The future of reproductive rights under Trump 2.0

On January 15th, a few days ahead of the inauguration of Donald Trump as the 47th President of the United States of America, Dr Laura Sochas, Dr Emily Adrion and Dr Nason Maani from the Social Policy subject area of the School of Social and Political Science held a panel discussion about health policy under Trump 2.0. Threats to reproductive rights were a very prominent theme, so GENDER.ED Associate Director Kaveri Qureshi sat down later with the panellists, to hear what they have to say. 

Kaveri: What likely changes do you see the new Trump administration making, and how will these impact on reproductive health and rights?

Laura: As the GENDER.ED community would be aware, in a case called Dobbs vs Jackson in 2022, the Supreme Court overturned the constitutional right to abortion that had been established in Roe vs Wade. Dobbs vs Jackson has led to major differentiation between US states in terms of the legality and ease of accessing abortion, in ways that leave poorer women and women of colour at greatest risk of not being able to access a needed abortion in time – compounding existing social and health inequalities. It seems unlikely that the new administration would bring in a federal abortion ban, partly because a majority of the US electorate supports legal rights to abortion, and Trump himself has said he would veto such a bill. But there are still many areas of concern. 

Five days into his second term, Trump issued an executive order to strengthens the Hyde Amendment, which bars federal funds from being used to fund abortion. The order rescinds two Biden executive actions, one compelling the government to expand abortion access and the other defining abortion as health care. Trump also brought back the Global Gag Rule, which prevents foreign NGOs from receiving US federal funding if they provide abortion counselling or referrals. So far, every Republican administration has implemented this rule, and every Democratic one has rescinded it. Last time, Trump expanded this rule to apply not only to family planning programmes and policy, but to all global health assistance. We can expect an expanded Global Gag Rule this time around, too. This would have monumental consequences for reproductive rights worldwide.

Back to the US domestic context, we’re still waiting to see whether Trump will threaten the legality of medication abortions – which are now a majority of abortions in the US, and which have lower financial and logistical costs for users – by using the 1873 Comstock Act. This is an old federal anti-vice law preventing anything “obscene” from being sent in the mail. As yet, legal challenges to the Food and Drug Administration around abortion pills have not been successful, but we could still see Trump’s future appointee to FDA create more obstacles in accessing these pills. 

Emily: Regarding the legal challenges, beyond the lawsuits related to mifepristone for medication abortion, there are a number of other ongoing lawsuits that the Justice Department under the Trump administration will no longer defend, with important implications for healthcare access and reproductive rights.  After Roe v Wade was overturned, the Biden administration issued guidance around the 1986 Emergency Medical Treatment and Active Labor Act, EMTALA, in response to states implementing highly restrictive abortion bans without health exceptions. Dropping the defence of the lawsuits would return physicians to a position of uncertainty around the legality of providing emergency abortion when medically necessary in states with bans. Additional litigation that the Trump administration will either stop pursuing or defending relates to the privacy of reproductive health information, the inclusion of abortion in employer accommodations for employees during pregnancy and childbirth, current and future litigation relating to gender-affirming healthcare services – and we’ve already seen Trump’s initial executive order legally instituting gender binarism in direct affront to gender identity protections pursued via the Biden administration.

Other lawsuits will be important to watch as well, like Braidwood Management Inc vs Becerra, which challenges the Affordable Care Act provision requiring preventive healthcare to be provided for free, including contraception and cervical cancer screening. More broadly I’m concerned about wider changes to public and private health insurance that the new administration looks set to introduce, which are likely to lead to greater numbers of uninsured people, lower quality coverage and higher patient cost-sharing, with impacts on reproductive health and on morbidity and mortality.

Laura: On the health system, Trump may again amend the Affordable Care Act’s contraceptive mandate, which states that insurance companies and employers have to cover contraception. Project 2025 wants to restore religious exemptions to the contraceptive mandate, as well as remove the week-after pill from the mandate. Trump could once more disqualify sites from the Title X programme – which helps people on low-incomes access contraceptives– if they provide information and counselling about abortion. As in Trump’s previous term, the new administration could also appoint anti-abortion judges to the courts, who could define foetal personhood in ways that apply not only to abortion but also, threaten most forms of birth control and the discarding of embryos from IVF. More broadly, Project 2025 seeks to blur the lines between contraception and abortion.

A wider context for these threats to reproductive health and rights, is the strong pronatalist ideology within the Trump support camp. Trump has said that he wants to see a “new baby boom”. Elon Musk has said that falling fertility is “the biggest danger that civilization faces”. From a reproductive justice perspective, here we have to point out that this pronatalism is selective, placing greater value on the reproduction of affluent white citizens than migrants or disadvantaged Americans; and how insufficient and fragmentary the existing welfare support is for families across the US, whilst the child protection system places poor and racialised families under invasive surveillance. 

Kaveri: There’s a scholar, Professor Laura Briggs who argues that all politics has become reproductive politics. If we follow that line of reasoning, Nason, what other policy changes do you think the new administration will make, that will ultimately impact on reproductive health and rights? 

Nason: Well, although health policy wasn’t a big feature of the debates in the run-up to the election, thinking about the issues that did feature – climate change, immigration, government efficiency and deregulation – these all could have major impacts on social inequalities in the US. Such inequalities are already deep and etched along racial lines, reflected in everything from healthcare access, to employment, household income, wealth and housing insecurity. These ultimately drive the unequal patterns of health outcomes in the US, like all-cause mortality and life expectancy, as Emily mentioned, and maternal mortality. But as Laura Briggs argues, these increases in social inequality – whilst social safety nets get cut – will amplify the tensions, stressors and unmet needs that accompany the manufactured crises of gender and sexuality that Trump has profited from. 

Dr Laura Sochas is a Chancellor's Fellow and Leverhulme Early Career Research Fellow whose research takes a critical feminist, reproductive justice stance on how power, institutions, and social policies affect health and reproductive inequalities. Dr Emily Adrion is a Senior Lecturer in Global Health Policy, and researches health systems. Dr Nason Maani is a Lecturer in Inequalities and Global Health Policy, and works on the structural and commercial determinants of health.