In its first 100 days, the Trump-Vance administration has attempted to dismantle and disrupt a broad range of domestic and international programs and policies, sowing chaos and negatively impacting the lives of millions. Through executive orders, funding freezes, contract terminations, mass layoffs and other actions—many of which have been challenged as unconstitutional—these policy changes have, by design, had an especially detrimental impact on the sexual and reproductive health and rights (SRHR) of people in the US and across the world.
These actions constitute an attack on both science and the basic value of reproductive freedom. Their impact has been immediate and will continue to have long-term and far-reaching consequences.
Eliminating Protections for Reproductive Health and Rights
The Trump-Vance administration wasted no time going after sexual and reproductive health (SRH) care. Within its first week, the administration:
- Revoked two Biden-era executive orders designed to protect reproductive health care, including health data privacy and access to emergency abortion care, both issued in the wake of Dobbs v. Jackson Women’s Health Organization—the ruling which struck down the federal right to abortion and created a patchwork of laws and access across the country.
- Pardoned 23 anti-abortion activists convicted of violating the Freedom of Access to Clinic Entrances (FACE) Act, a federal law that prohibits threats of force, obstruction, and property damage at reproductive health care facilities, including abortion clinics. Further, the Department of Justice (DOJ) issued an order to cease enforcement of the FACE Act, barring “extraordinary circumstances,” a step which has emboldened activists seeking to harass and threaten abortion patients and providers.
- Issued guidance reinstating the global gag rule, a policy that prohibits nongovernmental organizations based outside the United States (but who receive US funding) from using their own money to provide abortion services or engage in other related activities, such as referrals to abortion care or advocacy for abortion access. That same day, Secretary of State Marco Rubio announced the United States’ intent to again become a signatory to the Geneva Consensus Declaration, an extreme anti-abortion and anti-LGBTQI document seeking to overturn decades of well-established human rights principles.
- Pulled down reproductiverights.gov, a government website that informed people about their rights and how to access abortion and other reproductive health care services.
- Announced the United States’ intent to withdraw from the World Health Organization (WHO), which plays a critical role in global health policy and services, including reproductive health care.
In subsequent weeks, the administration’s direct attacks on abortion have continued.
- In late January, the Department of Defense (DOD) rescinded protections, including travel reimbursement and leave, for servicemembers and their families who need to travel to receive reproductive health care not covered by military insurance, including abortion and assisted reproductive services such as in vitro fertilization.
- In March, DOJ dismissed the lawsuit brought by the Biden administration to ensure that pregnant people in Idaho could receive abortion care guaranteed under the Emergency Medical Treatment and Labor Act (EMTALA). This reversal from the Biden DOJ position, while anticipated, signals that the Trump administration will not defend the right to emergency abortion care for individuals living in states with abortion bans.
Beyond these direct actions targeting reproductive freedom, the Trump administration's sweeping attacks on equity, science and health care more broadly have dangerous implications for sexual and reproductive health.
DOGE Cuts and Attacks on Diversity, Equity and Inclusion
On the first day of the Trump-Vance administration, a new office known as the Department of Government Efficiency (DOGE) began indiscriminately cutting programs and personnel across the majority of federal agencies, under the guise of eliminating waste, fraud and abuse. At the same time, President Trump signed an executive order to terminate all “diversity, equity, inclusion (DEI) and accessibility mandates, policies, programs, preferences and activities of the federal government.” Together, these efforts have targeted, disrupted and, in some cases, eliminated programs and funding that provide quality health care and promote health equity in the US and around the world—including in sexual and reproductive health. Such programs are particularly critical for communities already facing barriers to health care access due to systemic racism, global inequities, and other economic and social factors. Throughout the process, the Trump administration has undermined Congress and the federal budget process by withholding appropriated funds and, in many instances, disregarded courts’ authority to uphold the law.
Over the course of two months, DOGE and other departments within the Trump administration completely dismantled the US Agency for International Development (USAID). From freezing all funds and issuing stop work orders to firing nearly all USAID employees and terminating the vast majority of contracts, the administration has wreaked havoc on US and international development and humanitarian aid efforts. Claiming that USAID does not serve America’s core interests or values, the administration ignored Congressional authority and dismissed orders by federal courts that it pay contractors and restore employees’ computer and email access. The administration’s actions have cut off nearly all US foreign assistance, which has decimated global health programs and life-saving support for people in low- and middle-income countries.
US foreign assistance has been especially critical to advancing reproductive health globally. Despite Congress appropriating $607.5 million annually for international family planning, the administration nonetheless terminated all such family planning grants, including all US contributions to the UN Population Fund (UNFPA).Those terminations will lead to the denial of contraceptive care for 47.6 million women and couples annually. In turn that will result in 17.1 million unintended pregnancies and 34,000 preventable maternal deaths.
On April 1—on the heels of these cuts to international family planning assistance—the administration suddenly withheld funding to 16 domestic family planning organizations that receive grants through Title X, the nation’s only federal program dedicated to reproductive health service provision for people who lack health insurance or are underinsured. As a result of these withheld funds, at least 834,000 people—approximately 30% of Title X patients—could lose access to Title X-funded services such as contraception, STI testing, and cancer screenings over the course of a year, if the cuts are made permanent. Claiming (without evidence) that the grantees had violated its executive order prohibiting DEI efforts, the administration suspended their funding—despite Title X being specifically designed to address sexual and reproductive health inequities.
Beyond attacking access to contraception globally and domestically, the Trump administration is using DOGE and its DEI executive order as a backdoor to go after other federally funded projects that don’t align with the president’s agenda. Officials at the National Institutes of Health (NIH) have cut millions of dollars in grant funding, claiming that the grantees were in violation of the executive order because their research in some way related to diversity, equity, inclusion or transgender issues. All NIH grants recipients undergo a peer-reviewed application process that is among the most rigorous and competitive in the world, which suggests that these cuts are rooted in ideology rather than any evidence of misconduct or breaches of scientific standards.
Erasing Science and Data
Soon after taking office, the Trump-Vance administration began taking down government websites that contained published research, publicly available datasets, and clinical guidelines, many of which are critical to the provision of reproductive health care. These include but are not limited to the Pregnancy Risk Assessment Monitoring System (PRAMS) and the Behavioral Risk Factor Surveillance System (BRFSS), surveys that collect data on health behaviors, outcomes, and access through collaboration between the CDC and state health departments. In addition, the administration eliminated funding for and limited access to the Demographic and Health Surveys (DHS), a vital resource which oversees data collection in over 90 countries. Researchers rely on these three research initiatives, in addition to other datasets now at risk, to conduct research on a range of health topics, including SRH issues such as maternal mortality, pregnancy outcomes, contraceptive use and disparities in reproductive health care. Analyses of these data are essential to track health trends over time and to inform evidence-based policies and programs, both in the US and globally.
While the future of these critical public health resources remains unclear, even the temporary cessation of their data collection and dissemination efforts will have a long-term impact on research and health care. It has already generated confusion and distrust, raising questions about whether data was compromised or changed. Adding to the concern was Secretary of Health and Human Services Robert F. Kennedy, Jr.’s announcement of a massive restructuring of the agency, which included laying off most of the employees in the CDC’s Division of Reproductive Health—the division that oversees PRAMS, research on infertility care, contraception guidance for health care providers, and the CDC’s annual abortion surveillance report.
Nominating Leaders Who Oppose Science and Reproductive Rights
Department and agency leaders hold immense power and influence in the federal government, implementing key programs and policies. Many of Trump’s appointees pose a threat to reproductive health and rights, both because of their disregard for science and evidence and their anti-abortion ideology. Although many are still being confirmed, some of the most extreme anti-science nominees have already taken up pivotal roles in divisions of the Department of Health and Human Services (HHS):
- Robert F. Kennedy, Jr. was confirmed as HHS secretary despite his lack of qualifications and blatantly anti-science views, including an embrace of harmful conspiracy theories regarding vaccines and other topics. During his confirmation hearings, Kennedy admitted that he would implement Trump’s plans for restricting access to mifepristone, despite the medication’s proven safety record in abortion care and miscarriage management.
- Martin Makary leads the Food and Drug Administration (FDA), which plays a crucial role in approving new contraceptive methods and regulating medication abortion. Makary has spoken publicly about his anti-abortion views and has similarly refused to acknowledge the decades of scientific evidence demonstrating mifepristone’s safety and efficacy.
- Dr. Mehmet Oz poses a threat to evidence-based policy as administrator for the Centers for Medicare and Medicaid Services (CMS), an agency vital for sexual and reproductive health services. Throughout his career, Dr. Oz has promoted unproven and dangerous theories, medicines and therapies—demonstrating a willingness to forgo science and patient safety for personal and financial gain.
Beyond HHS, many other Trump appointees have established ties to the anti-abortion movement and have demonstrated a willingness to make decisions based on extremist ideology rather than scientific evidence. These include appointees to the Department of Justice (such as Attorney General Pam Bondi, Solicitor General Dean John Sauer, and Assistant Attorney General for Civil Rights Harmeet Dhillon), as well as Secretary of State Marco Rubio and others.
Targeting Transgender Health and Rights
The administration’s attack on the health and rights of transgender and other gender nonconforming and intersex individuals started with an executive order that mandates the federal government to exclusively recognize “an individual’s immutable biological classification as either male or female.” This was followed by another executive order directing federal agencies (including HHS and the Department of Defense) to restrict access to gender affirming care for individuals younger than 19 years of age, through actions such as excluding coverage of this care from federal insurance and banning such care provision by all providers who accept Medicaid and Medicare. These attacks follow the playbook used by anti-abortion advocates to restrict access to abortion, contraception and other reproductive health care services for young people. Following these orders, the HHS Office of Civil Rights rescinded its guidance protecting transgender patients from discrimination under Section 1557 of the Affordable Care Act.
In addition to including highly inaccurate and inflammatory language about transgender individuals, one of these executive orders (and the HHS website created in response) uses medically inaccurate definitions of gender and sex that erase the existence of trans, nonbinary, gender nonconforming and intersex individuals. The definitions also claim that sex is defined “at conception” which it treats as synonymous with fertilization—despite the fact that reputable medical associations agree that pregnancy itself does not begin until implantation. This language furthers the agenda of “fetal personhood” which not only ascribes legal rights to fetuses, but in some cases, also embryos and fertilized eggs. Attacks like these threaten not only the rights of transgender and gender nonconforming individuals, but also sexual and reproductive rights more broadly—putting at risk access to abortion care, certain methods of contraception, and assisted reproductive technologies.
Conclusion
The Trump administration’s actions in its first 100 days have already had disastrous effects on the lives and health of people in the United States and around the world. The administration's radical restructuring of federal policy and programs has been accompanied by a campaign of intimidation, selective defunding, and unlawful deportations designed to quell dissent and legal challenges to its policy agenda. These destructive and ideologically motivated steps should not, however, be surprising. In so many areas of policy, including sexual and reproductive health, the Trump administration is following the extremist conservative plan laid out in Project 2025. The sweeping policy proposals contained in that document suggest that threats to reproductive freedom, scientific integrity and health care access will continue to escalate in the weeks and years ahead. At this moment, it is critical that policymakers at all levels of government take steps to protect the health and rights of their constituents, and that the judicial system fulfill its responsibility to uphold people’s fundamental freedoms and constitutional rights.