How Project 2025 Seeks to Obliterate Sexual and Reproductive Health and Rights (original) (raw)

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

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.