I'm not an expert by any stretch, but it looks fairly legit.
You can see the lighting of the picture is similar to the lighting of the scene/world, including some mild reflection of the ground and cars in front of the dark parts of the picture (his black jacket).
These are very subtle details that, while always possible to fake, would have been a pretty serious investment in time and energy to have done.
That would be a fantastic political ad campaign. Picture of republican politician, "your body my choice", and maybe a bad quote or bill they sponsored. Dems need to step it up with impactful ads
It has only just occurred to me that this may be sexually motivated. I was only hearing it as more of the horrible misogyny coming from them. Well, TIL.