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Fact Sheet
October 2024



HOW PROJECT 2025 SEEKS TO OBLITERATE SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS



Project 2025 promotes a presidential agenda that rolls back civil and human
rights and implements extremist conservative policies across every federal
department and agency. Its sweeping far-right policy framework,1 by the
conservative think tank the Heritage Foundation, includes numerous attacks on
sexual and reproductive health and rights. 

The plan’s far-reaching recommendations would severely limit reproductive
autonomy and access to reproductive health care, while turning back the clock on
hard-won gains, both domestically and globally. This fact sheet enumerates some
of the agenda’s most serious threats to sexual and reproductive health and
describes potential effects.


1. THREATS TO MEDICATION ABORTION

Project 2025 proposes several strategies for restricting—and ultimately
eliminating—access to mifepristone, an extremely safe and effective medication
used in the most common regimen for medication abortion in the United States.2  

 * The plan proposes reinstating medically unnecessary restrictions on
   mifepristone that require in-person dispensing and limit who can prescribe
   and receive the medication. By effectively ending telehealth provision of the
   method, these restrictions would limit access to the method for anyone who
   faces barriers to reaching a brick-and-mortar clinic, including individuals
   receiving telehealth care (under the protection of shield laws) in states
   where abortion is banned. 
 * It also recommends revoking mifepristone’s US Food and Drug Administration
   (FDA) approval, which would remove the drug from the market entirely. Nearly
   two-thirds of all abortions provided by clinicians are medication abortions,
   and the vast majority of them use the combined regimen of mifepristone and
   misoprostol. Although use of misoprostol alone is also safe and effective, it
   is unclear how widely this regimen would be offered by providers, or taken up
   by patients, if mifepristone were no longer available.
 * Decreasing access to medication abortion by either mechanism could in turn
   increase demand for procedural care, placing additional strain on clinics and
   increasing wait time for patients.
 * Further, Project 2025 suggests that a hostile administration could bypass the
   FDA and effectively ban medication abortion—and potentially all
   abortions—through enforcement of the Comstock Act, an 1873 anti-obscenity law
   that prohibits mailing anything “intended for producing abortion.”3,4 The law
   could be used to prevent the distribution of medication and supplies needed
   for abortion care and if applied broadly, it could result in a nationwide
   total abortion ban. 


2. BROADER ATTACKS ON ABORTION ACCESS

Project 2025 also seeks to dismantle US abortion access in a number of other
ways. 

 * The plan calls on Congress to codify into law the Hyde and Weldon Amendments,
   harmful policies that limit access to abortion care in the United States by
   restricting the use of federal funds for abortion care and coverage.5 
 * It also proposes a full audit of Hyde compliance, including reviewing Biden
   administration executive actions and Medicaid-managed care in “pro-abortion
   states.”6 These investigations may suggest an intention to retaliate against
   states where state Medicaid funds are used—entirely legally—to provide
   abortion care. In reality, the documented violations of the Hyde Amendment
   involve the opposite: states refusing to cover abortion care under
   circumstances where Medicaid coverage is mandated.


3. DENYING ACCESS TO ABORTION CARE IN EMERGENCY SITUATIONS

Project 2025 calls for the Department of Health and Human Services to dismantle
the abortion protections provided under the Emergency Medical Treatment and
Labor Act (EMTALA), a federal policy that outlines requirements for emergency
departments that receive Medicare funds. 

 * The plan recommends rescinding Biden administration guidance from 2022
   stating that people needing abortion care as part of emergency treatment are
   entitled to that care under federal law, even in states where abortion is
   banned. It would also end investigations into cases where patients’ rights
   were violated by denial of necessary emergency abortion care.7
 * Further, it seeks to eliminate injunctions against states that have violated
   EMTALA and recommends that the Department of Justice withdraw from all
   ongoing litigation where it is currently defending the right to emergency
   abortion care. 
 * Refusal to enforce EMTALA’s protections for abortion care puts pregnant
   people’s lives in jeopardy, by forcing providers to risk criminal charges if
   they perform potentially lifesaving abortion care.


4. INCREASING MISINFORMATION, DISINFORMATION AND STIGMA

Project 2025 aims to implement a broad anti–sexual and reproductive health and
rights agenda across the government—including by changing the mandate of key
agencies and rewording policies to stigmatize and delegitimize sexual and
reproductive health terms and concepts.

 * The plan proposes changing the Department of Health and Human Services into
   the Department of Life, complete with an anti-abortion task force to replace
   the existing Reproductive Healthcare Task Force and a newly created position
   of “Special Representative for Domestic Women’s Health” to lead anti-abortion
   policy efforts across agencies.8
 * It recommends deleting all terms related to gender, gender equality,
   reproductive health, reproductive rights, abortion, sexual orientation and
   gender identity from all legislation, federal rules, agency regulations,
   contracts, agency websites and grants.9,10 Likewise, it encourages the use of
   US influence at the United Nations to remove language “promoting abortion”
   from UN documents, policy statements and technical literature.11  
 * Project 2025 uses charged, medically inaccurate anti-abortion
   rhetoric—including language falsely portraying abortion as unsafe—to break
   down support for abortion rights and bolster efforts to criminalize
   providers, misuse laws and regulations meant to protect against
   discrimination, and ultimately cut off access to abortion care.
 * The agenda also uses the false implication that abortion is unsafe to justify
   proposals to increase pregnancy and abortion surveillance at the federal
   level.12 The plan suggests mandated reporting of abortions—as well as of
   miscarriages and stillbirths—by all states (using denial of federal funding
   streams as means of enforcement). The potential weaponization of this data
   collection by a hostile administration poses an immediate threat to abortion
   providers and patients, and it paves the way for increased criminalization of
   pregnancy outcomes other than abortion. 
 * Project 2025 seeks to redefine basic sexual health education as
   “pornography”—and then to make pornography illegal—and also recommends
   replacing comprehensive sex education with abstinence-only curricula.13,14 


5. WEAPONIZATION OF FEDERAL MEDICAID DOLLARS

Project 2025 calls for the Centers for Medicare & Medicaid Services (CMS) to
encourage states to eliminate all Planned Parenthood facilities from their state
Medicaid programs, as some states have attempted in the past. It also suggests
that CMS create a new regulation that would disqualify abortion providers
nationwide.15 

 * This would have disastrous effects on access to basic health care services,
   particularly family planning, with other safety-net providers unable to
   increase their capacity to fill the gap that would be left if federal funding
   were pulled from Planned Parenthood and other reproductive health providers. 
 * The agenda also makes baseless claims that some states are violating the
   Weldon Amendment by requiring coverage of abortion care in private insurance
   plans.16 Project 2025 calls for withdrawing partial Medicaid funds from these
   states in retaliation—a weaponization of funding that provides crucial health
   insurance for people with low incomes.


6. ATTACKS ON CONTRACEPTION

Project 2025 seeks to severely undermine two cornerstones of US contraceptive
provision: Title X, the national publicly funded family planning program, and
the federal contraceptive coverage guarantee of the Affordable Care Act. 

 * The plan proposes reinstating the harmful “domestic gag rule,” which would
   prohibit health care providers who receive Title X funding from providing
   abortion referrals and would require them to be physically and financially
   separated from any abortion-related activities, including counseling.17
   Within about a year of this policy going into effect in 2019 (before it was
   rescinded in 2021), hundreds of clinics left the program and the number of
   patients served dropped by 2.4 million. 
 * Project 2025 goes further and recommends legislation that would prohibit
   Title X funding from going to entities that perform or help fund abortion
   care. Legislating such a policy makes it harder to reverse in the future
   (compared with administrative rulemaking);18 it would also disqualify
   providers who meet the gag rule’s already stringent requirements. 
 * In addition, the plan calls for broadening the contraceptive coverage
   guarantee’s existing religious and moral exemptions to make it easier for any
   employer—including large, for-profit corporations—to exclude contraceptive
   coverage from their employees’ health plan.19 Such exemptions deny people
   reproductive autonomy and access to needed health care, while over a decade
   of evidence show that the coverage guarantee reduced patients’ costs and
   helped them to use the birth control method of their choice and to use it
   effectively.


7. IMPACT ON REPRODUCTIVE HEALTH WORLDWIDE

Project 2025 also seeks to leverage US influence to undermine sexual and
reproductive health and rights globally, including by cutting US financial
support to countries and initiatives. 

 * It proposes immediately reinstating the global gag rule, which would prevent
   non-US NGOs from receiving US government global health assistance if they
   used their own, non-US funds to provide abortion services, information,
   counseling, referrals or advocacy.20 Past iterations of the rule have
   detrimentally impacted reproductive health outcomes, systems and services by
   decreasing access to contraceptive services and leading to clinic closures.
 * Project 2025 wants to take the policy further and have it apply to all US
   foreign assistance, including humanitarian aid.
 * The plan also proposes blocking funding to the United Nations Population Fund
   (UNFPA) which provides a wide range of critical sexual and reproductive
   health services to women and girls globally. When funding to UNFPA was
   withheld by the Trump-Pence administration, it caused a significant
   disruption to service delivery.
 * Project 2025 wants to impose its anti-rights ideology at the United Nations,
   too. It suggests expanding on the Trump-Pence administration’s Geneva
   Consensus Declaration on Women’s Health and Protection of the Family, an
   anti-rights, anti-abortion, anti-gender joint statement that undermines human
   rights (although that declaration was nonbinding and was never adopted by the
   UN).21


REFERENCES


1. Project 2025: Presidential Transition Project, Dans P and Groves S, eds.,
Mandate for Leadership: The Conservative Promise, Washington, DC: Heritage
Foundation, 2023,
https://static.project2025.org/2025_MandateForLeadership_FULL.pdf.
 
2. Mandate for Leadership, p. 459.
 
3. Mandate for Leadership, p. 459.
 
4. Mandate for Leadership, p. 562.
 
5. Mandate for Leadership, p. 474.
 
6. Mandate for Leadership, p. 473.
 
7. Mandate for Leadership, pp. 473–474.
 
8. Mandate for Leadership, p. 489.
 
9. Mandate for Leadership, pp. 4–5.
 
10. Mandate for Leadership, p. 259.
 
11. Mandate for Leadership, p. 266.
 
12. Mandate for Leadership, pp. 455–456.
 
13. Mandate for Leadership, p. 5.
 
14. Mandate for Leadership, p. 477.
 
15. Mandate for Leadership, pp. 471–472.
 
16. Mandate for Leadership, p. 472.
 
17. Mandate for Leadership, p. 491.
 
18. Mandate for Leadership, p. 491.
 
19. Mandate for Leadership, pp. 483–484.
 
20. Mandate for Leadership, p. 261.
 
21. Mandate for Leadership, p. 192.
×


REFERENCES

1. Project 2025: Presidential Transition Project, Dans P and Groves S, eds.,
Mandate for Leadership: The Conservative Promise, Washington, DC: Heritage
Foundation, 2023,
https://static.project2025.org/2025_MandateForLeadership_FULL.pdf.
 
2. Mandate for Leadership, p. 459.
 
3. Mandate for Leadership, p. 459.
 
4. Mandate for Leadership, p. 562.
 
5. Mandate for Leadership, p. 474.
 
6. Mandate for Leadership, p. 473.
 
7. Mandate for Leadership, pp. 473–474.
 
8. Mandate for Leadership, p. 489.
 
9. Mandate for Leadership, pp. 4–5.
 
10. Mandate for Leadership, p. 259.
 
11. Mandate for Leadership, p. 266.
 
12. Mandate for Leadership, pp. 455–456.
 
13. Mandate for Leadership, p. 5.
 
14. Mandate for Leadership, p. 477.
 
15. Mandate for Leadership, pp. 471–472.
 
16. Mandate for Leadership, p. 472.
 
17. Mandate for Leadership, p. 491.
 
18. Mandate for Leadership, p. 491.
 
19. Mandate for Leadership, pp. 483–484.
 
20. Mandate for Leadership, p. 261.
 
21. Mandate for Leadership, p. 192.


ACKNOWLEDGMENTS

This fact sheet was written by Anna Bernstein, Amy Friedrich-Karnik and Samira
Damavandi. It was edited by Haley Ball. All are of the Guttmacher Institute.




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