Lawmakers across Texas and around the world now face a rising public fight over who controls health decisions tied to pregnancy and gender-affirming healthcare. Since the U.S. Supreme Court ended federal abortion protections in 2022, Texas leaders tightened restrictions while international courts and governments moved in different directions.
That split now drives protests, lawsuits and medical guidance that reach from campus clinics to the World Health Organization.
Advocates in public health, law and campus groups describe a single through line: governments have moved control over bodies from patients and clinicians to political actors.
Texas officials describe a mission to protect what they call unborn life and to limit medical treatments for transgender minors. The state enforces multiple layers of abortion restrictions, including the state’s heartbeat law in 2021 and a near-total abortion ban that took effect after the Dobbs v. Jackson Women’s Health Organization ruling in 2022. Political leaders defend the regime as a pro-life milestone.
“Texas will always protect the right to life,” said Greg Abbott, governor of Texas, after the Dobbs ruling.
Texas’ 2021 law, known as Senate Bill 8, enabled private civil suits over most abortions. Ken Paxton, Texas’ attorney general, hailed the Dobbs ruling and issued guidance that mapped out criminal and civil penalties under the Human Life Protection Act. Critics counter that criminal penalties and civil liabilities can affect standard pregnancy care.
Critical-care physicians have told researchers that abortion bans complicate time-sensitive decisions for patients with life-threatening conditions, which can increase preventable harm.
“[The effect of abortion bans] is more than just the maternal piece,” Dr. Yolanda Lawson, a Texas OB-GYN, told Rewire News Group. “There is a downstream impact broadly on women’s health.”
Texas also restricts gender-affirming care for minors. In 2023, Abbott signed Senate Bill 14, which bars puberty blockers, hormones and surgeries for youth with gender dysphoria. Rep. Tom Oliverson, the bill’s sponsor, framed the law as a child protection measure. Abott directed the state’s child welfare agency to investigate certain gender-affirming care as child abuse, a move that critics and many medical groups rejected.
However, transgender Texans and their physicians call the law a direct intrusion into clinical judgment.
“Transgender people have always been here and will always be here,” said Ash Hall, the policy and advocacy strategist at the ACLU of Texas. “Our trans youth deserve a world where they can shine alongside their peers, and we will keep advocating for that world in and out of the courts.”
Major medical organizations continue to defend gender-affirming care.
“We stand firm in our support of gender-affirming care. Transgender and gender-diverse people deserve access to needed and often life-saving medical care,” the Endocrine Society stated in 2024 while urging policymakers to follow established clinical guidelines.
National policy remains unsettled. After the Dobbs ruling, the Biden administration used federal emergency care law to argue that hospitals must stabilize patients with pregnancy complications, including providing abortions when necessary. Courts split were over that claim. In 2024 and 2025, litigation over the Emergency Medical Treatment and Labor Act created fresh uncertainty about what emergency physicians must do and what they can do in states with abortion bans.
Global signals run in different directions. France amended its constitution in Mar. 2024 to protect abortion rights, with President Emmanuel Macron urging European leaders to add abortion to the EU rights charter.
“We’re sending a message to all women: your body belongs to you, and no one can decide for you,” Gabriel Attal, the Prime Minister of France, told lawmakers as the measure advanced.
Mexico’s Supreme Court also ruled in 2023 to decriminalize abortion at the federal level, a shift that expanded legal access across much of the country.
International health agencies have weighed in on the matter as well. A statement from the WHO in 2024 urged governments to “implement evidence-based, normative guidance” on sexual and reproductive health, eliminate stigma and dismantle harmful gender norms that block care. Human rights monitors warn that funding cuts and anti-LGBTQ rhetoric weaken protections for vulnerable groups, including transgender and intersex people.
The intersection of women’s health and transgender health grows most visible in emergency rooms, primary care offices and pharmacy lines. Patients seek medication to manage miscarriages, ectopic pregnancies, or severe bleeding, which can overlap with drugs used in reproductive or gender-affirming care.
The Guttmacher Institute stresses that abortion access does not only affect cisgender women. Meanwhile, researchers document barriers that compound for transgender and gender-diverse patients, from insurance denials to hostile environments. Clinicians report that patients now travel farther, pay more and delay care while they weigh legal risk.
Texas leaders maintain that state law reflects voter will and commitment to protect life. While advocacy groups and many medical societies argue that statutes should not criminalize standard care or block evidence-based treatment for transgender patients. The House of Delegates for the American Medical Association also moved in 2023 to support access to gender-affirming care as evidence-based medicine, reinforcing a broad front of national societies that oppose bans.
The result looks like a two-track world. France and a growing list of countries entrench reproductive rights in constitutional or statutory law. Texas and many U.S. states entrench prohibitions and compliance systems that pull medical decisions into courtrooms. The policy fight now turns on a core question that unites abortion care and transgender care: who decides what happens to a person’s body? Prime Minister Attal’s words sum up the stakes from one side of that debate: “Your body belongs to you and no one can decide for you.”
Texas leaders answer with a different premise: the state must defend unborn life and protect minors from medical interventions they view as harmful. Voters, courts and clinicians now shape which premise will govern care in the years ahead.
