When Wendy Davis wanted to get birth control as a teenager in the 1980s, she went to her local Planned Parenthood in Fort Worth, Texas, with a friend. “There is absolutely no way I would have asked my mother for her permission to do that,” says Davis, the former Texas state senator who famously filibustered an anti-abortion bill for 11 hours in a pair of pink sneakers. “That’s just not something that’s possible for many, many, many teenage girls.”
Forty years later, with abortion banned in wide swaths of the country, access to reliable contraception is more important than ever. Yet for Texas teens, getting prescription birth control is arguably harder now than it was when Davis was an adolescent. Over the past two years, federal courts—including the notoriously conservative Fifth Circuit—have ruled that minors must have parental consent to obtain prescription birth control from Texas clinics subsidized by a federal family planning program known as Title X. Flush with victory, Texas Republicans have made it clear: They have no intention of stopping there. In late July, Attorney General Ken Paxton filed suit to overturn a new federal rule that reaffirmed teens’ ability in other states to get contraception without their parents’ consent. “The Biden Administration continues to prove they will do anything to implement their extremist agenda,” Paxton said in a press release.
To anyone paying even a modicum of attention, the far-right’s plans to limit access to birth control have long been hiding in plain sight. When the Supreme Court overturned the federal right to abortion in the Dobbs decision in 2022, Justice Clarence Thomas wrote that the court “should reconsider” other rulings with similar legal principles, including Griswold v. Connecticut, the 1965 decision establishing a right to contraception (and, more fundamentally, a constitutional right to privacy). The ultra-conservative strategists behind Project 2025— including Roger Severino, longtime anti-abortion movement lawyer, and Russell Voght, an avowed Christian nationalist—have spelled out a plan for how a Republican-led White House could gut or rewrite key federal birth-control regulations, building on efforts that began during the first Trump administration. (While Trump has tried to distance himself from Project 2025, even claiming he doesn’t know who wrote it, at least 140 members of Trump’s team, including Severino and Voght, had a hand in drafting it.)
But what has escaped many Americans is that these threats aren’t just terrifying what-if-this-happens scenarios. As the Texas lawsuits show, in some parts of the US, that scary future has already arrived. States have been passing laws allowing pharmacies to refuse to fill birth control prescriptions based on moral objections, or proposing legislation that unscientifically classifies emergency contraception and IUDs as “abortifacients.” Reproductive Health and Freedom Watch has found that since 2021, at least 21 states have directed a total of $513 million to religiously affiliated crisis pregnancy centers and “alternatives to abortion” programs that actively spread misinformation about birth control and discourage its use.
And though contraception is supported by around 90 percent of voters, when Congress had the chance earlier this year to pass a law protecting access to birth control, Republican senators blocked it, claiming it was unnecessary.
The Biden administration has repeatedly pushed back—most recently, with a new proposed rule under the Affordable Care Act to require private insurance to cover 100 percent of the cost of over-the-counter birth control and offer patients more choices for prescription contraception. In a statement, Vice President Kamala Harris described the move as “the largest expansion of contraception coverage in more than a decade.” But the regulations won’t be finalized until after the presidential election, and the new rules are virtually certain to be challenged in GOP-packed federal courts even if Harris wins.
And what if she doesn’t?
A new Trump administration and its right-wing allies are expected to escalate attacks on contraception on a multitude of fronts, including appointing extremists to key government positions. Rather than outright bans, we should expect more subtle incursions—regulatory changes, limits on insurance coverage, and funding reductions for family planning, as well as rules like the parental consent requirement for teens, according to reproductive health policy experts interviewed by Mother Jones. “It would be cleaner if there was some direct attack on the right to contraception that opponents of reproductive healthcare were pursuing,” says Kelly Baden, vice president for public policy at the Guttmacher Institute. “They’re not. It is much more behind-the-scenes, around the margins. And yet, the impact is still potentially devastating.”
“It would be cleaner if there was some direct attack on the right to contraception that opponents of reproductive healthcare were pursuing. They’re not.”
“That’s what happened to abortion,” adds Amanda Stevenson, an assistant professor at the University of Colorado-Boulder who studies the impact of family planning policy. “Death by a thousand cuts.”
Here are four key strategies we can expect under a new Trump administration intent on undermining access to contraception:
Doubling Down on False Claims that Birth Control Causes Abortion
One of the most common attack lines against contraception is the claim that certain methods—notably IUDs and morning-after pills—are abortifacients, which is to say they cause abortion, purportedly by preventing fertilized eggs from implanting in the uterus. In fact, decades of research show that these methods block fertilization from ever happening—by preventing the release of eggs, for instance, or stopping sperm from reaching them. Yet the belief that IUDs and emergency contraception, like Plan B and Ella, end pregnancies rather than preventing them has become distressingly common, thanks in part to rampant misinformation spread by the anti-abortion movement—including appointees in the first Trump administration.
The falsehoods have made their way into Food and Drug Administration policy, with decades-long repercussions for reproductive health. Back in the early 2000s, when the FDA was trying to decide whether Plan B should be sold over the counter, it relied on an advisory committee that included several abortion opponents. Over the objections of their colleagues, those committee members persuaded the agency to include language in Plan B’s packaging that stated the drug “may also work” by preventing implantation. Not until 2022 did the FDA finally update the Plan B label to clarify the drug “does not terminate a pregnancy.” But anti-abortion groups could challenge that update in a second Trump administration.
Meanwhile, since 2015, the “abortifacient claim” has inspired lawmakers in at least seven states to vote to cut off funding for contraception or block bills to protect access to it, USA Today found in a recent investigation. Project 2025 also continues this line of attack, describing Ella as a “potential abortifacient” and proposing to wipe out mandatory insurance coverage for it. Some anti-abortion organizations, including the influential Students for Life, even falsely claim that the daily birth control pill is an abortifacient. As my colleague Kiera Butler has written, it’s all part of a growing right-wing movement to persuade women that hormonal contraception is just plain bad for them. If Trump wins, his appointees are likely to bring those arguments with them to the agencies they oversee, further threatening birth control access.
Rewriting Title X
Attacking government subsidies for contraception has been part of the GOP playbook for decades. A favorite target is Title X, a federal safety-net program that underwrites free reproductive health services—birth control, cervical cancer screenings, and STI screening and treatment, but not abortion—for low-income and uninsured people. Planned Parenthood clinics, a common provider of these services, receive about 20 percent of Title X funds.
No surprise: Texas has led the way in attacking the federal program since 2011, when the legislature slashed state funding for reproductive health care and redirected Title X money to primary care providers. The changes that year—designed to kneecap Planned Parenthood—forced scores of reproductive health clinics to close, and others to reduce hours, charge patients new fees, or ration the most effective (but expensive) forms of contraception, such as IUDs. As a result of the changes, the number of clients served by Texas family planning organizations fell by more than half, and the teen birth rate rose an estimated 3.4 percent. “It shredded the safety net for women’s health care in our state,” says Davis, now a senior adviser to Planned Parenthood Texas Votes. “Tens of thousands of women literally lost the only health care they had ever known, overnight. It was devastating, and slowly, we’ve been building our way back.”
“Tens of thousands of women literally lost the only health care they had ever known, overnight.”
Trump’s first-term appointees, following Texas’ lead, set about dramatically reshaping the entire Title X program. The administration’s “gag rule,” first proposed under Ronald Reagan but never fully implemented, which forbids any clinics that took Title X money from referring patients to abortion providers. It also required them to keep separate books and separate facilities from their abortion services, if they offered them—a logistical nightmare. Some 1,300 reproductive health facilities, including 400 Planned Parenthood clinics, withdrew from the program rather than withhold abortion referrals from patients who wanted them, and roughly 1.6 million patients lost access to federally subsidized birth control. “It was a very difficult time in the program,” says Clare Coleman, president of the National Family Planning & Reproductive Health Association. “Of course, the numbers plummeted.” What happened to the freed-up Title X money? The Trump administration sent some of it to a chain of Christian “crisis pregnancy centers” that refused to provide contraception or even referrals for birth control, as my colleague Stephanie Mencimer found in a 2019 investigation.
When Joe Biden took office, his administration promptly revoked the Trump rule, and the Title X network started rebuilding. But Vice presidential candidate Ohio Sen. JD Vance has already signaled that a second Trump administration would try again to defund Planned Parenthood—code for attacking Title X. Project 2025 urges the next president to “quickly” reissue the gag rule. It also advocates that Title X be “reframed with a focus on better education around fertility awareness”—a less-reliable method of cycle tracking favored by anti-abortion activists and wellness influencers—with grants opened up once again to anti-abortion religious organizations.
In anticipation of a Trump win, Coleman’s organization has been working with reproductive health clinics to prepare for the old gag rule to be reissued and even expanded soon after Inauguration Day. Not only could the next version of the rule pick up on Texas’ efforts to require parental consent for teenagers, Coleman warns Trump appointees are also likely to attack gender-affirming care. (Title X does not explicitly fund such care but some providers offer those services separately, just as they do abortion.) “They may say, if you take Title X, you can’t provide any of that care,” Coleman speculates. “We are quite concerned about them trying to enforce not only a gender binary—because we also do see men in the Title X program—but to recast it as: ‘This is a program about biological sex.’”
That’s if Title X survives at all: House Speaker Mike Johnson’s budget bill in September 2023 would have defunded the program entirely.
Gutting the Affordable Care Act
Before the Obama administration passed the Affordable Care Act, birth control accounted for around a third of women’s out-of-pocket healthcare expenses, according to the National Women’s Law Center. Monthly copays deterred women from getting the Pill, while an IUD could have an up-front cost of $1,000.
The ACA changed all that for over 62 million women. Starting in 2012, the law classified contraception as a form of preventive care and made it mandatory for private insurance to cover a wide range of prescription birth control at no cost to consumers. Last year, responding to the fallout from Dobbs, the Biden administration directed agencies to find ways to strengthen the contraception mandate and make sure insurers follow it; last month’s announcement on coverage of over-the-counter contraception follows that effort.
Fighting the contraception mandate has been one of the key ways conservatives and religious groups have sought to erode access to birth control. In 2014, the Supreme Court’s infamous Hobby Lobby ruling blew a crater in the ACA’s contraception mandate in the name of protecting religious freedom. There had always been a religious exemption for churches and houses of worship. But Hobby Lobby expanded that exemption to include 90 percent of US businesses—letting them deny coverage for birth control in employee insurance plans if the owners had a religious objection.
Trump broadened the exemption even further in his first term, allowing employers to decline to provide birth control based on moral, not just religious, objections. “It opens the door wide for any employer that provides health insurance to pick and choose what kind of contraception they would like to cover,” says Dana Singiser, cofounder of the Contraceptive Access Initiative.
Of course, there’s always the chance that a Republican White House and Congress would wipe out the ACA altogether, as Trump tried to do in 2017. Trump has since made conflicting statements about whether he would try again for a repeal or impose “concepts of a plan” to replace it. In late October, Speaker Johnson promised a “massive reform” of the ACA if Trump is elected.
Even with the ACA still on the books, experts say Trump could do significant damage, bypassing Congress by issuing new regulations or guidance from executive-branch agencies. Project 2025 leans in on this idea, urging the next president to make regulatory moves that would hobble the contraceptive mandate. “It’s not flashy,” says Lauren Wallace, senior counsel for reproductive rights and health at the National Women’s Law Center. “Every administration is allowed to put out proposed rules, put out guidance. So those are the ways this coverage can be stripped.”
“Every administration is allowed to put out proposed rules, put out guidance. So those are the ways this coverage can be stripped.”
The Biden administration is currently finalizing a replacement to Trump’s rule allowing moral objections to the contraceptive mandate; it’s safe to say that Trump would block or revoke it. He could also issue other regulations to make the contraceptive mandate “unworkable,” Wallace says. He could give insurers more agency to make rules around which types of birth control they choose to insure or require patients to try certain methods, before covering more expensive ones.
Project 2025’s authors, of course, have their own ideas about which forms of birth control are preferable. Their blueprint urges the next president to require the Department of Health and Human Services to issue new regulations about what is covered by the ACA contraceptive mandate. In: “fertility awareness” methods. Out: male condoms and Ella.
Shrinking Medicaid While Increasing Surveillance
Back to Texas.
Over the past decade or so, at the same time the state was attacking family planning clinics, it found a way to mess with the most common way people pay for birth control: Medicaid. And Davis sees what it did as a potential model for other states should Trump win.
First, the state passed a law banning abortion providers and their affiliates from participating in the state’s Medicaid-funded family planning program. The law conflicted with a federal rule allowing Medicaid patients to choose any “willing” provider. That meant Texas had to apply to the Obama administration for a waiver of the rule. “They got into a standoff,” Davis recalls. “The Obama administration said, ‘We’re going to remove all of your funding if you do this.’ And Texas said, ‘Fine, do it.’”
For the next few years, Texas ran a shrunken version of the program using state funding. Then Trump appeared, installing a National Right to Life Committee lobbyist to oversee national family planning policy. Texas applied for the Medicaid waiver again—and this time, received it. The Trump administration also gave the state permission not to cover emergency contraception in its Medicaid-funded program.
Davis predicts that other states will use the same maneuver to sever Planned Parenthood from Medicaid, should Trump return to office. Tennessee, which bans virtually all abortions, and South Carolina, which bans them at six weeks, have already applied for similar waivers. And Missouri recently enacted a law to ban all Medicaid reimbursements for abortion providers and their affiliates—even though the state’s abortion ban means they now only provide services like contraception and cancer screening.
Project 2025 proposes making Medicaid and other federal health funding conditional on states participating in a frighteningly detailed abortion surveillance system. “Because liberal states have now become sanctuaries for abortion tourism,” the blueprint says, “HHS should use every available tool, including the cutting of funds, to ensure that every state reports exactly how many abortions take place within its borders.” The database would include the gestational age at which the abortion was performed, the method, and the reason for it.
The proposal would force states to make an “impossible choice,” says Madeline Morcelle, senior attorney at the National Health Law Center. Participating in that “weaponized program,” she says, “would likely be used to criminalize pregnant people,” particularly immigrants, Black, Indigenous, and other people of color, young people, and people with disabilities. But dropping out would likely mean losing federal funding for vital Medicaid services affecting millions of those same low-income people.
Davis, in Texas, says she knows that predictions about losing access to birth control can sound exaggerated. She’s heard such criticisms before—from people who believed that Roe would never fall. “There are those out there who believe that this is hyperbole,” she says. But as a Texan who has witnessed how what appears radical becomes normalized, she has no illusions about the potential dangers. “I don’t think it’s unlikely at all that as Republicans become more and more extreme, and governed in a more and more extreme way by their rightward flank, that we are going to see these things become a reality.”
