Stuffed in the 900-page Project 2025 playbook, among the strategies to ban abortion pills and gut federal agencies, are several proposals to limit access to birth control. One of the groups on the advisory board of Project 2025 is Alliance Defending Freedom, a right-wing Christian legal organization that wrote the Mississippi abortion ban the Supreme Court used to overturn Roe v. Wade in 2022 and thereby end the federal right to abortion.
ACOG and its related foundation have two government grants: The first funds an advisory panel that recommends which preventive services, like contraception and health screenings, health insurance should cover without cost-sharing, known as the Women’s Preventive Services Initiative, or WPSI. The second funds the creation of protocols to make childbirth safer and generally improve maternity care—this is through a program called Alliance for Innovation on Maternal Health, or AIM.
Let’s break this down, starting with the birth control part. The Affordable Care Act says insurance companies have to cover a range of women’s preventive health services without cost-sharing like co-pays or deductibles. The law doesn’t name which services, but rather tasks an HHS agency to determine what services have strong evidence showing health benefits. That agency gave a contract to ACOG, which convenes the WPSI panel that includes representatives from its membership and three other major professional organizations. One of the panel’s recommendations is that “adolescent and adult women have access to the full range of contraceptives and contraceptive care to prevent unintended pregnancies and improve birth outcomes.” So insurance in the U.S. has to cover birth control pills, patches, rings, implants, IUDs, and tubal ligation without additional costs beyond people’s monthly premiums.
Groups like ADF do not like this requirement—especially the mandated coverage of IUDs and emergency contraception like Plan B or Ella. Conservatives falsely claim that these methods block implantation of fertilized eggs, which they believe is tantamount to abortion. (ADF represented one of the plaintiffs in the 2014 Hobby Lobby case who objected to covering these methods.) “This mandate has included a coverage requirement for contraception, including some items that can prevent the implantation of embryos after conception,” the ADF letter notes. “The failure to offer robust religious and moral exemptions to that mandate led to years of litigation and repeated trips to the U.S. Supreme Court.” Yes, they want employers to be able to object to covering birth control in their insurance plans for either religious or moral reasons, which could really mean anything, including sexist and eugenic objections to single women or people with disabilities being sexually active.
ADF urges HHS to end its relationship with ACOG and suggests that the HHS sub-agency, the Health Resources and Services Administration, conduct any scientific reviews in-house. (We should note that HRSA lost “hundreds of positions” in recent mass layoffs.) Alternatively, HHS could add members of anti-abortion groups to the advisory panel. Whatever happens here, potential changes to insurance coverage of certain birth control methods—based on the false idea that they cause abortions—is alarming. Redefining birth control as an abortifacient could open the door to outright bans on these methods at the state or federal level.
These ideas did not appear out of thin air: Ending mandated insurance coverage of Ella is a proposal in Project 2025 (page 485), as is restoring religious and moral exemptions (page 483), and ending this contract with ACOG (page 484). Trump tried to disavow the Project 2025 playbook on the campaign trail, but his administration is implementing much of it and conservative groups are asking him to enact parts he hasn’t gotten to yet.
Now, onto the ACOG-written protocols for safer childbirth and maternity care. The U.S. has been in a worsening maternal mortality crisis for decades, and Black women are three times more likely to die from pregnancy than women of other races or ethnicities. Under the Alliance for Innovation on Maternal Health, ACOG manages the website saferbirth.org and the AIM for Safer Birth podcast—both of which are intended for clinicians to help improve maternal health outcomes in the U.S. ACOG is providing resources about what to do if someone experiences conditions like high blood pressure or hemorrhage and lists warning signs of health emergencies. But to ADF, the health organization is promoting “critical race theory” and DEI because it suggests that clinicians also read books about white supremacy, like How to be an Antiracist by Ibram X. Kendi and Me and White Supremacy by Layla F. Saad.
“ACOG remains steadfastly committed to our mission,” the organization said in a statement to Jezebel. “We are proud of what we have achieved through our longstanding, evidence-based work with the federal government to save lives and improve health outcomes for all our patients; and we hope to continue this meaningful work in the future.”
Sadly, HHS’s effort to gut funding for, and undermine research into, reproductive health is already underway.
Diana Greene Foster, the researcher behind the landmark Turnaway Study that followed the outcome of people who were denied abortions, recently lost a National Institutes of Health grant to study the impacts of state abortion bans. HHS’s letter to Foster claimed that “research programs based on gender identity are often unscientific, have little identifiable return on investment, and do nothing to enhance the health of many Americans.”
In March, another researcher studying the horrifying nexus of domestic violence and maternal mortality also lost an NIH grant for similar reasons. In early April, the Trump administration froze birth control funding for low-income people due to grantees’ diversity initiatives and the care they provide to undocumented patients. In February, the CDC shuttered the Pregnancy Risk Assessment Monitoring System (PRAMS), which studies health data in order to help improve outcomes for moms and babies. The data collection program was reportedly halted because questionnaires referred to racism, discrimination, and sexual orientation.
And now it seems we could be on the precipice of insurance companies no longer having to cover IUDs because of unscientific opinions about how they work. Pregnancy is much riskier than abortion and taken with these other changes, it really looks like Republicans want more people to die and the public not to find out about it.
