A Second Trump Presidency: A Dangerous Time for Reproductive Health

The first few weeks of Donald Trump’s second presidential term have made clear that the civil rights and liberties of many Americans are at risk.

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And while Trump reinstated the Mexico City Policy, often referred to as the “global gag rule,” which prohibits nongovernmental organizations incorporated outside of the United States and receiving U.S. global health assistance funds from providing or even discussing abortions, abortion care in the United States has not yet been a major target. Nevertheless, the health of women and all persons capable of pregnancy in the United States remains in danger under a second Trump presidency. Amidst the frenzy of executive orders covering an extensive array of issues, it is important that we not lose sight of the enduring battles over abortion and reproductive healthcare.

Ongoing threats and harms to abortion and reproductive health care more generally remain for many reasons throughout the United States, including two recent U.S. Supreme Court decisions issued in June 2024: Food and Drug Administration v. Alliance for Hippocratic Medicine, which addressed access to medication abortion, and Moyle v. United States, which dealt with emergency abortion care.

In Alliance for Hippocratic Medicine, the Supreme Court handed the Biden Administration what could on its face be construed as a “win.” In a unanimous decision, the Court allowed mifepristone—one of two drugs approved by the U.S. Food and Drug Administration (FDA) to terminate pregnancy through 70 days gestation—to remain widely available without the reimposition of restrictions on its access. The Court’s decision rested largely on “standing,” which required the plaintiffs to establish that they had experienced a cognizable injury or harm caused by mifepristone’s availability on the marketplace. The Court concluded that the plaintiffs had failed to meet that burden in this case. Importantly, however, a ruling on standing only means that these particular plaintiffs lacked standing to sue the FDA. As the Court itself noted: “it is not clear that no one else would have standing to challenge FDA’s relaxed regulation of mifepristone.”

And in Moyle, the Court essentially issued a non-decision, concluding that it should not have agreed to hear the case at this time. As a result, the federal Emergency Medical Treatment and Labor Act (EMTALA) remains and continues to prohibit Idaho from enforcing its abortion ban in contravention of EMTALA while litigation proceeds.

Neither of these cases should be considered firm, long-term “wins” for reproductive justice. On the contrary, because both were decided on technical rather than substantive grounds, the Court left the door open to future substantive challenges to both medication abortion and emergency access to abortion. As of February 2025, the issues in both of these cases continue to be litigated in lower courts. If and when these issues return to the Supreme Court, the federal government under the second Trump Administration is unlikely to continue to defend medication abortion and EMTALA as the Biden Administration did previously. In short, with Trump in the White House and Robert F. Kennedy Jr.—who says he agrees with Trump that “every abortion is a tragedy”—likely at the helm of the Department of Health and Human Services, restrictions on mifepristone could be reimposed or its FDA approval revoked, and Idaho’s interpretation of EMTALA could become a widespread state- or federally-adopted standard.

Moreover, the ideological makeup of the Supreme Court Justices before which these cases return may be even more conservative if Trump has the opportunity to appoint new, young, and extremely conservative Justices to the Court. One individual thought to be a potential nominee is Judge Matthew Kacsmaryk of the North District of Texas, who issued the initial ruling that would have revoked the approval of mifepristone.

The unsettled nature of these cases is among many other reasons why women and persons capable of pregnancy are at risk under the second Trump Administration. Trump’s statements about abortion over time have been contradictory but he has many options to further restrict abortion access throughout the country and there is little doubt that many will be harmed in the process.

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About the author

Allison M. Whelan, JD, MA Bioethics, is an assistant professor at Georgia State College of Law, and an affiliate at the Center for Bioethics at Harvard Medical School.