This report contains a correction.
Roe v. Wade is the landmark 1973 U.S. Supreme Court decision that established the right to abortion. And while one would assume that the promise of Roe v. Wade—affirming the legal right of a woman to attain an abortion if she so chooses—would go hand in hand with access to abortion, the reality is that both rights and access to abortion care have been steadily restricted by anti-choice policymakers since the case was decided 45 years ago.
The Roe decision placed abortion in the hands of women, allowing them to better determine their futures, operate with greater autonomy, and achieve a level of equality in society; however, the decision has loopholes that allow continued restriction of abortion for certain groups. Moreover, this systematic and calculated subversion of the promise of Roe v. Wade most harshly affects low-income women, women of color, immigrant women, and others at the margins.
Explicit in Roe is flexibility for states to limit abortion at various stages of pregnancy, which has led to many barriers that have risen in number since 1973. For example, the Hyde Amendment has empowered states to refuse Medicaid coverage of abortion to enrollees: Only 17 states allocate state funding to allow Medicaid to cover abortion procedures. Similarly, women of color are more likely to live in areas without access to abortion clinics, making the entire procedure more lengthy, expensive, and harrowing for those populations.
While the promise of Roe is at best incomplete, the very core of the decision is being shaken under the Trump administration. Under this administration and a Republican-controlled Congress, there has been a particularly ferocious and obsessive effort to deny women their fundamental rights and to impede access to abortion and an array of reproductive health services. The current political environment is particularly hostile toward women at a level that is unprecedented, so much so that the nation has regressed to a place that severely stifles women’s rights and participation in society. Demonstrating this commitment, President Donald Trump will speak at the March for Life and is the first sitting president to address the annual rally. These 45 examples underline how the promise of Roe v. Wade has been threatened and undermined during Trump’s first year as president and the first half of this congressional session.
The Trump administration’s embrace of anti-choice rhetoric, tactics, and measures
- Throughout his campaign and time in office, President Trump has used negative language regarding abortion, which has contributed to an increasingly hostile climate toward the procedure. During his campaign, Trump stated that abortion should be a criminal offense: “There has to be some form of punishment.” Further, he promised to appoint judges to the Supreme Court who would repeal Roe v. Wade.
- Vice President Mike Pence is a long-standing proponent of anti-choice legislation. As governor of Indiana, he passed eight anti-choice bills during his less than four years in office. In 2007, as a member of Congress, he sponsored the first federal bill to block funding to Planned Parenthood and continued to do so until 2011, when the measure finally passed the House of Representatives. Vice President Pence was also the keynote speaker at the annual March for Life in January 2017.
- Despite her self-proclaimed role as the president’s adviser on women’s issues, Ivanka Trump has taken a silent, yet detrimental, role in her father’s actions toward abortion. She convened a private meeting with Planned Parenthood Federation of America’s president and CEO, Cecile Richards, shortly after President Trump took office, but has done nothing to counteract his appointments and executive orders that threaten access to abortion. More broadly, she did nothing to stop the president’s attempt to repeal and replace the Affordable Care Act (ACA), also known as “Obamacare,” which would have limited access to reproductive health care for millions of women. Ivanka Trump has been similarly silent on efforts to defund Planned Parenthood.
- Since Trump’s election, there has been a noticeable uptick in violence and threats directed at abortion clinics and providers, as well as more confrontational tactics used to deter patients from entering clinics. Additionally, online threats have nearly tripled since the election. Experts have attributed this rise in hostility against choice and abortion to the public pronouncements of President Trump and Vice President Pence, as well as Cabinet appointees such as Attorney General Jeff Sessions and former Secretary of Health and Human Services (HHS) Tom Price.
State-level anti-choice crusaders are emboldened
- The Trump administration has actively supported the congressional candidacy of state-level politicians who push anti-choice agendas, including Rep. Karen Handel (R) in Georgia, Roy Moore in Alabama (R), and Rep. Ron DeSantis (R) in Florida. President Trump encouraged his supporters to vote for Handel, who won the race in Georgia’s 6th Congressional District, and outright endorsed Moore for the U.S. Senate in a controversial election that Moore lost. President Trump endorsed the ultraconservative, anti-choice DeSantis for governor of Florida via Twitter.
- The election of President Trump occurred just a few months after another landmark Supreme Court ruling, Whole Woman’s Health v. Hellerstedt, which made targeted regulation of abortion providers (TRAP) laws a violation of the constitutional right to an abortion. However, Trump’s election encouraged state lawmakers to pursue TRAP laws—despite this clear ruling. In 2017 alone, 30 states introduced TRAP legislation—most likely in hopes that a conservative justice appointment to the Supreme Court would support anti-choice legislation. And as if that were not enough, 33 states could potentially ban abortion outright if Roe is overturned.
Trump’s appointees to federal courts shape future abortion law and policy
- President Trump has nominated 69 judges to lifetime appointments in the federal judiciary since taking office. Only 16 of those nominees have been women. On the campaign trail, Trump said that he “would appoint pro-life judges,” and all the evidence points to that being true. While judicial nominees often have purposefully obscure records on abortion, nearly all of the 19 lower court nominees confirmed in 2017 were affiliated with the Federalist Society, a right-wing legal network strongly connected with anti-abortion organizations.
- Justice Neil Gorsuch, President Trump’s appointment to the Supreme Court to fill the seat of Justice Antonin Scalia, has never ruled on abortion, but there are several indications that if an abortion case reaches the Supreme Court, he will rule in an anti-choice manner. Gorsuch has historically supported the right of businesses and religious organizations to refuse to provide their employees’ with health insurance plans that cover abortion, and he criticized a 10th U.S. Circuit Court of Appeals decision that protected the Planned Parenthood Association of Utah’s funding. Gorsuch holds a powerful role on the Supreme Court, as it is closely divided along partisan lines, so his vote in an abortion case could be disastrous for the pro-choice movement.
- Last October, the Supreme Court decided to rule on a case brought on by a crisis pregnancy center (CPC) in California. The National Institute of Family and Life Advocates (NIFLA) is challenging California’s law requiring CPCs to inform patients that the state offers free or low-cost contraceptive and abortion services in NIFLA v. Becerra. CPCs are known to prey on low-income women and women of color using tactics of shame, manipulation, and false information, and the law being challenged ensures that CPCs provide their patients with at least some medically accurate and comprehensive reproductive health information. President Trump’s appointment of Justice Gorsuch to the Supreme Court could have a significant impact on the outcome of this case. If the law is overturned, the federal government will allow CPCs to prioritize the rights of health care centers to disseminate incorrect or incomplete information over women’s access to comprehensive health care.
- During the 2017 congressional session, state legislators made abortion restriction one of their key priorities; they introduced and passed bills that tamper with the right to choose in a variety of prohibitive ways. These laws are guaranteed to be litigated through the courts. For example, the American Civil Liberties Union and the Center for Reproductive Rights filed a lawsuit in January 2017 challenging a bill in Arkansas that would restrict or ban abortion outright. The anti-choice leanings of President Trump’s appointed judges will likely have a detrimental effect on access to abortion, erasing the gains made in Roe v. Wade and other landmark cases.
Congress advances anti-choice legislation with renewed vigor
- In this congressional cycle alone, there have been 58 anti-choice* bills introduced in Congress—and only eight bills* intended to improve women’s health and access to abortion. Given that the congressional cycle is only about 10 months in, this indicates a strong commitment on the part of anti-choice legislators to introduce bills that strip away access to abortion for millions of women.
- The 58 anti-choice bills introduced this session include both a 20-week and a six-week abortion ban. The 20-week abortion ban is often branded by anti-choice politicians as a means to protect a fetus that is capable of feeling pain, but in actuality, it prohibits women from obtaining what can at times be a lifesaving procedure. Twenty-week abortion bans exist in 21 states. The 20-week ban introduced in 2017 was passed by the House of Representatives and endorsed by President Trump in an official statement of policy. It has been reported that the Senate could vote on the 20-week ban in the coming weeks.
- The six-week abortion ban originated at the state level and indicates a strategic commitment to abortion bans at the state legislative level. The six-week ban restricts abortions after an ultrasound can detect a fetal heartbeat—before most women even realize they are pregnant. Therefore, the six-week abortion ban is largely an all-out abortion ban. A federal six-week abortion ban bill, sponsored by Rep. Steve King (R-IA), serves as a prime example of federal lawmakers drawing from extreme state legislation while the political climate is ripe for anti-choice action. “[I]t’s time to emancipate every little unborn baby,” said Rep. King while narrating a sonogram during a hearing on the ban in the U.S. House of Representatives Judiciary Subcommittee on the Constitution and Civil Justice. The House has yet to vote on the proposal.
- The original drafts of the tax bill that passed in December included language that allows the benefits of the 529 college savings plan to extend to “an unborn child … at any stage of development.”*** This effort was not to increase access to college saving plan benefits—as parents or future parents can put money into a 529 account at any time and transfer the account over to their child. Instead, this precise and explicit personhood language was intended as a quiet attack on abortion, inserting it into a seemingly unrelated bill and thereby attempting to set a precedent to define life as beginning at the moment of conception.
- In January 2017, anti-choice congressional leaders attempted to codify the Hyde Amendment, as well as other funding bans, through H.R. 7. Also known as the No Taxpayer Funding for Abortion and Abortion Insurance Full Disclosure Act, H.R. 7 would also effectively ban private insurance companies from providing abortion services through the ACA exchanges and would eliminate subsidies for individuals who buy insurance plans that cover abortions, making health insurance far more expensive. Supreme Court Justice Thurgood Marshall once said that the Hyde Amendment was “designed to deprive poor and minority women of the constitutional right to choose abortion.” Thus, efforts to codify it further this destructive goal.
- There have been more than 2,000 anti-choice bills introduced** in the 45 years since the Roe v. Wade These include an array of abortion bans, funding restrictions, and restrictions on providers—many of which are re-introduced each congressional cycle by zealous anti-choice lawmakers. While many of these bills never pass, they waste precious time and taxpayer resources while Congress deliberates and they detract attention from issues of importance to voters, such as jobs and economic security.
- In April 2017, President Trump signed a bill passed in Congress to roll back an Obama-era rule protecting federal funds for Planned Parenthood and other organizations that provide low-cost family planning and reproductive health care services—otherwise known as Title X organizations. Obama’s rule required states to provide family planning grants to Title X organizations, regardless of whether the organization provided abortion with nonfederal funds. Trump’s action essentially allows states to discriminate against women’s health care providers that offer abortion services.
Ongoing attacks on the ACA aim to limit or eliminate access to abortion care
- The Trump-supported American Health Care Act (AHCA) was passed by the House in May 2017 but was not taken up by the Senate. The bill contained significant provisions to limit abortion coverage through health insurance plans. The AHCA would ban abortion coverage in all marketplace and non-marketplace health plans and would disqualify employers from receiving tax credits if they offer plans that include abortion. These changes would prohibit states from regulating private insurance plans in order to include abortion, as California and New York do, and deter employers from providing health insurance plans that cover abortion.
- The Better Care Reconciliation Act (BCRA), an amended version of the AHCA that was rejected by the U.S. Senate, contained the same anti-abortion provisions as the AHCA. However, the BCRA contained an additional provision that disqualified health insurance issuers covering abortion from receiving funds from the State Stability and Innovation Program, a program created by the BCRA. It would have allowed states to pursue creative solutions to increase health care access. Although the BCRA did not pass and the program was not implemented, the exclusion of abortion from a state health-care funding mechanism signals particular hostility toward the procedure.
- One of the most recent attempts to repeal and replace the ACA was through the Graham-Cassidy bill in September. The proposed bill would have prohibited the use of the ACA’s premium tax credits to pay for plans that cover abortion. This would have mandated that no plan offered on the health care exchanges could legally cover abortion—devastating blow for the 25 states that allow health insurance plans to cover abortion, as well as for California and New York, which require that all plans on the exchanges offer abortion coverage.
- The Trump administration has repeatedly threatened access to Medicaid in many different ways. Each effort to repeal and replace the ACA included a restructuring of Medicaid and cutting hundreds of billions of dollars from the program. The Trump budget released in May also called for similar changes to the program over a decade. And earlier this month, the Trump administration released guidance to states allowing them to impose work requirements on Medicaid beneficiaries. States have already applied for waivers, which are likely to be approved under the new directives from the administration; Kentucky’s was the first to be Even though the Hyde Amendment prohibits the use of federal funds to cover abortion under the Medicaid program—except in the cases of rape, incest, and endangerment to the life of the woman—some states use their own funds to cover abortion services for Medicaid enrollees. The changes proposed by the Trump administration would shrink the number of enrollees eligible for Medicaid and weaken the program, which would reduce access to state-funded abortion coverage.
- Trump and his allies in Congress have relentlessly targeted Planned Parenthood by tacking on measures to defund the front-line health care provider in bills aimed at repealing the ACA. These measures would have stripped Planned Parenthood of Medicaid reimbursements, essentially denying low-income women access to a trusted provider in their communities. While abortion is an essential aspect of comprehensive reproductive health care, Planned Parenthood does not provide abortion with federal funding, as it is prohibited under the Hyde Amendment and other restrictions.
- Congress’ tax plan repealed the individual insurance mandate that was a key component of the ACA. Experts predict that this move would raise health insurance premiums and make health insurance even more unattainable for low-income and middle-class Americans. Furthermore, 13 million more people would be uninsured due to the repeal of the mandate, many of them women in need of access to comprehensive reproductive health care.
Executive appointments and executive actions undermine women’s reproductive rights
Trump’s executive appointees and executive actions contain strong anti-abortion intention and show that the administration is serious about waging a war on women’s right to choose.
- The majority of President Trump’s cabinet appointments have a history of anti-choice sentiment. Secretary of the Interior Ryan Zinke, Secretary of Housing and Urban Development Ben Carson, White House chief of staff John Kelly, Secretary of Energy Rick Perry, Secretary of Agriculture Sonny Perdue, Attorney General Sessions, Secretary of Education Betsy DeVos, former HHS Secretary Price, and current HHS Secretary nominee Alex Azar have all made anti-choice statements, funded anti-choice organizations, voted for anti-choice legislation, or ruled in an anti-choice manner. This demonstrates Trump’s trend of appointing individuals with conservative views regarding abortion. More importantly, as high-ranking members of the administration, they have the political power to act upon those views in a dangerous way.
- Price, Trump’s first appointee for secretary of the HHS, is a notorious anti-choice advocate. As a congressman from Georgia, he routinely sponsored and voted for bills that would severely restrict abortion access and raise costs for contraception; he was also an outspoken supporter of repealing the ACA. As HHS secretary, Price immediately moved to cancel funding for several teen pregnancy prevention programs and led an action to repeal the ACA’s contraceptive mandate. Although he resigned in September following a scandal surrounding his usage of private airplanes, the damage he did as secretary was significant.
- Price aside, President Trump stacked the HHS with a crew of anti-choice and anti-LGBT characters. The set includes Assistant Secretary of HHS for Public Affairs Charmaine Yoest, who boasts a lengthy record of striving to limit women’s access to abortion through positions such as the former president and CEO of Americans United for Life and a senior fellow at American Values. Also among Trump’s picks are Valerie Huber, an abstinence education advocate who was appointed chief of staff to the assistant secretary of health at HHS, and the recently ousted Deputy Assistant Secretary for Population Affairs Teresa Manning, another notorious anti-abortion advocate. President Trump also selected Seema Varma, who has built her career on dismantling Medicaid, for administrator of the Centers for Medicare and Medicaid Services. These appointees to powerful positions help craft the administration’s policies toward women’s health, and their history and records on abortion paint a grim picture for women under the Trump administration.
- Trump’s pick for attorney general, Jeff Sessions, has an equally disturbing record of anti-choice language and action. As a legislator in Alabama and U.S. senator, Sessions cultivated a robust anti-choice voting record by sponsoring and voting “yes” on bills that would defund abortion providers and ban abortion. Additionally, Sessions has repeatedly voted against protections for abortion clinic staff. His role as attorney general is paramount in ensuring that both abortion providers and patients are protected by the law; however, Sessions’ commitment to this goal is questionable at best.
- Critics of Scott Lloyd, Trump’s appointee to director of the Office of Refugee Resettlement (ORR), claimed that he was unprepared and lacked the experience for the role. These claims were correct—Lloyd has little experience by way of refugee resettlement and also holds a storied history of anti-abortion activism, including serving on the board of directors for a CPC and co-founding an anti-abortion religious organization with its own “pro-life, pro-faith search engine.”
- Jane Doe, Jane Roe, Jane Poe, and Jane Moe—four unaccompanied, undocumented young women—were the unidentified targets of the Trump administration’s legal efforts to limit access to abortion. Under the direction of Lloyd, the ORR barred unaccompanied and undocumented minors from getting abortions. In late October 2017, a court ruled that the ORR’s action was unconstitutional and three of the so-called Janes have been able to receive abortion care. The fourth Jane, Jane Moe, still awaits the ability to exercise her right to an abortion. These cases show the administration’s extreme and unwavering commitment to withholding abortion access from those who often need it most.
- President Trump’s budget detailed $2 million in cuts to Violence Against Women Act (VAWA) grants. VAWA grants are critical for survivors of violence, as they fund supports such as housing, health care services, and job training programs. Survivors of violence often need access a full range of support services, and comprehensive reproductive health care, including abortion, is a key component of those services. Thus, cuts to VAWA programs can be detrimental to the ability of survivors to fully recover.
- The HHS strategic plan released last October made a point to clearly define life as beginning at conception, which could pave the way for HHS to fund CPCs, other religiously motivated organizations, and abstinence-only education programs under the guise of health care. These organizations do not offer women information based on sound scientific evidence and often omit reproductive health services such as abortion and contraception. And just days before the release of this report, news surfaced that the Trump administration will issue a proposed rule aimed at protecting health care workers who refuse to provide abortion and deny health care treatment to transgender patients based on religious or moral objections.
- In October, the Trump administration issued two rules aimed at undermining access to free birth control under the ACA’s contraceptive mandate. The regulations would allow any employer, health plan, school, or individual to request exemption from the mandate for “religious beliefs or moral convictions,” creating a pathway for these entities to insert themselves into women’s personal health care decisions and deny coverage of a vital health care benefit. Without contraceptive coverage, women with limited incomes may be at particular risk of experiencing unintended pregnancy and may lack the resources needed for an abortion if they so choose.
- After several failed attempts to repeal the ACA, President Trump introduced cheaper health plans into the individual insurance market that thwart ACA standards. These cheaper plans are expected to destabilize the ACA marketplace, as they provide a short-term, inexpensive alternative to plans that are more expensive, but also provide stronger consumer protections and comprehensive health coverage. The introduction of what critics call “junk” health care plans weakens the entire health care system—and subsequently the protection of women’s health care as a key component of the ACA.
- In addition to the introduction of these health care plans, President Trump eliminated subsidies to health insurance companies that help pay low-income people’s the out-of-pocket costs. By removing the incentive for health insurance companies to assist low-income people with access to health care, including abortion, Trump effectively imposed an additional barrier on poor communities and could cause vital health care services to remain out of reach for millions.
- One of President Trump’s first executive actions was to reinstate and expand the Mexico City Policy, also known as the Global Gag Rule—a draconian policy that denies women access to comprehensive reproductive health care. First instituted in 1984 by then-President Ronald Reagan and rescinded most recently by then-President Barack Obama in 2009, the policy has been used as political football and is instituted or rescinded via executive order based on a president’s position on abortion. A retreat from previous iterations, Trump’s Global Gag Rule restricts all U.S. foreign aid from being used to support abortion in any way. Under the policy, nongovernmental organizations cannot use even private, non-U.S. funds to offer abortion care, discuss abortion, or engage in activities to change restrictive abortion laws in the countries in which they work.
- In late December, the Trump administration ordered a ban on the usage of seven words in Centers for Disease Control and Prevention (CDC) documents. The restriction includes the following words: diversity, fetus, transgender, vulnerable, entitlement, science-based, and evidence-based. The restriction of the use of “fetus” will have a significant impact on the CDC’s ability to conduct research and transmit findings about abortion, specifically. The CDC provides critical, comprehensive unbiased evidence-based research and analysis on issues that include women’s health, and the Trump administration’s word ban will certainly curtail the quality the CDC’s research related to women’s health and LGBT issues.
- President Trump’s 2018 budget request last May sought to cut 17 percent, or $1.2 billion, of CDC funding when the agency was conducting critical research on transmission of the Zika virus and its effects on children and pregnant women. The Trump budget also cut funding to the National Institutes of Health (NIH) by $5.8 billion, which would weaken the organization’s ability to adequately address the Zika virus. In early September, both chambers of Congress moved to increase funding to the NIH rather than to cut it, as proposed in Trump’s budget request. As Zika has particular effects on children and pregnant women, adequately funding Zika research is tied closely to the ability of women to have healthy pregnancies and make informed health care decisions.
- The Trump budget also included deep cuts to public benefits and programs for the working class and people in poverty, including Medicaid, nutritional assistance, disability payments, and more. These measures—especially enacted without job training or pro-education programs—will increase poverty and force individuals and families already at the brink to make decisions that may sacrifice their health, welfare, and education. As abortion is often a cost-prohibitive procedure, pushing more people into poverty will impede abortion access for low-income populations.
Congress’ continued approval of funding bans impedes abortion access for millions of women
- The Hyde Amendment prohibits coverage of abortion under the Medicaid program, except in the cases of rape, incest, or endangerment to the life of the woman. As of 2016, there were 9 million women of reproductive age enrolled in Medicaid.
- Coverage of abortion is prohibited for military personnel and their dependents, except in cases to preserve the life of the mother. In 2013, the policy was changed to expand abortion coverage in cases of rape and incest for military women and affects more than 1 million women with coverage under TRICARE and other military health plans.
- Under the Federal Employees Health Benefits Program (FEHB), abortion coverage is prohibited except in the cases of rape, incest, and endangerment to the life of the woman. The FEHB is the largest employer-sponsored health insurance plan in the country, covering more than 9 million employees and dependents.
- More than 4,000 women currently serve as Peace Corps volunteers. Abortion coverage is prohibited under the Peace Corps health care plan, except in the cases of rape and incest.
- Abortion coverage is prohibited under the Indian Health Service, except in cases of rape, incest, and endangerment to the life of the woman. The restriction affects more than 400,000 Native American women of reproductive age.
- Abortion coverage is banned for women detained in federal prison. Exceptions are permitted in the cases of rape and endangerment to the life of the woman.
- Congress has banned the District of Columbia from covering abortion for its residents since 1979. However, coverage is permitted in the cases of rape, incest, and endangerment to the life of the woman. This ban extends beyond the use of federal funds—it also prohibits the district from using its own money to cover abortion for women in need.
President Trump and congressional Republicans have waged an all-out war on women with seemingly endless efforts to deny the right to abortion and access to comprehensive reproductive health care. Research from the Center for American Progress has found that attacks on abortion, such as the passage of TRAP laws, is correlated with limited economic opportunity for women—from lower wages to more job lock. This demonstrates how limiting women’s bodily autonomy is representative of an overall negative attitude toward women’s inclusion and economic security. These issues do not exist in silos, and attacking one aspect of women’s empowerment through limiting access to abortion and other reproductive health care services is linked to diminishing women’s potential overall.
At the same time, women are emboldened and recognize the sense of urgency to protect their fundamental rights. Women-led reproductive rights and justice organizations lead the charge in introducing legislation such as the Equal Access to Abortion Coverage in Health Insurance (EACH Woman) Act and the Global Health, Empowerment, and Rights (HER) Act, which would permanently repeal abortion funding restrictions. Women’s health advocates have worked to ensure insurance coverage of abortion at the state level. Women are organizing, marching, and resisting and a record number of them are running for public office. The Women’s March demonstrated the ways in which women value the connection between myriad issues, which exist in tandem to comprise women’s empowerment. Although Trump and his allies in Congress remain steadfast in their efforts, women will stop at nothing to protect their hard-won rights and equality for not only themselves, but also the rights and equality for generations of women to come.
Jamila Taylor is a senior fellow at the Center for American Progress. Anusha Ravi is a research assistant for the Women’s Initiative team at the Center. Lia Parada is the director of Government Affairs at the Center. Kate Bahn is an economist at the Center. Michele Jawando is the vice president for Legal Progress at the Center.
Authors’ note: Bans on federal funding of abortion also affect women overseas due to the Helms Amendment; veterans; women in detention centers; and enrollees in the Children’s Health Insurance Program and Medicare.
* To arrive at these figures, the authors calculated the number of abortion bills introduced in U.S. Congress since the congressional cycle began in 2017. The database www.congress.gov was used to access abortion bills introduced between January 3, 2017, and January 18, 2018.
** To arrive at this figure, the authors calculated the number of abortion bills introduced in U.S. Congress since Roe v. Wade was decided in 1973. The database www.congress.gov was used to access abortion bills introduced between 1973 and 2018.
***Correction, January 19, 2018: A source has been updated in this report.