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Transforming reproductive health: Potential changes under the Trump-Vance administration

Writer's picture: Leanna Coy, FNP-CLeanna Coy, FNP-C

Different forms of birth control sit on a blue background. Pills, IUD, implant, condom, ring, and diaphragm are all present.

Reproductive health advocates are on high alert as the Trump-Vance administration takes office. President Trump’s record of taking steps to limit access to reproductive health put the country on alert. Just one day after the election win in November, Planned Parenthood reported a 760% increase in the number of appointments for IUDs. They also saw a 1200% bump in appointments for vasectomies and a 140% increase in appointments for gender-affirming care. Americans are worried.


Reproductive healthcare is essential. It includes contraception, abortions, pregnancy care, menopause, and gender-affirming care. Executive orders, litigation, and enacting legislation are just some of the tools at Trump’s disposal. With these tools, the anticipated restrictions could affect reproductive care nationwide.  


Preventing abortion access nationwide. Trump's Supreme Court appointees reversed the long-standing Roe v. Wade abortion decision three years ago. Now, twelve states have completely banned abortions. One state has a near-total ban, and ten more states have restrictions in place.


The fall of Roe v. Wade led to an increase in the use of medication abortions nationwide. In 2023, one year after the repeal of Roe v. Wade, 63% of abortions were medication abortions. This was a 53% increase from the number of medication abortions in 2020. These numbers do not include abortion medications mailed to people in states with total abortion bans.


The Trump administration could restrict the use of mifepristone. Mifepristone is the pill used in medication abortions. One method of reducing the use of this medicine could come with the enforcement of the Comstock Act. Passed in 1873, this federal law made it illegal to send obscene materials through the mail. This includes:


  • Contraceptives

  • Information about contraception

  • Instruments, medication, or substances used to induce abortion

  • Obscene writings and pornography


In the 1970s, amendments to the law repealed restrictions on contraceptives. These days, the law primarily covers cases of child pornography. Yet, enforcing the Comstock Act is a possibility as anti-abortion advocates have pushed for implementing its use. Enforcement would affect people who distribute or receive abortion-related materials.


End access to birth control benefits. The Trump administration also plans to remove or limit contraceptive coverage. The Affordable Care Act currently requires private insurance to cover birth control, prenatal care, and preventative services. Policy changes could allow companies to use moral or religious exemptions against contraceptives. This would allow them to avoid coverage of birth control in their health plans. In turn, limiting reproductive health coverage for employees, dependents, and students.


Bringing back the domestic gag rule. Established in the 1970s, the Title X program aimed to improve access to contraception and reproductive health. The program serves underinsured and low-income people. In 2019, Trump prohibited clinics that received Title X funds from discussing abortions. Known as the 2019 Title X Final Rule or domestic gag rule, this included providing information or counseling about abortions. Biden nullified the domestic gag rule during his time in office. With abortion care remaining tenuous, there is a genuine concern for the incoming Trump administration to restore this ban.


Reinstating the global gag rule. The United States gives funds worldwide for health services. In 1984, a policy began preventing foreign non-government organizations (NGOs) from using their own funds to share abortion information. The Mexico City Policy, known as the global gag rule, keeps NGOs from receiving health funds if they:


  • Share abortion information

  • Offer abortion counseling

  • Provide abortion services

  • Refer for abortions

  • Advocate for abortions


Essentially, NGOs must choose between providing complete reproductive health services or health funding from the U.S.


As with the domestic gag rule, Biden removed the global gag rule as one of his first acts as president. Despite more than half of voters opposing the ban on global health services, Trump will likely reinstate the rule.


Revoke anti-discrimination protections. Trump plans to quickly roll back years of diversity, equity, and inclusion. He plans to issue executive orders declaring the U.S. government will only recognize two sexes, male and female. Trump also promises to stop all federal agencies from providing access to gender-affirming care at any age. An executive order could wipe out federal laws and programs currently in place for gender-affirming care.


The next four years will challenge the health and wellness of those in need of reproductive health services. Every person deserves the right to healthcare without bans or barriers. Organizations around the country continue their tireless efforts to keep reproductive services unrestricted. Time will what new challenges we all will face.


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