The “Project 2025” blueprint includes proposals to remove requirements that insurance cover male condoms and emergency contraception.

By Alice Miranda Ollstein and Megan Messerly

05/29/2024 05:00 AM EDT

Updated: 05/29/2024 09:38 AM EDT

Donald Trump says he won’t ban birth control if he returns to the White House. But he could make it a lot harder to get.

As president, Trump enacted several policies that made it more difficult for people, particularly the working class and the poor, to obtain contraception — from allowing more employers to opt out of birth control coverage in their workers’ health insurance to imposing restrictions on the Title X family planning program that triggered a mass exodus of clinics.

Conservative allies want to reimpose those policies and go further if he wins in November. Their “Project 2025” blueprint includes proposals to remove requirements that insurance cover male condoms and emergency contraception and instead require coverage of natural family planning methods.

Taken together, the policies highlight the many ways a second Trump administration could hamper access to contraception, short of a blanket ban. The impact would also be much greater now that roughly one-third of states prohibit nearly all abortions.

In the wake of the Dobbs decision, to the consternation of some conservatives, the Biden administration has worked to make contraception more accessible, approving the first birth control pill available over-the-counter and requiring more types of contraception be covered by insurance.

“I’ve been very concerned with just the emphasis on expanding more and more contraception,” said Emma Waters, a senior research associate at The Heritage Foundation, which spearheaded the blueprint.

Waters criticized the Biden administration for promoting “an absolute right to contraception” and said she sees the proposed policies not as “restrictions,” but rather “medical safeguards” for women.

“We want to make sure they’re getting the thing that’s best for them,” she said.

The former president sparked outcry from the Biden campaign and other Democrats earlier this week when he said that he is “looking at” restrictions on contraception, promising an “interesting” policy plan “very shortly.” He quickly walked that statement back in a social media post, vowing never to “ban” contraceptives.

Roger Severino, a former Trump administration official who drafted the health care section of the Project 2025 blueprint, argued that the restrictions proposed in the document are a “far cry” from pulling contraceptives off the market or criminalizing their use — actions some Democrats have warned conservatives plan to implement.

“The notion that there’s a formal organized movement to ban contraception across America is downright silly. I don’t know how that idea came about. But it strikes me as political posturing in the wake of the Dobbs decision to try to mislead people into thinking everything is up for grabs having to do with sex,” Severino said. “It’s fearmongering.”

The Biden campaign said Wednesday that Trump’s contraception remarks are the latest example of the chaos he has wrought for women’s reproductive rights, particularly by appointing three conservative justices to the Supreme Court.

“If Trump returns to the White House, he’s going to make things even worse. He has made that crystal clear.”

Mitch Landrieu, Biden national campaign co-chair

Asked if Trump plans to reimpose the contraception policies he had when president, the campaign referred POLITICO to his Truth Social post, in which he said, he “will never advocate imposing restrictions on birth control, or other contraceptives.” In a statement, Chris LaCivita and Susie Wiles distanced the campaign from Project 2025’s plans for a second administration, saying no policies are official unless they’re directly announced by the campaign.

As part of their 2025 wish list, conservatives want to overhaul which forms of birth control insurance companies must cover for patients at no cost under the Affordable Care Act. For instance, they have drafted plans to allow insurers to drop coverage of emergency contraception, such as Plan B pills, which some on the right believe are abortifacients because they make it harder for fertilized eggs to implant in the uterus.

“Instead of a mandate of a particular potentially abortifacient drug, it should be opt-in instead of opt-out,” Severino said. “Mandates are a difficult thing to impose on the American people, especially when you have something as fraught as issues of potential loss of life.”
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Conservatives also want to remove the requirement to cover male condoms — arguing that federal health officials “should not incorporate exclusively male contraceptive methods into guidelines that specify they encompass only women’s services.” They also call for a requirement to cover “fertility awareness-based methods” of family planning, such as apps to track menstruation. Waters said she would also like to see the National Institutes of Health or another entity study the long-term effects of birth control.

Trump allies also hope he will bring back a number of policies from his administration.

During Trump’s four years in office, his administration slashed hundreds of millions of dollars in funding from the Teen Pregnancy Prevention Program and sought to repeal the Affordable Care Act, which has allowed at least 58 million women to access birth control with no out-of-pocket costs.

Federal health officials in Trump’s administration also issued rules allowing virtually any employer to refuse to cover contraception in their health plans, a policy supporters of the former president hope will be restored in 2025.

The administration’s biggest impact on contraception access came from its overhaul of the federal Title X program, which provides free and subsidized birth control, STD screenings and other services to millions of low-income people.

Trump’s health officials first cut the length of grants to clinics in that program from three years to eight months, creating more uncertainty and paperwork burdens for already strapped clinics. They then issued rules that banned providers from referring patients for an abortion or discussing it as an option and required clinics to construct fully separate facilities for the procedure and other services. Proponents argued the policies would ensure taxpayer dollars didn’t inadvertently support abortion, but many critics considered it a “gag rule” that prevented open communication between doctor and patient.

The Trump administration also changed Title X program rules to allow funding to flow to faith-based centers that don’t offer condoms or hormonal birth control.

More than a dozen grantees who collectively ran more than 900 clinics nationwide quit the Title X program in protest, including 11 state health departments. As a result, the network provided services to 844,083 fewer clients in 2019 — the first year the rule took effect — compared with the previous year, according to HHS. In particular, 225,688 fewer patients received oral contraceptives; 49,803 fewer received hormonal implants; and 86,008 fewer clients received intrauterine devices.

“Our experience of Trump in the first term was that, while he can say whatever he wants, when his supporters say, ‘This is what we want done,’ it gets lifted up and executed,” said Clare Coleman, president and CEO of the National Family Planning and Reproductive Health Association, which represents Title X.

Coleman noted that some clinics never rejoined the Title X program even after President Joe Biden repealed the Trump rules, in part, over fears that the rules could be revived and expanded.

The Project 2025 blueprint urges Trump to reinstate restrictions on Title X “quickly” and require participating clinics “provide information to customers about the importance of marriage” and “focus on better education around fertility awareness.”

Coleman also pointed to Trump allies who have sought to define life as starting when a sperm fertilizes an egg rather than when an embryo implants in the uterus, and who argue that contraception methods that prevent implantation, including Plan B and IUDs — are akin to abortion.

“When candidate Trump says — and, first of all, who can believe anything he says? — but when he says, ‘I’m not going to ban it.’ The question is, what is ‘it’?” Coleman asked.