It was one year ago that millions of women worldwide marched against newly inaugurated US President Donald Trump.

The marches were meant to send a message to Trump after a presidential election that "insulted, demonised and threatened" women, immigrants and those from the LGBTQ community and others.

"[The march] will send a bold message to our new administration on their first day in office, and to the world that women's rights are human rights," organisers declared ahead of the 2017 women's march.

Over the last year, women have not stopped marching and organising, calling on governments to do more to support women's rights.

More women have entered politics in the US, and on Saturday and Sunday, hundreds of thousands took to the streets again to demand that they have a seat at the table.

Despite the gains, however, 2017 also saw an "assault" by the Trump administration and Congress on women's health, advocates and health experts say.

"We have faced assaults constantly on the legislative front to reproductive rights and to access to healthcare generally for people in America across the board," Amy Friedrich-Karnik, a senior policy adviser at the Center for Reproductive Rights, told Al Jazeera.

As women call on Trump to take more steps to protect women's rights, Al Jazeera examines some of the key ways activists and health experts say the administration has targeted women's health.

1. Reinstating and expanding the Global Gag Rule

During his first week in office, Trump began issuing executive orders that reversed Obama-era policies. Among them was a decree that reinstated the Global Gag Rule.

The Reagan-era policy bans international organisations that receive US funding from providing abortion services or offering information about the procedure. George W Bush was the last president to reinstate the rule.

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In May, the Trump administration took additional steps to expand the rule, also called the Mexico City policy, to include funding coming from the US Department of State, USAID and the Department of Defense.

This includes nearly $9bn aimed at the prevention and treatment of HIV/AIDS, malaria, the Zika virus and other health issues worldwide.

According to reproductive health advocates, the move "severely" restricts the work of international organisations.

"[The rule] severely limits their [NGOs] ability to take US funds and then do the work that they need to do on the ground to ensure that women have access to the healthcare they need," Friedrich-Karnik said.

"We know from when the Gag Rule was in place in the past that it has a really devastating effect on women's health and women's access to services," she added.

We have faced assaults constantly on the legislative front to reproductive rights and to access to healthcare generally for people in America across the board." Amy Friedrich-Karnik, Center for Reproductive Rights

Dr Barbara Levy, vice president of health policy at the American College of Obstetricians and Gynecologists (ACOG), said that due to the wide scope of the new gag rule, many organisations that may qualify for funding are withholding services out of fear.

"What we're hearing is that organisations are refusing to do any counselling, any referrals or anything to do with even saying the word ['abortion'] because they're afraid of losing what US support and funding they have," Levy said.

"It [Global Gag Rule] has the potential to impact all of the good that is happened in HIV and the PEPFAR funding, [and] all of the good that has happened with malaria prevention because all of those are global health efforts, and frequently on the ground outside the US, the NGOs that are implementing these things are also doing family planning or other reproductive health services, " she added, referring to the US President's Emergency Plan for AIDS Relief (PEPFAR).

"So it has a potential to be very broadly negatively impactful, not only for women's health, but for health in general."

2. Limiting birth control access

Last week, the Trump administration announced that it was expanding protections for doctors, nurses and other healthcare workers who have a moral or religious objection to performing services like abortion, euthanasia or gender reassignment surgery.

The move, hailed by conservative religious groups, includes the creation of the Conscience and Religious Freedom Division within the Department of Health and Human Services to provide oversight.

"For too long too many of these healthcare practitioners have been bullied and discriminated against because of their religious beliefs and moral conviction," acting HHS Secretary Eric Hargan said on Thursday.

The announcement came a day before the annual March for Life, where thousands protested across the country against abortion.

Speaking to the protesters, Trump, who in the 1990s said he "hates the concept of abortion", but was still "pro-choice", boasted about his steps during his first year in office to defend the "right to life".

During his presidential bid, Trump said he "evolved" on the issue.

In October, HHS also introduced new rules that would allow companies and organisations that have moral or religious objections to file for an exemption from a federal mandate that they provide contraceptive coverage in health insurance policies without a co-pay.

In December, a second federal court blocked the move over a "reversal" in the Trump administration's "approach to striking the proper balance between substantial governmental and societal interests".

While anti-abortion rights organisations have commended Trump on the steps he has taken over the last year, reproductive rights advocates and other health experts say the new rules represent a "deep pattern seen over the last year".

"We believe that the primacy is not on any individuals, whether it's employers or employees or your own personal feelings," said Lucia DiVenere, officer of government and political affairs at ACOG.

"It's really the patient's needs," she told Al Jazeera.

"We over and over again implore and advise the Trump administration to put patients first and to make sure there is no political interference between patients and the care they need.

"It's really a very dystopian view of women's healthcare and their access to healthcare."

3. Anti-abortion rights activists appointed to key posts

Reproductive rights advocates also point to Trump's appointments of prominent anti-abortion rights activists to high-level posts in HHS and other departments.

Among the most controversial appointees is Charmaine Yoest, who led the leading anti-abortion rights group Americans United for Life for seven years.

Yoest serves as the assistant secretary of public affairs at HHS. She was an active supporter of the Trump campaign and has been known to cite unreliable claims regarding women's health issues.

In 2012, she told the New York Times that the scientific establishment is "under the control of the abortion lobby".

Republican Senator Paul Ryan congratulated Yoest on the appointment on Twitter, saying "Yet again, this [administration] demonstrates strong commitment to the pro-life cause".

Trump also appointed Teresa Manning to the post of head HHS's family planning programmes. Manning, who resigned last week for unknown reasons, according to local media, was openly opposed to abortion and has questioned how effective specific contraception methods are.

Many also point to the conservative appointments of Neil Gorsuch to the US Supreme Court, and the Office Refugee Resettlement's Scott Lloyd, who attempted block a 17-year-old rape survivor and other immigrant teens in federal detention from getting an abortion.

In May, Vice President Mike Pence called Trump's appointments an "A-team" of "pro-life leaders".

"For the first time in a long time, America has an administration that's filled top to bottom with people who stand without apology for life," Pence told a crowd at the Susan B Anthony List Campaign for Life gala.

While anti-abortion rights groups have hailed Trump's appointments, many who advocate for reproductive rights say they show a calculated move by the president to "go after women's health rights".

"I think it just signaled a very clear intent on the part of President Trump and his administration to systematically go after women's health, women's rights and dismantle kind of the system that we have in place to ensure that all people have access to the reproductive healthcare that they need," the Center for Reproductive Rights' Friedrich-Karnik said.

4. Attempts to repeal Affordable Care Act

While Republicans, backed by Trump, have so far been unsuccessful in their multiple attempts to repeal the Affordable Care Act, commonly called 'Obamacare', women's health advocates have expressed grave concern over the implications of such a move.

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"This was an incredible fight that lasted over several months and … we expect many cases that will continue this year," Friedrich-Karnik said.

"I think what stood out over the whole fight was that every version [of the repeal] had the same really harmful provision on women's health," she added.

"So a lot of the bills would roll back guarantees of coverage, which is one of the most important pieces of the Affordable Care Act was ensuring that certain types of healthcare were required to be covered, whether it was no copay contraception or whether it was maternity care."

Versions of the bills would have also defunded Planned Parenthood for at least a year and eliminated guaranteed coverage for pre-existing conditions.

According to the Center for Reproductive Rights and ACOG, the list of "attacks" on women's health goes on and on.

On Friday, the administration announced it was rescinding Obama-era guidance that made it harder for states to defund Planned Parenthood. States have also introduced legislation that advocates say is aimed at restricting or eliminating abortion action.

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While reproductive rights activists and advocates say they have had to go on the defensive over the last year, many still say they have hope.

"I think that it has been very heartening and probably not surprising … to see that kind of outcry that you saw over a year ago at the women's march has in no way dissipated and that anything has only strengthened," Friedrich-Karnik said.

"I think that you're just going to see more activism, engagement and wins for reproductive rights, for equality and justice broadly."

This article is part of a multipart series that examines the State of America Under Trump. Also read:

Trump's America: A shrinking space for protests

Trump's America: 'Dreamers must make deal with devil'

Trump's America: An 'attack' on climate change fight

Trump's America: 'War of attrition' on journalists

Trump's America: A war on police, or their detractors?



