The Limits of NGO Alternatives
Some smaller NGOs, with fewer direct ties to the Democratic Party, have focused on education and resourcing materials for self-managed medication abortion (SMA), and on opposing the criminalization of miscarriage under fetal homicide or feticide laws. These efforts were vital even before Dobbs, as clinic abortion was already physically or financially inaccessible for many pregnant people. Self-managed abortion is a particularly important resource for trans people, sex workers, and drug users, to whom the medical system, including abortion clinics, is structurally hostile. In the wake of Dobbs, with the National Right to Life Coalition proposing criminal penalties for individuals and organizations who “aid and abet” abortion, legal defense of SMA has never been more crucial. At the same time, the smaller NGO’s focus on the availability and legality of self-managed abortion has effectively ignored the question of who runs the clinics and how they operate, or how to defy those who seek to close them.
At a rank and file level, the pro-abortion organizers most committed to the decriminalization of self-managed abortion are black and brown women and trans people, who draw frequent connections between the policing of miscarriage (spontaneous or induced) and the policing of pregnant/parenting people who use drugs, and who sell sex. Still, even the NGOs that call for “direct action” and “mutual aid” in defense of abortion rights are trapped in a kind of respectability politics. When anarchist affinity groups calling themselves “Jane’s Revenge” vandalized anti-abortion fake clinics across the country, Reproaction ED Erin Matson put out a statement denouncing the tactics, while self-branding as “the national leader in non-violent direct action and innovative community organizing to protest anti-abortion fake clinics.” She writes:
Vandalizing anti-abortion fake clinics does not help people seeking abortions. What it does do is fuel the right’s false claims of victimization, all while they target and harass abortion providers, patients, and staff. Non-violence is widely practiced within the reproductive and progressive movements, and it is how we win.
This is a fundamental betrayal of the principles of “direct action,” a cornerstone of working-class militancy and radical organizing premised on acting without asking permission. Direct action makes oppressors feel victimized, whether it is blocking a highway or smashing a window: this is the point. Every hour that a fake clinic must stay closed in order to sweep glass or wash spray paint is an hour that people seeking abortions are not misled, harassed, or manipulated inside. Meanwhile, while denouncing militant sectors of the class keeps NGO funding streams intact, it is not “how we win.” If it were, we would be winning.
The NGOs, divorced as they are from the people most targeted by abortion restrictions, are structurally incapable of confronting the causes of our present crisis. They are constrained by the networks of their funders, by the legal requirements of 501c3 status, and by the cowardice of their leadership, whose individual and collective interests depend on capitalism continuing as-is. And here the parallel between LGBT NGOs and abortion NGOs is easiest to draw.
In response to the Texas directive which named gender-affirming healthcare as child abuse, LGBT NGOs shared stories of cisgender heterosexual parents who, while initially unsupportive, came around to the absolute necessity of hormone blockers or HRT for their child. These stories tug on the heartstrings of well-meaning liberals, and speak to the deeply felt wishes and fears of trans adults, most of whom never received parental consent for our transitions. The commonsense narrative “parents and doctors know what’s best for their kids, not lawmakers” prevails. The slick marketing aims at a liberal donor-class, avoids any committed political struggle, and leaves behind those without supportive parents, or any parents at all.
Of course, parents and doctors most often do not know what’s best for their kids any more than the lawmakers do. Most trans children are not supported by their parents in medically or socially transitioning. Even those cis parents who do allow childhood transition usually treat it as a last resort, after many attempts to prevent or delay the “bad outcome” of a trans life.
To name this contradiction risks incurring “groomer” blood libel: much like the anti-abortion movement, the anti-trans movement situates children’s bodily autonomy as a gateway to sexual abuse and sex trafficking, despite research showing that a sense of ownership/agentic control over one’s own body protects against such victimization. While most children who experience sexual abuse are victimized by someone close to the family, the heterosexual family never faces such “groomer” accusations. “Grooming” libel is not actually about sexual abuse, but instead targets trans and queer adults as sources of “social contagion.” Providing support and historical or cultural context for trans/queer youth is suspect precisely because it models possibilities outside of cisgender/heterosexual expectations. As such, these attacks are a core tactic of right-wing organizing.
Primarily targeting LGBTQ schoolteachers, Save Our Children was an organized and well-funded campaign against laws banning sexual orientation discrimination in housing, employment, and public accomodations. As the initial coalitional fight of the Moral Majority, it mobilized the Christian right through moral panic tactics still in use today. In 2011, the right-wing astroturf organization Live Action staged an “exposé” of Planned Parenthood, posing as a pimp seeking an abortion for an underage trafficking victim. This was itself modeled off the 2009 Project Veritas sting of ACORN, which bankrupted the housing rights organization. Even established, institutionally-embedded nonprofits are not immune to these attacks.
Anti-trans activists cherrypick narratives of detransition and “transition regret” which blame gender dysphoria on past sexual trauma, and urge clinicians and parents to root out the underlying reasons why youth seek transition. This is, of course, a call for conversion therapy. “Trauma therapy” to fend off transition is no different than psychological pathologization that explored the traumatic roots of gay identity/attraction/behavior. No concern is extended for trans abuse survivors seeking hormones who experience mandatory counseling as violent, intrusive, or retraumatizing, or for the open secret of sexual abuse within gender clinics utilizing conversion practices.
The Contested Horizons of “Healthcare”
Trans people’s relations to medicine are fraught— shaped by the intertwined legacies of conversion therapy, of medical gatekeeping delineating the terms of allowable transsexuality, and of medical neglect and denial of care. Yet despite the violences of the clinic, many of the U.S. trans rights movement’s most tangible political wins have been those reforms establishing transition as “medically necessary care.” As of 2021, 34 of 51 states (and D.C.) Medicaid programs explicitly cover gender-affirming hormone therapy, with 25 of 51 paying for some gender-affirming surgeries.
As Sophie Lewis notes, the political framing of abortion as healthcare has similarly resulted from struggle, and has won out over previous hegemonic framings of “safe, legal, and rare” through concerted struggle by reproductive justice organizers. Lewis writes:
Best practice in the mainstream pro-choice milieu is now to vindicate abortion in the name of human rights, on the grounds that it is medical. This is great, firstly because we’ve held onto the ‘safe’ part: medicine, after all, is about making our flesh as safe as possible to embody. Secondly, the healthcare framing subtly demotes the idea of ‘legalising’ abortion. After all, healthcare doesn’t usually need legalising. Common sense tilts intuitively, as a result, towards ‘deregulation’ or ‘decrim’ – that is to say, gestational decrim.
Yet Marxist analysis of abortion struggles tend to reject the “healthcare” frame, unless they incorporate it into a more “universal” denunciation of for-profit healthcare (usually ending with a call for Medicare for All). Lewis seems ambivalent themselves, framing abortion as an anti-work refusal of care labor, and referencing the yet-unrealized [collective] bargaining position of unpaid gestators. ““Let us learn to celebrate,” they write, “without recourse to healthcare, necessity, or special pleading, the beauty and power of a gestator’s ‘no.’”
In this model of power, the framing of “healthcare” is itself a concession, limiting the leverage of would-be gestators who choose to terminate pregnancies. Appeals to medical necessity can be a legitimizing (and deradicalizing) force – at worst, they can actively demolish solidarity, through the construction of hierarchies of deservingness.
But the subject position of “patient” is not inherently depoliticizing, nor must specific struggles around stigmatized and criminalized healthcare be flattened into a generic call for “access.” As Kade Doyle Griffiths writes in Transgender Marxism:
From an organizing and class struggle perspective, queers represent a reservoir of movement history, strategy, and experienced cadre for healthcare struggles. And at the level of consciousness, the demand by trans people for care raises the possibility that healthcare battles may become a politics that refuses to separate self-fashioning from survival. Our struggle to secure social reproduction leads us to refuse to surrender ourselves to a one-size-fits-all profit-driven standard of what constitutes the bare minimum necessity for human survival.
In this sense, the fight for abortion is not simply a refusal of biological reproduction, but a struggle to reproduce ourselves on our own terms. Criminalization of abortion, or of trans healthcare, enforces the alienating reproduction of capitalism.
There is a world of difference, however, between existing forms of ‘access’ and our fullest capacities for self-fashioning in common. The clinics are still privately-owned by the bourgeoise, or else funded through NGO structures that bind them to capital. Though she may face political scrutiny, the CEO of Planned Parenthood does not provide abortions: it is thousands of clinic workers, and countless unpaid accomplices of self-managed abortion, who do that every day, and will continue to do so regardless of court rulings. It is not the NGO leadership, but these workers, also reproducing themselves under the alienating compulsions of capital, who are our natural allies.
Our fights for healthcare, and against criminalization, are inseparable from the labor rights of healthcare workers, and of the nonprofit workers doing unpaid overtime in the wake of the Dobbs ruling. More than ever, we must build strong, independent unions willing to defend workers who refuse to enforce these bans: Texas social workers who defy the mandatory reporting of childhood transition as “abuse,” nurses who turn a blind eye to a possibly-induced miscarriage. It is no coincidence that the workers on the frontline of criminalization are in fields dominated by women, fields where queer workers are overrepresented and underpaid. Under capitalism, the policing functions of these jobs are inseparable from their care functions: “social reproduction” entails both.
But just like productive labor, the labor of social reproduction is not necessarily, not inherently alienated. Queer and trans people, alongside sex workers, drug users, and other criminalized subjects, are already performing everyday labor of counterreproduction, facilitating survival and self-formation on our own terms. These reproductive networks are not simply a stopgap, and need not require abdicating of a fight for institutional power: they are a basic requirement for any continued struggle, and are key to building class-independent institutions from the ground up. As states pass new laws criminalizing abortion and medical transition, and our task becomes even more urgent, the shelters we build for ourselves can be scaffolding for the new world we fight to build.