This story was originally published by 19
The inauguration of President-elect Donald Trump will restore enormous power to the staunchest ally of anti-abortion activists, whom many in the movement once considered the “most pro-life president” in the nation’s history.
Four years after Trump first left office, the state of access looks radically different. From 2022 the collapse of Roe v. Wadevoters across the political spectrum have repeatedly shown they support reproductive rights, even voting for GOP legislators. That deters some Republicans, including Trump, from at least publicly supporting restrictions that could be politically toxic.
Once in office, however, Trump and his administration will have significant power to further restrict abortion. And with the overturning of Roe, the opportunities to achieve this are greater than last time.
“There are so many levers he can pull,” said Greer Donley, a law professor at the University of Pittsburgh who tracks abortion policy. Despite his recent hesitations, she added, “There’s no world in which I think he wouldn’t do anything.”
Trump’s past actions offer some clues about what he could do this term, even without assist from Congress.
Medication abortion
Abortion opponents urged Trump to impose up-to-date restrictions on mifepristone, one of the drugs used in most abortions. The Food and Drug Administration, a subsidiary of HHS, approved mifepristone for exploit in abortions and said it can be prescribed via telemedicine and taken from home, a decision supported by a immense body of medical research.
In the past, the FDA operated with political independence. But that may change. Abortion opponents argue that the agency should be used to limit when and how mifepristone is used – by revoking approval for telemedicine or even seeking to withdraw the drug from the market. Such decisions would be contrary to scientific evidence. Although medical abortion is still possible without mifepristone, using higher doses of a drug called misoprostol, this single-drug regimen is slightly less sheltered and effective.
Some health care providers are unsure whether they would still offer medication abortion without mifepristone. Telehealth abortions using medications currently account for approx 1 in 5 abortions in the country—including many drugs prescribed and provided in various states, and health care providers in abortion-friendly states ship drugs to people in states with bans.
Asked if he would recommend that the FDA withdraw approval of mifepristone, he said yes unclear.
Comstock Act
Some of the most extreme anti-abortion activists also want the up-to-date administration to restore the 1873 anti-abortion law, known as Comstock Act, which prohibits mailing material that could be “used or applied to induce an abortion or for any indecent or immoral purpose.”
This law has never been repealed, but it has gone unenforced for decades. Some abortion opponents believe this could now be used to ban the distribution of all abortion drugs or even ban abortion altogether. The Biden administration’s Justice Department rejected this interpretation.
In AugustTrump said he would not enforce Comstock’s law. But others in his orbit, including the authors of the conservative policy agenda known as Project 2025supported this approach.
Planned Parenthood and Title X
During his last presidency, Trump partnered with family planning clinics, including Planned Parenthood, the nation’s largest reproductive health care provider, a federal program that supports family planning clinics for low-income people.
The Title X program does not directly fund abortion; the money supports health services such as contraception, cancer screening and testing for sexually transmitted diseases. However, reproductive health clinics supported by the program can sometimes refer patients for abortion. Planned Parenthood, a regular target of abortion opponents, operates most of the clinics eligible for Title X funds.
The previous Trump administration prohibited Title X clinics from informing patients about abortion options, even if they did not provide such services themselves. The the rule resulted at more than 400 Planned Parenthood clinics that have lost federal funding, as well as at more than 600 clinics outside the organization. The Guttmacher Institute, which tracks reproductive health policy, estimates that the change cut Title X program capacity in half, affecting about 1.6 million patients. Biden administration reversed this policy.
The first Trump administration also decided to allow anti-abortion facilities – mostly non-medical facilities that focus on discouraging people from having abortions – to apply for and receive Title X funds, another policy that the Biden administration has thwarted.
On the 2024 campaign trail, Vice President-elect JD Vance said that once in office, Trump will support “defunding Planned Parenthood” – suggesting he may reinstate the rule when he returns to the White House.
Medicaid
By law, Medicaid, the public insurance program for low-income Americans, cannot discriminate against qualified family planning providers, which means beneficiaries should be able to exploit this coverage at Planned Parenthood clinics. Medicaid is funded and administered jointly by the federal government and individual states, so it can only cover abortion if the state government has specifically set aside money for that purpose.
During Trump’s previous presidency, HHS authorized countries provide “greater flexibility” in determining which providers can participate in the program, which some have interpreted as making it easier for states to exclude Planned Parenthood from Medicaid. In 2024, the Biden administration issued guidelines the rest state that they were required to allow Medicaid patients to choose their family planning provider and that they could not prohibit a qualified clinic from participating in the program.
Currently, two states—Arkansas and Missouri—are actively enforcing laws that prevent local Planned Parenthood clinics from participating in the Medicaid program. Similar laws in other states have been blocked by courts.
The Supreme Court agreed listen to the case considering whether states could actually kick Planned Parenthood out of their Medicaid programs, even if the insurance plan is not used to cover abortions. The case concerns A 2018 Executive Order issued by South Carolina Governor Henry McMaster, who sought to prevent Medicaid funds from being sent to Planned Parenthood.
Department of Justice
The Biden administration has actively defended abortion rights in many cases.
One of them, whether the Emergency Medical Treatment and Labor Act protects access to abortion in certain medical emergencies, is pending before the U.S. Court of Appeals for the Ninth Circuit. Another one, regarding the legality of medical abortion, is also working its way through federal courts.
After the transition, Trump’s Justice Department could withdraw these cases or similarly refuse to defend abortion rights in court. The up-to-date Justice Department could also eliminate abortion rights initiatives, such as: Task Force on Reproductive Rightswhich was established after Roe was overturned and monitored state anti-abortion policies that may have violated federal law.
The incoming administration could take the opposite approach to the Justice Department under Biden and file lawsuits challenging state laws protecting abortion rights, rather than suing states that impose specific restrictions.
Abortion for immigrants
The Trump administration sought to deny abortions to pregnant immigrant minors held in U.S. prisons. This effort was led by the Office of Refugee Resettlement, a subsidiary of Health and Human Services (HHS). E. Scott Lloyd, who headed the office under Trump has personally worked to discourage detained teenagers from having abortions.
In one such case, a 17-year-old woman detained in Texas sought an abortion. The Trump administration tried to deny her access, prompting the ACLU to file a lawsuit. A teenage woman had an abortion after a federal appeals court ruling almost two months later.
Global gag rule
The previous Trump administration said that recipients of U.S. foreign aid could not “perform or actively promote abortion as a method of family planning,” a rule that weakens reproductive health care providers far beyond the country’s borders. The global gag rule applied to organizations that received money from government agencies – such as the U.S. Agency for International Development – to work in other countries.
A version of this policy that was quickly reversed by President Joe Biden was enforced under previous GOP presidents; Democratic administrations have consistently reversed this. The Trump administration has taken a more radical approach, preventing global aid organizations from talking about abortion. Under previous GOP administrations, the silence rule, also known as the Mexico City Policy, applied to organizations receiving family planning funds. During Trump’s presidency, this affected all global health care funding spent by the United States.
The broad scope of the rule meant it covered approximately $12 billion and included work on contraception, HIV treatment, child nutrition, water treatment, malaria and tuberculosis. The State Department during Trump’s first term also expanded the policy to include contractors who worked with organizations that received U.S. funds, even if they individually received no aid.
Research shows that implementing a global gag rule usually results closure of family planning clinics, a decline in contraceptive exploit and an escalate in the number of abortions. It is unclear whether Trump’s broader rule has increased the impact of these policies.
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