How to protect your reproductive health during Trump’s second Presidency
Clinicians, prescribers, and pharmacies reported a surge in purchases and requests for abortion pills, emergency contraception (EC), and birth control. Experts say it’s difficult to predict what the next four-years will bring. But they agreed the U.S. will likely see further restrictions–if not a complete ban–on abortion, significant undermining of the nation’s federally-funded family planning program, and threats to reproductive health-care coverage for both government-funded and private insurance plans.
The previous Trump administration’s policies and proposals outlined in Project 2025 documents could provide some clues, said Brigitte Amiri, deputy director of the American Civil Liberties Union Reproductive Freedom Project.
Trump could pose the largest national threat to abortion care without Congress ever introducing a law, Amiri said. Trump’s supporters have suggested that the president-elect can direct his Justice Department to enforce the Comstock Act despite Trump’s earlier claims that he wouldn’t sign a federal ban on abortion into law. The Comstock Act, first passed in 1873 and limiting the mailing of “obscene material” such as abortion pills or information on abortion, was a law that has been around since then. Any Trump administration attempt to enforce the anti-vice law would effectively ban abortion nationwide, Amiri said.
With a Republican-controlled Congress, it is possible that a national abortion ban could be drafted, passed, and signed into law–all without invoking Comstock–though experts debate on the likelihood of this scenario. Amiri stated that if Congress enacts a nationwide ban, it will “override a state constitution protection for abortion including those passed recently in Missouri, Michigan, Ohio, and Arizona.” Congress could cut funding for the entire program making it difficult for existing clinics. Trump could also re-institute policies from his first administration–including rules requiring providers be physically separated from any abortion activities; banning clinicians from discussing or referring patients for abortion care; and allowing anti-choice pregnancy centers to apply for grants.
“We’re gonna see Title X completely reshaped into a form that will no longer actually support any of the people that it was supposed to support,” said Robin Marty, author of The New Handbook for a Post-Roe America and executive director of WAWC Healthcare, a reproductive health clinic in Tuscaloosa, Alabama. Marty was formerly a reporter at RNG. A Trump administration could change its interpretation of the Emergency Medical Treatment and Active Labor Act. Amiri said a Trump administration could change its interpretation of the Emergency Medical Treatment and Active Labor Act.
Trump could also gut reproductive health care that the Affordable Care Act (ACA) must cover, making things like contraception less likely to be covered by insurance, more expensive, and less accessible, experts said.
Privately insured patients may not feel the rollback of reproductive health-care coverage mandates for some time, Marty said. Amiri said a Trump administration could change its interpretation of the Emergency Medical Treatment and Active Labor Act. This would make contraception less likely to be covered by insurance, more expensive, and less accessible. But those under government-funded plans and programs, including Medicaid, could lose coverage much more quickly, she said.
“I think we’re also likely to see more attacks on the FDA and how they regulate and approve drugs related to contraception and abortion,” Henderson added in her TikTok video.
For states with restrictive abortion laws and reproductive health-care deserts, Marty said, any one of these efforts could have devastating consequences for the health-care system.
With a Republican-controlled Congress and a President Trump, Marty added, state legislatures could further restrict and criminalize reproductive health-care services. And despite experts’ planning and predictions, there could be unexpected legislative and regulatory curveballs.
“We were surprised by things in the last Trump administration,” Amiri said. “And I’m certain that that will be the case in this Trump administration as well.”
Still, people can take some steps ahead of Trump’s presidency.
Abortion care
Even before Roe was overturned in Dobbs v. Jackson Women’s Health Organization, abortion access varied widely among states. Experts expect Trump to impose even more restrictions. Plan C explains the legal risks associated with each abortion option. Public platforms such as Aid Access and Red State Access provide abortion pills by mail to people living in restrictive states and who cannot access in-person treatment. Like Plan C, they routinely connect patients to information about and access to abortion medication.
Medication abortions typically follow a regimen that includes two different drugs: mifepristone and misoprostol. Mifepristone, taken first, stops a pregnancy’s growth. Then, one or more doses of Misoprostol are given to cause the uterus contract and expel pregnancy. Nisha Verma, an OB-GYN and complex family planning specialist providing clinical care in Georgia and Maryland, said providers have seen a rise in self-managed abortion as statewide restrictions increase. Nisha Verma, an OB-GYN and complex family planning specialist providing clinical care in Georgia and Maryland, said providers have seen a rise in self-managed abortion in the wake of growing state-level restrictions.
“Ordering medications and managing your abortion from these reliable sources–like Plan C, like Aid Access–that is safe and effective in many cases, and there are resources for people if questions come up,” Verma said.
Red State Access connects pregnant patients to no-cost community pill networks in restrictive states. Marty says that community pill networks usually provide free abortion pills. “It won’t necessarily be in the blister packs that you’re used to.” When that happens, patients can look up the pills they receive online to make sure they received the right medication.
Some pill providers, including Aid Access, allow patients to order abortion pills even if they are not pregnant. RNG consulted experts who said that these policies may allow people to store abortion pills for future use. She said that pills should not be kept in humid, warm environments such as bathrooms. Good storage options could include a bedside drawer, a closet, or a cabinet not typically exposed to heat or moisture, according to MedlinePlus.
Emergency contraception
It may also be wise to keep a few doses of emergency contraception on hand, experts told RNG.
As of publication, emergency contraception is legal, though some states have made it easier for pharmacists to refuse to sell it to patients and allow insurance plans to deny coverage for it. The most common kinds of emergency contraception–pills–are available in all 50 states.
Hormonal emergency contraceptive pills often referred to by the brand name “Plan B” are available without a prescription and are sold at pharmacies and online. Plan B pills are recommended by Planned Parenthood to be taken within 72 hours of unprotected sex. Plan B is less effective for those who are heavier than 155 lbs. A non-hormonal contraceptive pill called ella is more effective and is best for those who weigh between 195 lbs. It can be taken up to five days after unprotected sex, but requires a prescription and may impact breastfeeding for a short period of time, according to Planned Parenthood.
It’s also important to be conscious of how much emergency contraception people purchase for preventative reasons, Henderson said.
“There are people who need Plan B today, tomorrow, the next day,” she said. They need it now.” But a medical professional needs to place it, which means patients could face barriers including cost, appointment availability, and future efforts to restrict access.
Other contraception
Concerns about future access to birth control after Deanda v. Becerra have prompted some social media users to recommend getting longer-acting forms of birth control, like IUDs.
“It’s a great option for a lot of people,” Henderson reported. “It’s not the only option, and it’s not the best option for everyone.”
While the fate of birth control access under Trump is still unclear, there are a range of contraceptive options still currently available. Experts told RNG it’s important to carefully consider what options might be best and consult a medical professional where appropriate.
Folks looking to access more permanent birth control methods, including tubal sterilization (which is supposed to be covered under the ACA) and vasectomies, will require care by a health-care provider. It could cost up to $6,000 and be difficult to schedule prior to Trump’s inauguration. But the procedures are among the most effective long-term methods of preventing pregnancy.
Longer-acting options include IUDs, which last between three and ten years depending on the type, and the birth control implant, which is FDA-approved to last up to three years. According to some research, the implant may be effective up to five-years. All of these options have to be placed by a health-care provider, which could make them more difficult to access.
Providers have reported a surge in requests for longer-term pregnancy prevention options. And if the Trump administration guts protections afforded by the Affordable Care Act or repeals the legislation altogether, it’s possible that the costs associated with placing IUDs and implants could make the option unaffordable for many patients.
Another thing to consider, Marty said, is that you may want or need to remove longer-acting contraception before it expires. The providers’ willingness to assist you in this could vary. Many require a prescription. Many of these options are available via telehealth if you cannot easily get to a prescriber or see a doctor in person. Some popular options include the Nurx, Pandia Health, and Planned Parenthood Direct platforms.
One birth control pill, Opill, is available without a prescription, and typically costs $15-20 per pack. This oral contraceptive method is effective and safe. Those without access to a prescribing physician who are worried about potential side effects can use a self-screening tool to assess their risk. There are many reproductive health clinics, and pharmacies in the United States that offer affordable access to low-income or uninsured women. Converge is one of the companies that offer telehealth services where patients can order reproductive health kits, including emergency contraception, and receive care. Converge offers telehealth to only Mississippi patients, but has told RNG that it plans to expand to Tennessee in early 2025. Talking to a provider
For those who are working with a medical professional to get services, it can be intimidating to bring up the future of reproductive care. Experts say that these conversations should not be avoided, even if privacy or access to care is a concern. You can ask your doctor about their views on abortion and birth-control. She said asking a clinician if they would be willing to prescribe emergency contraception proactively could be a great way to determine whether you can trust them. She said asking a clinician about whether they’d be willing to proactively prescribe emergency contraception could be a great way to ascertain whether you can trust them.
“If they’re gonna balk at that, then that’s a red flag,” she said.
Patients aren’t alone in their concern for what a future Trump administration could mean for abortion care and other forms of reproductive health access. Clinicians are having conversations with each other–and patients–about ways to protect health information and preserve reproductive health-care access amid growing restrictions.
In mid-November, the American College of Obstetricians and Gynecologists (ACOG) published new guidance, which Verma helped author, outlining steps OB-GYNs can take to better protect patients who may have self-managed an abortion. That’s because the biggest risk to patients in wake of Dobbs is not a medical complication.
“The greatest risk is actually legal risk and risk of criminal prosecution,” Verma said. “We come out very clearly in this guidance, recommending that our members really avoid practices that could lead to criminalization of patients for actions taken during pregnancy, including self-managing an abortion.”
As part of her work as an ACOG senior advisor for reproductive health policy and advocacy, Verma has educated both providers and patients about what a harm-reduction approach to criminalization risk could look like in practice, including ways to chart symptoms and care plans without including unnecessary details about what preceded the encounter.
And when in doubt, multiple experts told RNG, you don’t have to disclose information that could be used against you. They said that in most cases doctors are unable to tell the difference between self-managed and miscarriages. She wants them to know that they can get help if they are in need. If patients “are in a setting where they don’t feel comfortable, or don’t know how the health-care team would react, or don’t know if it’s safe, they don’t have to disclose that information,” she said.
Protecting your privacy
Reproductive health-care providers are not the only ones who can take steps to protect patient privacy in the years to come. Everyday people can too, said Daly Barnett, a staff technologist at the Electronic Frontier Foundation (EFF).
Barnett recommends that individuals understand their unique privacy and security risks, and develop a plan to help mitigate them. She suggested that the EFF Abortion Access Playlist is a good place to begin, as it helps people develop threat models and customize security strategies. The Digital Defense Fund has similar resources available on its website.
“There’s no one-size-fits-all security solution, so the best thing anyone can do is prepare now and figure out what will work best if you need those contingency plans,” Barnett said.
Barnett suggested people get into the habit of taking steps to communicate more securely and compartmentalize sensitive activities online. This could include using encryption to communicate and using a privacy-conscious browser to access websites. It may also mean adding privacy protection tools such as VPNs, if they are affordable and practical. Digital Defense Fund offers a list with free and low-cost options. She said that without sweeping federal legislation on data privacy, communities and individuals are left to fight this “existential” threat alone. Privacy experts and social media users argued over whether it was safe to use apps for tracking periods after the Supreme Court’s Dobbs decision. That conversation has been revived as people who can become pregnant prepare for a second Trump administration.
Both Barnett and Henderson said you don’t necessarily need to delete period tracking apps to preserve your security. Henderson stated that for women who are concerned about access to abortion, keeping track of their cycle is essential in identifying pregnancy early. The mobile app Euki, which is known for its multilayered approach to privacy protection, has been widely praised. This is in part due to the fact that it stores data on each device and requires a pin code to open it. Experts told RNG that it’s generally considered to be the most secure app available. Clue, Henderson explained, is one of the most popular apps because it does not share data. It does store your data in the cloud, she said, which could introduce added risk.
Regardless, the tangible digital security and privacy methods will only get people so far.
Your reproductive health information is as secure as the people you choose to share it with, Barnett said. In the coming months and years, folks will have to find ways to identify and confirm those with whom they entrust their reproductive health information.
“Digital privacy is a team sport,” Barnett said. You have to trust others in your community to protect each other.
