Executive branch agencies are among the most important players in the US government, with the power to influence and shape sexual and reproductive health policies and programs domestically and globally. They play a key role in determining how government programs are administered, staffed and prioritized. Agency leaders are political appointees who set policy agendas that are guided both by the president and by the views and vision they bring to the office. While other branches of the federal government control different levers—Congress passes legislation and appropriates funds, and courts make legal decisions related to reproductive rights—the executive branch agencies dictate how key programs and policies will be implemented on the ground and in real time.
This fact sheet outlines the main federal agencies and offices with the most influence on sexual and reproductive health care and rights in the United States and globally (recognizing that others also have some role in this area), and includes ways that access to services and the protection of rights could be affected if politically appointed agency leaders oppose reproductive autonomy, full access to sexual and reproductive health care, scientific facts and evidence-based policymaking.
US Department of Health and Human Services
There are 13 operating divisions within the US Department of Health and Human Services (HHS) and 14 offices within the office of the HHS Secretary, all charged with carrying out the broad mission of “enhancing the health and well-being of all Americans.” Many of these entities have jurisdiction over aspects of sexual and reproductive health care, giving the HHS Secretary considerable influence in setting the direction of policies and programs.
Centers for Medicare and Medicaid Services
The Centers for Medicare and Medicaid Services (CMS) administers Medicare, Medicaid, the Children’s Health Insurance Program and the Health Insurance Marketplace, providing health care coverage to more than 160 million people across these programs. Medicaid, a federal-state partnership, is the largest source of public funding for family planning services, ensuring that millions of people receive this care. Federal law dictates that states must cover family planning services—such as education, counseling, and contraceptive methods and visits—in their Medicaid programs, but does not specify which services states have to include in their programs. Medicaid also plays a central role in maternal health care, covering roughly 40% of births.
Federal and state policies governing these insurance programs, whether through legislation or regulations set by CMS, have a profound impact on access to sexual and reproductive health care. For example, Medicaid is severely restricted in covering abortion with federal funds because of the Hyde Amendment. However, 19 states fill this gap by providing coverage using state Medicaid funds, helping to reduce the financial burden for many people. Furthermore, CMS has the power to approve Section 1115 demonstration waivers, which states can use for pilot or experimental projects within their Medicaid programs.
Through decisions on these waivers—and with the power to guide other types of regulations on health coverage—CMS administrators can allow expansions on access to services in a particular state, and what types and where that care is available. However, a CMS administrator opposed to expanding access to sexual and reproductive health care can use that same power to restrict access and services throughout the country.
Office of Population Affairs
The Office of Population Affairs (OPA) within HHS “advances reproductive health outcomes and adolescent health and well-being by supporting high-quality clinical services, evidence-based and innovative programs, rigorous research and evaluation, and the engagement of communities and partners to inform policy.” OPA oversees the Title X program, the only federal program dedicated to providing comprehensive family planning to low-income individuals, particularly those who do not have insurance or are underinsured. Title X grantees provide person-centered, culturally appropriate comprehensive care in an effort to advance health equity. OPA also oversees the Teen Pregnancy Prevention (TPP) program, a national grant program focused on improving adolescent sexual health outcomes. As part of its work, OPA also issues guidance to program implementers, as well as other health care providers; for example, offering recommendations on quality family planning services.
Because of the office’s leadership role in running these programs, sexual and reproductive health care programs are deeply threatened if OPA leadership is hostile to reproductive autonomy. For example, there is the threat that Title X funding could be funneled away from comprehensive health care providers—particularly those who also provide abortion services with separate funding streams—in favor of clinics that provide only fertility-awareness or abstinence counseling. Within the TPP program, evidence could be pushed aside and abstinence-only education could be prioritized over comprehensive sex education.
US Food and Drug Administration
The US Food and Drug Administration (FDA) regulates all medical devices and drugs available in the United States, including contraceptives and medication abortion, and is guided by rigorous science and evidence-based review processes that are intended to advance public health. While FDA decisions about whether to approve drugs and how to regulate them should not be influenced by political factors, there are instances in which the FDA has placed medically unnecessary restrictions on medications that created barriers to accessing safe, effective abortion care and contraception, particularly for those who already face challenges accessing health care.
Having an agency governed by political appointees who want to restrict or eliminate access to medication abortion or certain contraceptive options could lead to pressure on scientists within the FDA to ignore evidence showing a specific medication’s safety and effectiveness, thus undermining the rigorous process of approving and regulating medications.
Centers for Disease Control and Prevention
As part of its broad mission to fight disease and increase health security in the United States, the Centers for Disease Control and Prevention (CDC) supports national and state efforts to collect health-related data and disseminate health information through education, technical assistance, and guidance and recommendations. The CDC supports sexual and reproductive health programs in various ways.
For example, the CDC promotes evidence-based practices and policies that seek to improve adolescent sexual and reproductive health, tracks data on sexually transmitted infections nationwide, and supports global reproductive health through program monitoring and evaluation and capacity building among local partners. The CDC has a role in overseeing key sexual and reproductive health data collection efforts and houses the National Center for Health Statistics. Many of the studies overseen by the CDC (such as the Behavioral Risk Factor Surveillance System, the Youth Risk Behavior Surveillance System and the Pregnancy Risk Assessment Monitoring System) provide crucial data on contraceptive use, pregnancy-related statistics and other indicators for sexual, reproductive and maternal health. Specific to abortion incidence data, the CDC compiles information from states and jurisdictions that choose to report data on the number and characteristics of people obtaining abortions.
If the CDC’s leadership opposes sexual and reproductive health and rights, they could not only hinder efforts to advance public health in this area but also cause new harm. For example, they could use data related to abortion, contraception and STIs in damaging ways; weaponize surveillance of pregnancy outcomes; de-prioritize public health efforts to combat the spread of STIs; or thwart efforts to advance and track adolescent health outcomes.
Health Resources and Services Administration
The Health Resources and Services Administration (HRSA) supports equitable health care for various underserved communities through its grantmaking, programs and research.
The agency has worked to reduce maternal mortality rates through its maternal health programming in the Maternal and Child Health Bureau. The Title V Maternal and Child Health Services Block Grant provides funds to improve access to services for those who need prenatal, delivery and postpartum care. The HIV/AIDS Bureau manages the Ryan White Program to reduce HIV prevalence and fund entities and organizations providing health care services to individuals living with HIV across the country. A hostile presidential administration could threaten these programs—particularly for grantees that also provide services such as gender-affirming care.
In addition, HRSA supports the Women’s Preventive Services Guidelines, which provide recommendations for health services that must be covered by private insurance plans with no copay as part of the Affordable Care Act; the guidelines include the full range of contraceptive methods. A presidential administration opposed to sexual and reproductive rights could roll back the gains made in women’s health through access to preventive services by threatening these programs, including by eliminating coverage of certain contraceptive methods or weakening coverage of contraception overall.
Office of Global Affairs
The Office of Global Affairs (OGA) is the “diplomatic voice” of HHS, providing expertise on global health security and diplomacy through bilateral, regional and multilateral partnerships. This office leads the US government’s work at the World Health Organization and the World Health Assembly.
This office has advanced sexual and reproductive health and rights in processes such as the 30th anniversary of the International Conference on Population and Development at the United Nations (UN). Additionally, OGA has recognized inclusion of sexual and reproductive health and rights as essential in achieving UN aims of universal health coverage and the Sustainable Development Goals. In recent years, OGA’s global strategy has acknowledged that sexual and reproductive health and rights are human rights and critical for advancing equity.
If OGA’s leaders oppose access to the full range of sexual and reproductive health care, including abortion, they have the power to turn back progress on reproductive health gains globally and to export their anti-rights agenda to other countries.
National Institutes of Health
The National Institutes of Health (NIH) both conducts and funds public health and biomedical research, and this includes studies and grants related to sexual and reproductive health and maternal health. For example, NIH invests in research to prevent maternal mortality and morbidity, expand understanding of contraceptive methods and contraceptive use, and identify causes of infertility. As part of its biomedical portfolio, NIH research sometimes uses stem cells or fetal tissue. Despite leading to medical advancements in areas like vaccine development and transplantation science, such research has been and continues to be targeted and threatened by anti-abortion activists and policymakers, including staff in the first Trump administration who touted fetal personhood rhetoric and disinformation.
Under an administration hostile to sexual and reproductive health and rights, a wide swath of research is at risk of losing funding, which could impede important medical advancements as well as the ability to fully understand and respond to the crisis in abortion access across the country, rise in maternal mortality, and attacks on and barriers to use of contraception.
US Department of Justice
The US Department of Justice (DOJ) is responsible for enforcing and defending federal laws. This includes laws related to sexual and reproductive rights, such as the Emergency Medical Treatment and Labor Act (EMTALA), which outlines requirements for emergency departments that receive Medicare funds and includes emergency abortion care, and the Freedom of Access to Clinic Entrances (FACE) Act, which prohibits the threat or use of force or obstruction to prevent individuals from obtaining or providing reproductive health services. DOJ can take legal action in many ways, including by filing lawsuits or statements of interest and by intervening in litigation between other parties.
A hostile administration could weaponize the DOJ to halt enforcement of protections for access to reproductive health services; embolden law enforcement to charge pregnant people with alleged crimes like child neglect or homicide related to their pregnancy outcomes, whether because of drug use, pregnancy loss or seeking an abortion; and place abortion patients and providers at risk of prosecution by misapplying laws and policies that were never intended to criminalize abortion care.
US Department of State
The US Department of State is responsible for leading the US government’s foreign policy. In addition to working directly with nations around the world, the State Department leads multilateral relations through the US permanent missions to the UN in New York and Geneva. Mission representatives, including ambassadors and diplomats, engage in negotiations on behalf of the US government and try to influence language in UN documents and resolutions, including as it relates to sexual and reproductive health and rights. The State Department issues annual Country Reports on Human Rights Practices that, under Democratic administrations, have outlined the status of reproductive rights within a human rights framework; this section is generally omitted under Republican administrations. The State Department’s Bureau of Global Health Security and Diplomacy leads the US government’s work on HIV/AIDS through the President’s Emergency Plan for AIDS Relief (PEPFAR).
A hostile presidential administration could attempt to undermine negotiations on UN documents mentioning gender, sexual and reproductive health and rights, or LGBTQ+ rights in key international forums like the UN Human Rights Council, the UN Commission on the Status of Women and the UN Commission on Population and Development. The administration could also threaten programs like PEPFAR and other efforts to advance a holistic view of global health that includes sexual and reproductive health.
US Agency for International Development
The US Agency for International Development (USAID) leads the country’s international development and humanitarian assistance projects. As the largest bilateral donor of family planning assistance, USAID works with foreign governments, multilateral organizations and local partners to support sexual and reproductive health and rights globally. USAID supports family planning and reproductive health programs in 41 countries, and has been instrumental in providing access to a wide range of contraceptive methods. Within the Bureau for Global Health, USAID supports work on family planning, youth and adolescent sexual and reproductive health care, postabortion care and postpartum care. The agency also seeks to integrate family planning with efforts to end child marriage and gender-based violence, provide maternal and child health services, and offer HIV programming.
A hostile administration could attempt to divert funds away from evidence-based reproductive health programs to abstinence-only programs and compromise the gains made by global health programming.