As the new presidential administration takes action on many fronts, CORE anticipates significant impacts for reproductive healthcare. We previously outlined expected policy changes that will impact access to contraceptive care. In this post, we switch focus to possible presidential actions that would restrict abortion access.
Statements from members of the Trump administration, policies proposed in Trump’s first term as president, and plans from allied groups indicate at least four strategies that could undercut people’s access to abortion and the ability to make informed choices about their pregnancies, including in Wisconsin.
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The Department of Justice, under the new administration, may use the 1873 Comstock Act to ban the mailing of medications used for abortion. Such an action would effectively impose a nationwide ban on medication abortion, regardless of state laws.
As written, the 150-year-old Comstock Act prohibits the mailing of materials that can be “used or applied for producing abortion, or for any indecent or immoral purpose.” While the law was never repealed, for many decades, legal authorities and federal agencies have interpreted the law as not applying to abortion. Following the June 2022 US Supreme Court Dobbs decision that overturned the federal right to abortion, policy advisors to the current administration have argued that the Comstock Act can be applied to mailing abortion medications.
The impact: This move could severely restrict access to the most common method of abortion in the U.S., accounting for 63% of all abortions in 2023. (Medication abortion is less common in Wisconsin, likely due to many state laws restricting its use.) Applying the Comstock Act to abortion would impact the mailing of medication abortion to all states, not just those with abortion bans. Millions of people would lose access to a safe and effective form of abortion care, harming individuals, families, and communities.
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Food and Drug Administration (FDA) leadership can greatly influence drug approvals and restrictions. The president has asked his Secretary of Health and Human Services, who oversees the FDA, to review the use and safety of mifepristone, a drug the FDA approved for use in medication abortion in 2000.
Despite mifepristone’s proven safety and efficacy, this review could lead to restrictions on its use, including limiting use to earlier stages of pregnancy, banning telehealth access, or revoking its approval altogether.
The impact: Such actions could drastically reduce access to medication abortion, which represents nearly two-thirds of all U.S. abortions. What’s more, mifepristone is used for miscarriages and other medical conditions. Restricting access to mifepristone would affect millions of Americans seeking abortion care (see #1) and potentially endanger people needing care for early pregnancy loss by limiting clinical options.
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The president may direct the Department of Health and Human Services to stop enforcement of EMTALA, the Emergency Medical Treatment and Labor Act. This federal law requires hospitals to provide emergency abortion care to pregnant people who need it.
The impact: EMTALA is crucial for ensuring that pregnant individuals facing life-threatening conditions receive necessary care, including abortions, to preserve their health, life, and fertility. Clinical guidelines for care in pregnancy emergencies include abortion in such cases. Since the Dobbs decision, there have been instances in Wisconsin and nationwide in which the denial of emergency abortion care has endangered pregnant people’s health and lives.
The impact of rescinding EMTALA’s protections would disproportionately affect Indigenous and Black women, as well as those living in rural communities, who already face significant healthcare barriers and are at a higher risk of pregnancy emergencies. Indigenous and Black women, who face double and triple the pregnancy-related mortality rates of white women, would be especially vulnerable.
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The president has expressed both support for and resistance to a national abortion ban. Most recently, the Secretary of Health and Human Services testified that the president supports a ban on abortions later in pregnancy.
The impact: Being denied an abortion at any point in pregnancy harms pregnant people, their families, and communities. As explained in this CORE brief, abortion bans based on gestational duration cause additional unique harms.
Gestational bans inflict physical and emotional distress on individuals discovering life- or health-threatening pregnancy complications later on. They also disproportionately impact people of color, people living on low incomes, and people unaware of their pregnancies until later stages. Learn more about the harms of gestational bans and the structural challenges that intensify their impacts.
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