Ever since the 2022 fall of Roe v. Wade, when the US Supreme Court erased 49 years of precedent with regard to legal abortion access that then paved the way for other limits on reproductive health care, Americans’ right to bodily autonomy and the ability to decide how, when, and if they get pregnant has been particularly vulnerable. Yet as the 2024 presidential election nears, the stakes couldn’t be any higher thanks to the massive agenda known as Project 2025.
By now, you’ve likely heard of Project 2025—that beefy 922-page blueprint of far-right political ideas. There’s a ton of stuff in it that can seriously impact your health and well-being, so it’s important to understand what it all means before you cast your vote in this year’s election—a vote that could determine whether any of these policies actually become a reality. That’s where SELF can help; we dug into Project 2025 to get a sense of how this agenda could affect your overall health, and your reproductive health specifically.
First, a quick overview on what Project 2025 even is: A conservative political think tank called the Heritage Foundation has been releasing updated versions of a document referred to as Mandate for Leadership for more than four decades; Project 2025 is the latest iteration. The idea is that incoming Republican administrations can consider adopting some or all of its policies, which touch on just about every inch of the federal government, from veterans affairs and environmental pollutants to education and transportation. But this year’s ninth edition has really caught the public’s attention, largely because of its extreme views on reproductive health amid a nationwide fight to win back the right to bodily autonomy. (Just one teensy example of this? The document explicitly states that “abortion is not healthcare.”)
While former president Donald Trump has distanced himself from the agenda, even claiming, “I have nothing to do with Project 2025” during the debate on September 10, there’s evidence to suggest otherwise. He delivered a keynote speech at a 2022 event hosted by Heritage and said that its proposals “detail plans for exactly what our movement will do.” Meanwhile, a CBS News review found that more than a third of the policies included in the playbook mirror ones that Trump enacted or promised to implement, including downsizing the Department of Education and removing protections for trans people. And according to the Heritage’s own review, Trump “embraced nearly 64% of the 2016 edition’s policy solutions after one year.” It’s worth noting, too, that his running mate, Senator JD Vance, has said that there are some “good ideas” in Project 2025; he also wrote the foreword to Heritage president Kevin Roberts’s new book titled, Dawn’s Early Light: Taking Back Washington to Save America.
“So many of the policies and proposals that are advanced in Project 2025 really get to the heart of their objective, which is to completely ban all access to abortion care, stigmatize it, shame folks, and instill fear in providers,” Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute, a policy and research group that works to support and advance sexual and reproductive health, tells SELF. “It’s a really, really dangerous vision.”
Given that there’s a very real possibility that a lot of Project 2025’s policies could be adopted by a future Republican administration, I read all 922 pages (seriously!) and consulted with policy experts to help you better understand how it could affect your reproductive health. Here are some major takeaways that you should be aware of.
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Abortion pills could be banned or almost impossible to get.
You might have a tougher time getting screened for STIs and cancer.
Emergency contraception would be harder to access—and threats to birth control and fertility treatments could follow.
Abortion pills could be banned or almost impossible to get.
Most abortions in the US—63%—are completed with the help of a couple of medications. Mifepristone (once known as RU-486) blocks the hormone progesterone, which stops a pregnancy from progressing, and misoprostol is taken 24–48 hours later to make the uterus contract and expel the tissue. To say that this access to safe and effective abortion medication is a hard-won achievement is a vast understatement. Mifepristone was developed in the 1980s, and it has taken more than three decades of political battles to ensure people can easily get the pills (often by mail) and end a pregnancy in the privacy of their home (although several states have enforced restrictions that limit access to these pills).
However, Project 2025 recommends that the FDA reverse its approval of abortion medications (it doesn’t specify if that includes both drugs or one of them). Misoprostol is also used to prevent ulcers and treat miscarriages and ectopic pregnancies, so if approval for this drug is reversed as well, more than abortions would be impacted. “Just the notion that Project 2025 wants a presidential administration to tell the FDA to withdraw approval of a medication that has been approved for 24 years is absurd,” Friedrich-Karnik says, “and it interferes with science and medicine.”
The agenda goes further, stating that medication abortion causes more “complications” than its surgical alternative, even though research shows that both options are very safe and carry relatively few risks, not unlike other medical interventions. Medication abortion does cause bleeding and cramping, but that’s completely normal and rarely leads to major complications, especially when people can access the care they need in the unlikely event that a problem occurs. (Not to mention, carrying a pregnancy to term can be far more dangerous than either option—one study found you are more than 14 times more likely to die having a baby than having an abortion.)
Failing an outright reversal of FDA approval, Project 2025 proposes a Republican administration chip away at access in other ways, and suggests that people shouldn’t be allowed to take the abortion medication past the first seven weeks of pregnancy (it’s currently approved for up to 10 weeks, but research shows it can be safely taken up to 12 weeks). Another suggested policy would allow pharmacies and pharmacists to refuse to give you your meds if it violates “their sincere moral or religious objections.”
On top of that, you would no longer be able to receive these meds via mail and would have to physically visit a licensed medical professional to get a prescription (as opposed to telehealth)—if you live in a state where the drugs are permitted. (The FDA did away with the in-person dispensing requirements for mifepristone in 2021, which reproductive health advocates say were “medically unnecessary.”) Without access to abortion medications, people’s only legal option would be to visit abortion clinics IRL, which is easier said than done. Clinics have been under siege for years and are now few and far between (in some cases, literally hundreds of miles away from the patients who need them) thanks to the bans following the overturning of Roe v. Wade, a decision handed down by Trump’s Supreme Court justices, which he praised and took credit for during September’s debate. The ultimate result could be thousands of people carrying unintended pregnancies to term, something research shows is associated with prenatal and postpartum depression and domestic violence. (FYI, a leading cause of death during pregnancy is murder.)
“Being forced to carry a pregnancy to term that you don’t want is not healthy, equitable, or fair,” Friedrich-Karnik says.
You might have a tougher time getting screened for STIs and cancer.
Project 2025 suggests completely gutting taxpayer funding for Planned Parenthood, the nonprofit organization that provides sex education and health care in the US and around the world, because it also provides elective abortions. One in three women in the US have visited a Planned Parenthood clinic, which offers mental health support, HPV and COVID vaccines, breast cancer screening, Pap smears, HIV testing and treatment support—the list truly goes on.
Yet Project 2025 proposes disqualifying abortion providers from Medicaid (a joint federal and state health insurance program) and Title X, a publicly funded family planning program that makes reproductive health care accessible to people with low incomes or who lack insurance. Because Planned Parenthood receives a large portion of its funding via state Medicaid plans—about 70% of people seeking care through them are low-income—it would no longer be reimbursed for offering any other services to the millions of people who depend on Medicaid or Title X.
Some states have already made similar moves in their attempt to attack abortion care, so it’s pretty well-established what might happen if these rules are implemented nationwide. For example, efforts to defund Planned Parenthood in Indiana caused a clinic in rural Scott County to close down in 2013. The result? The worst HIV outbreak in the state’s history, which the organization says was due to a lack of testing they used to provide. (At its worst, 20 new cases were being diagnosed every week in the county, according to Planned Parenthood.) Similarly, chlamydia and gonorrhea infections surged in Shawano County, Wisconsin after a Planned Parenthood clinic closed there. And experts from the organization say that reduced access to screening, treatment, and vaccines will lead to more cancer cases, delayed treatment, and worse health outcomes.
By the way, Medicaid doesn’t actually cover abortions in most states because of the Hyde Amendment, which blocks the use of federal funds for the procedure except for cases of rape, incest, or life endangerment. So access to these other services would be gutted, despite the fact that abortion care for people with Medicaid is already limited.
Emergency contraception would be harder to access—and threats to birth control and fertility treatments could follow.
Emergency contraception, a.k.a. the morning-after pill, is a safe and effective way to prevent pregnancy after unprotected sex, contraceptive failure (like a broken condom), and rape. But Project 2025 wants to make it a lot harder for people to access the most effective type out there: ulipristal acetate, which you might know by the brand name Ella.
Basically, the proposal wants to eliminate Ella, which it incorrectly categorizes as a “potential abortifacient,” from the “contraceptive mandate” that lives under a provision of the Affordable Care Act. As part of this mandate, most private health insurers are required to cover contraception that people get with a prescription (Ella, unlike some other forms of emergency contraception, is only available with a prescription) without any cost to the patient. In other words, if this went through, you might have to pay out-of-pocket for Ella, which is at least $50. In theory, levonorgestrel emergency contraception like Plan B would still be covered under the existing mandate only if it’s prescribed. (You can buy these pills over-the-counter now; however, health insurance won’t pay for them unless you have an Rx). But Ella is the most effective emergency contraception pill overall and one of the best options for people who weigh between 165–195 pounds. (Getting an IUD inserted within five days of unprotected sex works really well no matter how much you weigh.)
“This whole idea of conflating emergency contraception with abortion and kind of blurring all those lines is a big theme that’s prevalent throughout [Project 2025],” Friedrich-Karnik says. “They’re throwing everything at the wall…. Do I think they would stop with Ella? No.”
As Friedrich-Karnik points out, what’s maybe more concerning about eliminating Ella from the coverage mandate is the implication for the future right to contraception. Project 2025 says Ella is “like its close cousin, the abortion pill.” This couldn’t be further from the truth. Ella actually works by delaying ovulation (when an ovary releases an egg into the fallopian tubes) for up to five days when all the sperm has died, so there’s nothing left to fertilize an egg. Put simply, emergency contraception doesn’t even allow a pregnancy to occur in the first place. (There’s also no evidence that suggests accidentally taking Ella while pregnant, which is not advised, can affect a fetus.)
Project 2025’s claim that life begins at conception and the bigger movement among conservative politicians to give “personhood” rights to a fertilized egg can ultimately threaten access to birth control and even fertility treatments like IVF, Friedrich-Karnik says. (Although IVF is not explicitly mentioned in the document.) Laws and rulings that say that embryos and fetuses are people who deserve rights, paired with inaccurate information about how emergency contraception works, would mean that we could see criminal or civil legal repercussions for accidental harm caused to an embryo—like an unsuccessful embryo transfer into a person’s uterus during IVF treatment. We’ve already seen the kind of havoc this confusion can cause. In Alabama, for example, a State Supreme Court ruling deemed that frozen embryos can be considered children under the law, which caused multiple clinics and providers to pause IVF services due to fear of legal liability. (The state’s legislature soon after passed a law protecting IVF providers from liability.)
Project 2025’s blatant attack on reproductive rights is perhaps the most flagrant example of the dystopian society it wants to create—one in which the government, not the people, have all the power. The power to ignore the advice of medical and scientific experts and ultimately, the power to decide what happens to your body. So consider what its policies might mean for your health and that of those you love—and then vote like your life depends on it, because it does.
Your health is always on the ballot—and your vote is more powerful than you realize! Read all of SELF’s coverage of the 2024 election and make sure you’re registered to vote.
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Source : Self.com