By Lauren Rankin for Yes! Media.
Broadcast version by Farah Siddiqi for Ohio News Connection reporting for the Yes! Media-Public News Service Collaboration

Donald Trump didn't deliver on many of his campaign promises as president, but he did achieve one of his administration's stated goals: overturning Roe v. Wade. After appointing three of the five justices who ended the constitutional right to an abortion and unleashed a growing tragedy, Trump has bragged about his role in undoing nearly 50 years of reproductive health care precedent.

But as we face the prospect of another potential Trump presidency, the architects of Project 2025 have made it clear that overturning Roe was just the first in a multistep plan to eradicate access to safe abortion. Though the Republican Party removed a federal abortion ban from its official party platform, there's something more sinister that's been hiding in plain sight for 150 years.

The Comstock Act, signed into law in 1873, made it a federal offense to disseminate contraceptives, abortifacients, and information about either across state lines or through the mail. Named after Anthony Comstock, an anti-obscenity crusader who inspired the title of the biographical book The Man Who Hated Women, the Comstock Law had far-reaching tentacles. Even married couples who used contraception could be sentenced to up to one year in prison.

Over time, various challenges to the Comstock Act, including United States v. One Package in 1936, which made it possible for physicians to distribute contraception across state lines; Griswold v. Connecticut in 1964, which established the constitutional right to contraception; and, of course, Roe v. Wade in 1973, essentially made it unenforceable. However, the law was never repealed and has instead become a "zombie law," a term used to describe laws still on the books that have been overruled by other legal cases. Take, for instance, Arizona's 1864 abortion ban, a zombie law that became legally viable after the Supreme Court struck down Roe v. Wade. Though Arizona's law was repealed in September, it still remained on the books long enough to instill fear in those seeking and providing abortions in the state.

Now, after the fall of Roe, Project 2025 plans to revive the zombie Comstock Act and make it workable. Since it's already on the books, Congress isn't required to pass the Comstock Act. Instead, a president and appointed judges can choose whether to enforce it. Project 2025 architects hope that, if given another term, Trump will do just that.

A Significant Threat to Abortion

Abortion bans are deeply unpopular in the U.S. Since Roe fell in June 2022, voters have supported abortion rights every single time the issue has been on the ballot, even in traditionally conservative states like Kansas, Montana, and Ohio. While a national abortion ban could threaten congressional seats for Republicans, it would also require control of both houses of Congress and the executive branch, a higher threshold than simply winning the presidency. So, it seems, the architects of Project 2025 have developed a workaround to meet their aims.

After Roe was overturned, President Joe Biden's Department of Justice issued guidance about whether the Comstock Act could be used to criminalize someone who receives mifepristone and misoprostol through the United States Postal Service. "We conclude that section 1461 does not prohibit the mailing, or the delivery or receipt by mail, of mifepristone or misoprostol where the sender lacks the intent that the recipient of the drugs will use them unlawfully," the memorandum opinion states. "Federal law does not prohibit the use of mifepristone and misoprostol," the memorandum continues. "Indeed, the U.S. Food and Drug Administration ('FDA') has determined the use of mifepristone in a regimen with misoprostol to be safe and effective for the medical termination of early pregnancy."

But under a Trump presidency, the DOJ would likely have a different view, especially since Project 2025 explicitly calls for the enforcement of the Comstock Act "against providers and distributors of [abortion] pills."

Additionally, the spate of radical, far-right judges Trump appointed during his first term have already proven their willingness to ignore existing case law to curb access to abortion. In 2023, U.S. District Judge Matthew Kacsmaryk, who has deep ties to the anti-abortion movement, defied court precedent to suspend the approval of mifepristone. "The Court does not second-guess FDA's decision-making lightly," he wrote in his decision. "But here, FDA acquiesced on its legitimate safety concerns-in violation of its statutory duty-based on plainly unsound reasoning and studies that did not support its conclusions."

If Trump is able to appoint even more partisan judges like Kacsmaryk to the federal bench, it's possible they would use the Comstock Act to criminalize folks sending or receiving mifepristone and misoprostol (or even information about it) through the mail. "If the Comstock [Act] were enforced, it would seriously impact the work we do," says Sneha S. Nair, partnerships coordinator at Women First Digital, a collection of online platforms that provides abortion and contraception information and services. "We rely on digital platforms to share [sexual and reproductive health] content worldwide, and restrictions like the Comstock [Act] could lead to significant censorship and suppression of vital information."

But even the threat of Comstock being enforced is concerning for abortion advocates and providers. "What people believe the law to be is just as important, if not more so, than what the law actually is," says Farah Diaz-Tello, senior counsel and legal director at If/When/How, a legal organization that aims to transform the policy landscape to make reproductive justice a reality. "When people have to second-guess what their options are and they just know that there's a sort of vague and looming fear of criminalization ... that is not a risk that everybody has the privilege to tolerate."

For Black and Brown people, who have already borne the brunt of criminalization for pregnancy outcomes, even the threat of an enforceable Comstock Law could be enough of a deterrent to prevent them from seeking necessary care.

Refusing to Be Silent

While Project 2025's architects may be banking on the Comstock Act, they will have to contend with a network of providers and advocates refusing to put the genie back in the draconian bottle. For example, Shout Your Abortion's post-Dobbs campaign, "Fuck SCOTUS, We're Doing It Anyway," promotes information about and access to medication abortion online.

Similarly, the Four Thieves Vinegar Collective, a DIY medical collective, has literally turned an information card about medication abortion into medication abortion. Embedded in the cards are three doses of misoprostol, which can be used on its own to induce an abortion, and since it's a paper card, the pills are harder to detect.

Others believe the best way to combat Project 2025's insidious ploy to use the Comstock Act as a backdoor abortion ban is to refuse to be cowed into silence about the revolutionary power of being able to terminate a pregnancy in your own home.

Today, the majority of abortions in the U.S. are induced through medication, most often a combination of the drugs mifepristone and misoprostol. Telehealth for abortion care, in which a provider virtually prescribes these drugs to patients, has become increasingly popular, even in states with abortion bans.

"The number of people served through telehealth has just grown exponentially since the pandemic," says Elisa Wells, co-founder and co-director of Plan C, which promotes access to medication abortion online. "[When people find out] that you can get an abortion by the mail, which is a really new idea ... they think, 'Wow, that's amazing!'"

Research from the Society for Family Planning's WeCount project revealed that in the second half of 2023, more than 40,000 people in states that restrict telehealth or ban abortion were able to receive medication abortion from providers in states that have "shield" laws that protect providers from being criminalized. Plan C's website traffic has surged since Dobbs; Wells says they now receive approximately 2 million visitors annually.

There's also the option of self-managing abortion with abortion pills. For people in states with severe restrictions or bans, self-managed medical abortion with pills has become an option for many who otherwise wouldn't have access to abortion care. Plan C, for example, showcases many sites that prescribe and mail medication abortion to folks directly, including Aid Access and Hey Jane.

There is a vast digital ecosystem of medication abortion information and services that abortion seekers can have mailed right to their door-unless Project 2025 goes into effect.

"What we are most concerned about is that people have access to accurate information about how to get the pills, how to use the pills, and the fact that in some states there might be legal risks associated with using the pills," says Wells. "Every day is a risk assessment, and people can make good decisions about their lives. It's not for me to say about somebody else's life. What's the best choice for you?"


Lauren Rankin wrote this article for Yes! Media.


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A recent poll shows widespread concern among Missourians about the future of birth control access.

The survey from the Right Time Initiative reveals almost 40% fear birth control will become harder or even impossible to obtain. Some medical industry experts believe the uncertainty is fueled by a lack of access to future Title X funds, which provide affordable family planning services to thousands in the Show Me State.

In an unprecedented move, the U.S. Department of Health and Human Services has withheld funding from several grantees.

Michelle Trupiano, executive director of the Missouri Family Health Council, said her organization is one of them.

"I think this polling shows what Missourians already know," Trupiano asserted. "Both the state and the federal government are doing everything they can to make it harder for people to access care."

Missouri Family Health Council has led the Title X program in the state since 1981 and in Oklahoma since 2023, serving nearly 44,000 people in 2024. Both states are set to lose more than $8 million in Title X funding.

Trupiano noted her organization is always communicating with policymakers to ensure they are aligned with what voters and constituents want and argued the survey shows the will of the people, across party lines.

"What this polling shows is that an overwhelming percentage of Missourians, over 80%, believe that birth control is something that everybody should have access to," Trupiano pointed out. "They want their lawmakers to actually do more to support access."

Although a total restriction on birth control is not widely supported, there is stronger opposition to methods like Plan B and IUDs, compared to more common methods such as condoms or regular birth control pills.

Today marks the last day of Black Maternal Health Week, a nationally and internationally recognized observance that serves to build community collaboration around addressing the maternal health statistics for Black women.

Black women in the U.S. are more than three times more likely to die of a pregnancy-related cause than white women and are more than two times more likely to experience complications that negatively impact their health. The majority of them are preventable.

The weeklong campaign that serves to highlight these disparities was founded in 2018 by the Black Mamas Matter Alliance. Its executive director, Angela Aina, said while there have been great strides since the launch, more attention needs to be paid to the root causes of maternal morbidity and mortality.

"It really does point to how pervasive and how systemic and structural gendered racism and obstetric violence is very, very much seeped in our systems," she explained.

The rate of adverse outcomes for Black women in Wisconsin have increased significantly in the past decade. Across the state, they are more than 1.5 times more likely to experience adverse outcomes, and more than twice as likely to experience a pregnancy-related death.

In 2023, the overall maternal mortality rate in the U.S. decreased while rates for Black women slightly increased. The outcomes also impact infant health, with babies born to Black, American Indian and Alaska Native and Native Hawaiian and Pacific Islander women experiencing an increased mortality rates than those born to white people.

Aina said while Black Maternal Health Week amplifies the lived experiences of Black women, it does not exclude others.

"We want to see a change for those most impacted, those most vulnerable, those most at risk of these issues and these challenges - and that when we address it, has a ripple and domino effect for everybody else," she insisted.

Aina said such structural issues as housing, economics and maternity-care 'deserts' all play a role, and emphasized the need to increase midwifery care, the number of birth centers, and funding to community-based organizations to positively affect Black maternal-health outcomes.

"To really understand and value the lives of Black people, and the lives of Black women in particular, the lives of us all," she explained, "and the fact that we are all deserving of quality, comprehensive maternal and reproductive health care."


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By Jade Prévost-Manuel for Yes! Media.
Broadcast version by Farah Siddiqi for Ohio News Connection reporting for the Yes! Media-Public News Service Collaboration

Taylor Young has never wanted to be a mom. From the time the now 27-year-old began dating, she experienced persistent anxiety around the thought of getting pregnant in Ohio, a Republican-controlled state where Young felt her right to abortion was tenuous.

In 2018, she discovered the childfree subreddit, an online forum on Reddit for people who do not have children and do not want them. In that forum, she learned about bilateral salpingectomy, a procedure that removes both fallopian tubes and permanently prevents pregnancy.

"I was 19 or 20, and I knew I probably wouldn't be able to get it," says Young, who didn't meet the minimum age requirement to have a Medicaid-funded sterilization procedure at the time. "But it was something that was kind of in my back pocket."

In 2022, when a document suggesting the U.S. Supreme Court was likely going to overturn Roe v. Wade was leaked, Young, who now met the minimum age requirement, immediately made an appointment with her gynecologist for a bilateral salpingectomy.

After observing the mandatory one-month waiting period, Young received the procedure. "[I had felt like] an animal in a trap," she says. "But when I woke up from that surgery, it was just ... indescribable peace."

Young is one of many people of reproductive age whose health care decisions have been influenced by the overturning of Roe v. Wade, the fundamental ruling protecting the right to abortion in the United States.

In the years since, the rate of permanent sterilization procedures for people between 18 and 30 has jumped, particularly among female-born people. During the 2024 election, abortion rights were a key ballot issue and several states, including Maryland and Colorado, enshrined the right to abortion into their state constitutions.

Political promises to legalize abortion-a critical issue, but one topic in the much larger ecosystem of reproductive health care-have overlooked some of the discussions the country must have to improve reproductive rights for the millions of reproducing people in America. When we take a closer look at the quality of reproductive health care that most people receive, it's clear that simply restoring Roe v. Wade isn't enough.

"The populations with the best reproductive health care outcomes ... have all of [their] basic and human life needs met," says Dr. Regina Davis Moss, president and CEO of In Our Own Voice: National Black Women's Reproductive Justice Agenda, a group that amplifies Black voices to advocate for reproductive equity. "That is why we have some of the worst outcomes when we compare ourselves to other industrialized countries."

Pregnant people in the United States are more likely to die during pregnancy, childbirth, or postpartum than any other high-income nation, even though more than 80% of maternal deaths are preventable. The maternal death rate is double for Black women, who statistically are less likely to have access to high-quality medical care. On average, giving birth in the U.S. can cost more than $18,500.

Cost is a leading prohibitive factor for those who most need to access birth control, abortion, and other reproductive health care. But there are legal barriers to subsidizing reproductive health care services-such as the Hyde Amendment, which bans the use of federal funds for abortion with few exceptions-and in many counties, no one to provide them. An estimated one-third of American counties, for example, do not have a single birthing facility or obstetric clinician to deliver maternal care.

So, what might reproductive health care look like in a reimagined America that puts equity first? There's already a framework for it: reproductive justice, a critical feminist framework that advocates for the right to have children, the right not to have them, and the right to raise children in a safe environment.

A Quest for Overall Well-Being

In 1994, a group of Black women activists coined the term "reproductive justice" to achieve, as Loretta J. Ross writes, "the complete physical, mental, spiritual, political, social, and economic well-being of women and girls, based on the full achievement and protection of women's human rights."

While reproductive justice promotes equitable reproductive health care for everyone, the idea was born out of the struggles that people of color-particularly Black women-have faced in the United States since slavery, when they were forced to bear children to work on plantations.

The framework acknowledges that Black women face poorer reproductive health outcomes-and aims to do something about it. "The reproductive justice framework analyzes how the ability of any woman to determine her own reproductive destiny is linked directly to the conditions in her community-and these conditions are not just a matter of individual choice and access," Ross writes. "Reproductive justice addresses the social reality of inequality-specifically, the inequality of opportunities that we have to control our reproductive destiny."

There is a modern-day implicit bias in health care, says Davis Moss, that women as a whole can't be trusted to make their own decisions about their bodies. For example, Black women commonly report that health care providers are not offering them the full range of contraceptive options.

"The subjugation, the control, all that has happened ever since the country was born," says Davis Moss. "We've seen that happen over the years in our health care system, in segregated hospitals, all the way up to modern day in clinical care encounters."

Though Young's bilateral salpingectomy, which can cost thousands of dollars without insurance, was fully covered by Ohio Medicaid, cost remains a prohibitive factor for many people accessing reproductive health care in the United States.

Take contraception, for example. A 2022 KFF Women's Health Survey, which interviewed more than 5,000 female-born participants, looked at how cost influences contraceptive choice. Researchers found that a quarter of those surveyed with insurance had to pay at least part of their birth control costs out of pocket. "Any time you have to make a choice about day-to-day expenses and a copay... you know, living expenses, keeping food on the table... that is going to have an impact [on health]," says Davis Moss.

The survey also found that of those who were in their reproductive years, one in five women who were uninsured had to stop using a contraceptive method because they couldn't afford it. That data is supported by a Commonwealth Fund survey of women in several high-income nations, which found that women of reproductive age in the U.S. were the most likely to skip or delay necessary care due to cost.

Solutions for the Future

In 2023, In Our Own Voice and more than 50 other Black women's organizations published the Black Reproductive Policy Agenda, a playbook on how to improve reproductive justice for birthing people at the policy level.

The report makes more than a dozen policy recommendations that Davis Moss calls "proactive, comprehensive, and life-saving." Among them are making prescription birth control free, requiring states to provide maternity and newborn care for at least one year (the time frame in which most maternal deaths occur), and increasing access to doulas and midwives who advocate for patients.

Passing acts like the Equal Access to Abortion Coverage in Health Insurance Act would require the federal government to provide funding for abortion services. "That in and of itself directly impacts a large percentage of Black women of child-bearing age [who] are on Medicaid and Medicare," says Davis Moss.

For people struggling to pay for contraception, with or without health insurance, the cost of an in-person abortion-the median price is $600-is somewhat unthinkable. Medication abortion, however, can be cheaper and more accessible. Such is the promise of telehealth abortion, a virtual way to connect with a doctor, receive a prescription, and take abortion pills in a supportive environment.

Increasingly more women in the United States are finding themselves living in maternity care and reproductive health care deserts-areas where there is limited or nonexistent access to prenatal, postnatal, maternity, contraceptive, or abortion services. Telemedicine can provide a range of services for people living in these areas at a fraction of the cost-the median price of a telehealth medication abortion is $150.

"Telehealth does a lot to remove barriers to access to health care," says Dr. Ushma Upadhyay, a public health scientist at UC San Francisco who researches the impacts of telehealth abortion. "People who live in rural areas, young people, people who report facing food insecurity... in our research, they are the most likely to have said that telehealth enabled them to have an abortion."

But even with the advent of telehealth, both Upadhyay and Davis Moss say addressing racism is essential to establishing an equitable reproductive future. That's one of the reasons the Black Reproductive Policy Agenda recommends funding anti-Black racism programs as a part of its agenda.

"This is the reason those 12 Black women 30 years ago said 'You can't only focus on abortion,'" says Davis Moss. "It's impossible to have one without the other."

After getting a bilateral salpingectomy, Young feels relieved. Yet she still worries about what will happen with Medicaid and the Affordable Care Act-the resources she relies on to help her afford care for chronic health issues-under the Trump administration, and what that means for others seeking care.

"Thinking about if other women don't have access, that breaks my heart, and from the abortion side [...] it's too much to bear," she says, emotion tugging at her voice. "I feel relieved I got [the procedure] done when I did. I feel safe."


Jade Prévost-Manuel wrote this article for Yes! Media.


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