During the 2024 campaign, President Trump repeatedly tried to distance himself from the Heritage Foundation’s far-right policy agenda Project 2025,¹ claiming to know nothing about the framework or the people behind it (despite many of its authors having roles in his first administration). One year in, however, it is clear that Project 2025 is serving as the Trump administration’s playbook for implementing an extreme policy agenda at the federal level, attacking sexual and reproductive health and rights (SRHR) both domestically and globally.  

While the crisis in sexual and reproductive health access started long before 2025, Trump’s return to the White House has been marked by a slate of regressive policies and actions. These include steps explicitly laid out in Project 2025: removing Biden-era protections for abortion access post-Dobbs; drastically undermining access to contraception, gender-affirming care and other reproductive health services; and dismantling evidence-based resources related to public health in general and sexual and reproductive health in particular. Underlying all those actions is a reliance on misinformation, inaccurate language and inflammatory rhetoric that create stigma, confusion and fear around many essential SRH services. As modeled in Project 2025, this approach deploys anti-abortion, anti-science and transphobic language that undermines the autonomy and erases the identities of targeted communities. Taken together, the administration’s policies and rhetoric will undoubtedly have devastating and sustained impacts on sexual and reproductive health and well-being in the United States and globally.

This fact sheet summarizes key components of Project 2025’s anti-SRHR agenda and then describes how and to what extent each has been implemented during the first year of the current administration.

Attacking Abortion Access

Trump Action: In January 2025, Trump issued an executive order (EO) revoking several Biden-era EOs designed to protect and expand reproductive health care access, including one that directed the Department of Health and Human Services (HHS) to take steps to support access for patients who need to travel out of state for abortion care. The resulting Biden-era guidance to governors, which had invited state applications for Medicaid waivers to support such travelling patients, was removed from the HHS website after Trump’s EO. The ability to use Medicaid waivers for this purpose may also be affected by the release of a July 2025 Department of Justice (DOJ) slip opinion stating that the Hyde Amendment prohibits the use of federal funds for “ancillary services necessary to receive an abortion.” Project 2025 targeted such protective policies in part because interstate travel for abortion care has played a crucial role in preserving access since the Dobbs decision, with tens of thousands of people crossing state lines for care because of abortion bans and restrictions in their home states. 

Trump Action: In August 2025, the Trump administration issued a notice of proposed rulemaking to rescind a Biden-era regulation that had, for the first time, allowed VA facilities to provide abortion counseling and services in cases of rape, incest, or when the pregnant person's life or health is threatened. The rule goes beyond previous prohibitions, forbidding coverage of abortion counseling and services for veterans through their medical benefits package and for their dependents under the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA.) These restrictions apply even if the pregnancy endangers the patient’s health or life or is the result of rape or incest. A memo released in mid-December confirmed that the administration had begun implementing these changes before completing the regular rulemaking process. The rule was finalized on December 31.

Trump Action: While federal law already restricts the military’s health insurance program (TRICARE) from covering abortion services, in January 2025, Secretary of Defense Pete Hegseth issued a memorandum rescinding Biden-era policies that had provided allowances for servicemembers and their dependents to travel and take time off to access abortion care. 

Trump Action: In its first year, the administration has initiated steps that could culminate in the severe restriction of mifepristone. 

In the fall of 2025, HHS Secretary Robert F. Kennedy Jr. and Food and Drug Administration (FDA) Commissioner Martin Makary announced that they are undertaking a review of the safety of mifepristone (one of two drugs used in most medication abortions), with an eye toward tightening the Risk Evaluation and Mitigation Strategy (REMS) restrictions attached to the drug. This review process lacks transparency and appears to be operating outside of standard FDA procedures. Furthermore, the impetus for reviewing mifepristone, which has a well-established track record of safety and efficacy, appears to be a number of retracted papers and junk science put forth by anti-abortion groups. If the administration decides to reinstate some of the most burdensome and unscientific aspects of the REMS, including a requirement that physicians must dispense the drug in person, it would effectively eliminate telehealth access to medication abortion. It would also have a devastating impact on abortion access more generally, particularly in states where telehealth provision makes up the majority of abortions. Kennedy has repeatedly stated that he will defer to Trump for the final decision about whether mifepristone should remain available at all, suggesting that the conclusions of any scientific review process may be overridden by political interference.

Threatening Patient Privacy and Safety

Trump Action: In June 2025, Trump appointee Judge Matthew Kacsmaryk vacated Biden administration regulations designed to protect patients seeking lawful reproductive health care from having their personal health information turned over to law enforcement. This was a particularly important protection for abortion patients residing in states where abortion is banned and who have to travel to receive care. The Trump administration has taken no action to defend the regulations or otherwise protect patient privacy. 

Trump Action: In January 2025, Trump pardoned 23 people who had targeted abortion clinics and had been convicted of violating the FACE Act. (Since being pardoned, two of these activists have already been charged in Pennsylvania for trespassing at an abortion clinic.) Trump's DOJ subsequently issued an order to cease enforcement of the FACE Act in almost all cases. 

Trump Action: In February, the Trump administration rescinded Biden-era guidance on Section 1557 of the ACA, which had been interpreted to provide protection against discrimination on the basis of gender identity. In November 2025, a federal court vacated provisions of Section 1557 regulations related to gender identity discrimination.

Denying Abortion Access in Emergency Situations

Trump Action: The Trump administration rescinded Biden’s EMTALA guidance to hospitals in June 2025. Although the EMTALA statute remains unchanged, this stance adds to the chaos and confusion for providers and patients and puts pregnant people’s lives at further risk. 

Trump Action: In March 2025, the Trump administration dismissed a lawsuit initiated by the Biden administration against Idaho, which had charged the state with violating EMTALA by enforcing an abortion ban without a health exception.

Weaponizing Federal Medicaid Dollars

Trump Action: Through the 2025 budget reconciliation law, also known as the “One Big Beautiful Bill Act” (OBBBA), the Republican-controlled Congress and the Trump administration have enacted a one-year provision to “defund Planned Parenthood.” The policy, which took effect in July, makes Planned Parenthood affiliates and some other abortion providers ineligible for any federal Medicaid funds if they continue to provide abortion care. While federal Medicaid funds are already largely prohibited from covering abortion care, this defund provision extends to all other services otherwise covered by Medicaid, including contraception, STI testing and cancer screenings. Despite many Planned Parenthood health centers and some states using their own funds to support this care for Medicaid patients, their ability to do so is limited and the policy has already had devastating consequences.  

Trump Action: Trump’s budget reconciliation law compels Medicaid recipients enrolled under the ACA Medicaid expansion to meet new work requirements—a policy with onerous reporting and administrative burdens that is ultimately designed to drive people off Medicaid. Set to go into effect in January 2027, the provision threatens to eliminate Medicaid coverage for between 2.1 and 6 million women of reproductive age (19–49 years), a group that will be particularly impacted by a loss of coverage for SRH care.

Attacking Contraception

Trump Action: In April 2025, the Trump administration abruptly withheld funding for 22 grants under Title X, the nation’s only federal program dedicated to providing family planning services to low-income people. While the program already does not provide funding for abortion care, the administration claimed that the Title X grantees were in potential violation of recent executive orders, including prohibitions on diversity, equity and inclusion (DEI) programs. While some of the grants were eventually restored, Title X funding for many Planned Parenthood grantees is still being withheld.

Targeting Reproductive Health Worldwide

Trump Action: In January 2025, President Trump issued a presidential memorandum directing the Departments of State and HHS to reinstate the global gag rule, with the same restrictions on global health funding that had been in place during the previous Trump administration. 

Trump Action: The Trump administration abruptly terminated funding agreements to UNFPA in February 2025, and Congress voted to rescind funding previously appropriated to UNFPA through the Rescissions Act of 2025. The administration then cut off all future US funding to UNFPA by invoking the Kemp‒Kasten Amendment, a policy that has been repeatedly misapplied for the purpose of defunding UNFPA.  

Trump Action: The Trump administration went beyond what was outlined in Project 2025 and completely dismantled USAID. After first imposing a 90-day funding freeze to review grants and programs, the administration then cancelled all international family planning grants and cut funding and staff for global health and SRH programs. By July 2025, the agency had officially shut down and the few hundred remaining staff were incorporated into the Department of State. In September, the State Department released an “America First Global Health Strategy” that outlines new goals for foreign health assistance said to make “America safer, stronger, and more prosperous,” and which focus on bilateral country-to-country agreements.

Undermining International Human Rights

Trump Action: Upon taking office in 2025, the Trump administration rejoined the so-called Geneva Consensus Declaration, an anti-rights, anti-abortion, anti-gender joint statement that undermines human rights. The declaration is a non-binding document that was never adopted by the United Nations. 

Trump Action: The State Department announced in November that their annual report on human rights will now categorize abortion as a human rights violation. In a radical departure from focusing on democracy and established human rights norms, US officials were given new guidance to include state subsidization of abortion and gender-transition surgeries for minors as infringements of human rights. They were also asked to report on the number of abortions performed in each country and to collect data on the enforcement of diversity, equity and inclusion programs.

Promoting Mis- and Disinformation to Attack Equity

Trump Action: Trump rescinded the Biden executive order and disbanded the Gender Policy Council, a group of advisors within the White House that was convened to advance gender equity in domestic and global policy.

Trump Action: Upon taking office in 2025, President Trump issued an executive order mandating that the federal government recognize exclusively “an individual’s immutable biological classification as either male or female”—a direct attack on the health and rights of transgender, gender nonconforming and intersex individuals.  

Trump Action: Days into the Trump administration, federal agencies, including the Centers for Disease Control and Prevention (CDC), began taking down government websites that are critical to the provision of reproductive health care, and which contained published research, publicly available datasets and clinical guidelines. While many of those sites have been restored (some as a result of court orders), others now contain troubling messages undermining the sites’ content. For example, the page for the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) now begins with this disclaimer: “Any information on this page promoting gender ideology is extremely inaccurate and disconnected from truth. The Trump Administration rejects gender ideology due to the harms and divisiveness it causes. This page does not reflect reality and therefore the Administration and this Department reject it.” 

Trump Action: Also on his first day back in office, President Trump signed another executive order to terminate all “diversity, equity, inclusion (DEI) and accessibility mandates, policies, programs, preferences and activities of the federal government.” This order has been used to justify the termination of NIH research grants and funding for programs that support people with low incomes, among other cuts and restrictions.

Attacking Transgender Rights and Health Care

Trump Action: Just a week into his second term, President Trump issued an executive order banning transgender individuals from serving in the military. Additionally, Secretary of Defense Hegseth issued a memo on February 7 pausing all gender-affirming medical procedures for service members. On February 26, the Department of Defense issued another memo cancelling Biden-era policies that had protected trans individuals in the military, prohibiting trans individuals from serving, and directing trans individuals currently in the military to be separated from service.

Trump Action: In December 2025, Trump’s CMS went even further than Project 2025 and released two proposed rules to restrict access to gender-affirming care. One rule would bar federal Medicaid and Children’s Health Insurance Program (CHIP) funding from going towards gender-affirming care for individuals under the age of 18. The other regulation would go even further, barring hospitals that participate in Medicare and Medicaid from providing gender-affirming care to anyone under the age of 18—forcing hospitals to decide whether to stop providing necessary and life-saving care or lose federal funding.