Introduction
A number of President Trump’s executive actions severely threaten the future of sexual and reproductive health care access and equity. Some rescind Biden-era orders and others establish new policy priorities and issue agency directives. Important to note, however, executive orders do not change federal law or regulations. They outline the administration’s priorities and direct federal policy makers to take certain actions. Many advocates have already challenged various recent executive orders by filing lawsuits in federal courts, resulting in several injunctions. Yet, the chilling effect of these orders cannot be understated as people try to navigate through fear and confusion about what is or is not legal today and what will require additional actions (e.g., rulemaking) to take effect. Below is an overview of how executive orders (EOs) that President Trump has issued during the first weeks of his administration impact sexual and reproductive health care access for low-income and underserved communities.
Executive Order 14182: Enforcing the Hyde Amendment
On January 31st, President Trump issued an executive order “reaffirming” the Hyde Amendment’s restrictions on federal funding for abortion coverage. The Hyde Amendment is an annual federal appropriations bill rider that severely restricts federal funding for abortion services to the narrow circumstances of pregnancies that result from rape or incest, or that endanger the pregnant person’s life. The Hyde Amendment is particularly harmful to BIPOC populations who, due to systems of oppression designed to fuel poverty, are more likely to receive health care coverage through Medicaid which only covers abortion in these limited circumstances. Despite President Trump’s false claims in his executive order, no federal funding is currently used to cover abortions outside of these narrow circumstances. The executive order also revokes two Biden-era orders related to abortion. The first directed agencies to consider actions to improve Medicaid enrollees’ access to sexual and reproductive health care, and the second instructed agencies to identify actions to protect reproductive health care data privacy. While EO 14182 has no practical effects, it sends the clear signal that abortion access for Medicaid enrollees is a target for the new administration.
Executive Order 14168: Establishing “two sexes” in the federal government
This EO, signed on January 20th, seeks to end the executive branch’s recognition that Transgender, Non-Binary, and Intersex people exist. The executive order attempts to define scientifically inaccurate and reductive definitions of two “biologically distinct” sexes and defines sex as “an individual’s immutable biological classification as either male or female” (emphasis added). These definitions are inaccurate for various reasons, such as the fact that chromosomal sex is established at fertilization (not conception), the first signs of sex differentiation do not emerge until six weeks later, and people with variations in sex characteristics exist. The definitions also erroneously imply that personhood begins at “conception,” signaling this administration may adopt the extremist anti-abortion position on fetal personhood. They also implicitly set the stage for federal policies that undermine protections in of the ACA’s nondiscrimination provision (§ 1557) related to sexual and reproductive health.
Transgender people have already challenged provisions of this executive order. A Transgender woman in federal prison filed a lawsuit after she was moved to a separate housing unit and informed she would be transferred to a men’s facility due to the order. Additionally, three other Transgender women who are incarcerated filed a similar lawsuit in Washington D.C. In both cases, the presiding judge issued a temporary restraining order blocking prison officials from transferring the plaintiffs and from revoking access to hormone therapy.
Executive Order 14187: Ending gender-affirming care for youth
On February 3rd, the President issued an executive order that aims to curtail gender-affirming care access for people under the age of 19. The executive order is riddled with disinformation and deception about medical standards of care and uses harmful language about Transgender, Gender Diverse, and Intersex youth. The executive order calls to limit federal funding for gender-affirming care for people under age 19. It also supports the criminalization of parents who help their children access gender-affirming care and of providers of gender-affirming health care. This order aims to restrict the bodily autonomy and gender expression of minors by attempting to limit access to necessary, life-saving medical care.
Many of the provisions of the executive order will require additional guidance or rulemaking to implement before they actually go into effect. Nevertheless, the impacts of this executive order are already chilling access to care for Transgender, Gender Diverse, and Intersex youth. Already, some providers have stopped providing some or all gender-affirming care to young people. Advocates representing families with Transgender and Non-Binary children and Attorney Generals from three states filed separate suits in federal court to challenge sections of the executive order that calls to prohibit federal funding for this life-saving, necessary care. On March 4th, a federal judge issued a nationwide preliminary injunction that blocks enforcement of this executive order.
Executive Order 14173: Ending DEI/A in the federal government
President Trump issued an executive order on January 31st that claimed that diversity, equity, inclusion, and accessibility (DEI/A) programs violate federal civil rights law, neglecting that DEI/A efforts are an outgrowth of the civil rights movement. He ordered all executive departments and agencies to terminate any program, policy, etc. that promotes DEI/A or requires “advancing equity.” It also specifically directs agencies to include in any contract or grant an agreement that the recipient will not operate programs promoting DEI/A. Acting under authority from the EO, the U.S. Office of Personnel Management issued a memo instructing agencies to terminate DEI/A offices and positions.
This has broad implications for sexual and reproductive health-related programs, such as Title X family planning grants, the Ryan White HIV/AIDS Assistance Program, and funding for Federally Qualified Health Centers that provide sexual, reproductive, and gender-affirming care. Organizations that rely on federal funding to provide vital sexual and reproductive health care to their communities will be harmed by this order. Immediately, organizations and programs experienced confusion from an effort to freeze DEI/A federal funding which was stayed and then rescinded.
It also could result in agencies such as the National Institutes of Health defunding sexual and reproductive health equity research, such as studies to better understand and identify effective interventions to address Black maternal health inequities or disability reproductive inequities. Already, this directive has resulted in agencies such as the Centers for Disease Control and Prevention pulling down vital information and data on HIV/AIDS and LGBTQ+ youth health disparities.
Executive Order 14216: Expanding access to in vitro fertilization (IVF)
President Trump issued an executive order directing the Domestic Policy Council to provide the President with policy recommendations to protect IVF access and reduce out-of-pocket and health insurance costs for IVF. While access to IVF is undoubtedly an important reproductive health care service, there are reasons to proceed with caution in examining this EO. This EO comes on the heels of President Trump rescinding various Biden-era EOs to improve health care affordability. Further, given the slew of anti-LGBTQI+ actions the administration has already taken, it is also unlikely that any policy recommendations that result from this EO would increase access to IVF for LGBTQI+ couples. The EO showcases the administration’s policy priority of promoting heteropatriarchal family formation, signaling its support for dangerous pronatalist policies consistent with Project 2025 that focus on relegating cisgender women to roles where their main value is tied to increasing birth rates. Both Elon Musk and Vice President J.D. Vance have explicitly stated their eagerness for increasing birth rates.
Executive Order 14148: Rescinds other Executive Orders
This executive order rescinds numerous Biden-era executive orders, two of which directly bear on sexual and reproductive health. First, Executive Order 14075 directed HHS to leverage legal authorities to protect LGBTQI+ individuals’ access to health care, including gender-affirming, sexual, reproductive, and mental health care, from harmful state and local laws and practices. Second, Executive Order 13988 directed agencies to review all actions to implement legal protections against sex discrimination, including implementing protections in line with the decision in Bostock v. Clayton County.
Memorandum to Reinstate the Global Gag Rule
President Trump reinstated the Global Gag Rule, a regressive policy that restricts U.S. international assistance to non-governmental organizations providing, counseling, or advocating for legal abortion services, with no consideration of local laws or non-U.S. funding sources. The Global Gag rule has previously had devastating effects on sexual and reproductive health outcomes around the world, such as decreased contraceptive provision and usage, increased rates of unintended pregnancy, and increased number of clinic closures.
Looking Forward
President Trump’s executive orders and actions reflect his ongoing commitment to decimate access to sexual and reproductive health care. NHeLP is ready to advocate against dangerous and detrimental administrative actions and legislation. In addition to our federal work, we are deeply involved in state advocacy. NHeLP will defend and enforce legal rights to affordable, high-quality, and nondiscriminatory health care for low-income and underserved populations under the Medicaid Act, ACA, and civil rights laws.
