Though ballot measures to expand abortion rights and access won in 7 out of 10 states during the 2024 election, the future of abortion access remains very uncertain in the wake of the overall election results that have put a Republican anti-abortion majority in charge of Congress and the White House.
Since the 2022 Dobbs Supreme Court decision that overturned the Constitutional right to abortion that had been in place since 1973, abortion rights and access have been determined by states rather than be a guaranteed right for all. The Dobbs decision paved the way for abortion opponents to roll back access to a range of reproductive health services and advance an extreme agenda that attacks IVF (In Vitro Fertilization), undermines birth control, and makes abortion a crime for patients and providers.
For those that live in states controlled by Democratic lawmakers, access to abortion remains intact and people have access to the full range of reproductive health options. But in 13 states abortion is currently illegal and in most others there are restrictions that make it hard to access or require patients to jump through cumbersome and expensive hoops to get the healthcare they need. Check out this map to see what the current status of abortion law is in your state.
Despite pressure from the most extreme wing of his anti-abortion constituency, President-elect Trump promised to refrain from passing a national abortion ban during this upcoming term. Unfortunately, many other Republicans don’t agree. The Republican Study Committee which represents about 80% of GOP Members in the House released a budget proposal earlier this year that included support for a national abortion ban with no exceptions for rape or incest. That bill would also ban mifepristone – an FDA-approved, safe and effective medication that is used in abortions and other treatments. If passed, a national abortion ban would override state-level protections, even abortion rights codified in state constitutions like the ones passed on election day.
The ban on mifepristone is important to consider because while Trump may keep his promise and refuse a national ban abortion, the Trump Administration can still take significant action to restrict access to abortion pills which may be administered to patients via telehealth or delivered in the mail. Most abortions in America today are conducted via medication abortion, using mifepristone in combination with another medicine. A Trump controlled FDA (Federal Drug Administration) could try to rescind approval of mifepristone, end mail distribution or limit its use in other ways. Similarly the DOJ (Department of Justice) under Trump could enact the Comstock Act to categorize medication abortion through the mail as illegal.
These actions would add more barriers for people who live in states that have abortion bans or limits to access that put abortion out of reach. These people would also face increased health risk because of delays that mean people would have to wait longer to terminate a pregnancy, travel, or endure significant stress to access this basic procedure.
At the same time that abortion could get even harder to access, preventing pregnancy, ensuring pregnant people are healthy and providing adequate postpartum care may also be more challenging in the upcoming four years.
That’s because Medicaid, the largest payer of birth control and of births in most states, is facing tremendous threats in the coming Congress as Republican lawmakers contemplate cuts to the program in order to finance extension of the Trump tax law which expires in 2025. The Trump tax law gives away trillions in tax breaks that largely benefit the most wealthy households. In 2025, the top 1% richest households will get an average tax cut of more than $60,000 compared to an average tax cut of less than $500 for households in the bottom 60 percent, for instance.
Medicaid is in the crosshairs as Republicans push to make the Trump tax law permanent, even though cuts to Medicaid are likely to result in more unintended pregnancies, more risks to pregnant people and families, and worse health outcomes for mothers and kids. Low-income women and women of color will be most impacted since they are most likely to lack adequate access to health coverage and resources to access abortion services.
A growing body of research shows that abortion restrictions have negative health and economic consequences for women and their children, including 2024 research from Harvard. The study, for instance, found a link between denial of abortions and a growing number of children in foster care.
A perfect storm of conditions are swirling as the nation transitions into Republican rule. We could be facing even more restrictions and barriers to abortion while at the same time seeing diminished access to birth control–particularly in states like Florida, Texas, Mississippi, Alabama and others that never expanded Medicaid in the first place and now may face cuts to their existing programs because of proposed federal changes to the program.