Introduction

The U.S. health care system is in crisis. There is a nationwide provider shortage, and OB-GYNs specifically are leaving medicine in unsustainable rates. Simultaneously, health centers and hospitals are closing in droves, for reasons that include abortion bans, private equity in health care, and low insurance reimbursement. Yet instead of supporting patients and providers, the administration is gutting the few protections they have.

Emergency abortion care guidance

Emergency abortion care guidance

Within weeks of taking office, the Trump administration dropped the government’s lawsuit seeking to protect emergency abortion care under the Emergency Medical Treatment & Labor Act (EMTALA) in the face of Idaho’s extreme abortion ban. EMTALA is a federal law that requires hospital emergency rooms to treat patients experiencing a medical emergency in order to stabilize their condition. In dropping this case, the Trump administration has turned its back on pregnant people in the most dire situations, those facing life-threatening medical emergencies.

On June 3, 2025, the Centers for Medicare and Medicaid Services (CMS), under the leadership of anti-abortion physician Dr. Mehmet Oz, withdrew its guidance on emergency abortion care. The guidance reminded hospitals of their obligations under EMTALA to provide a pregnant patient experiencing a medical emergency with abortion care if necessary to stabilize their condition. While the withdrawal does not change EMTALA’s requirement that hospitals provide stabilizing treatment, including abortion, it does increase confusion at hospitals.

The federal government’s refusal to provide clarity on emergency abortion care only serves to chill care for pregnancy complications and ultimately harm patients living in states with abortion bans. When providers feel like they cannot provide patients with necessary care without the threat of severe penalties, they will choose to leave the state. In fact, since Idaho’s abortion ban took effect in 2022, the state has lost nearly one in four OB-GYNs and six of its initial nine maternal-fetal medicine specialists. The loss of doctors has led to the closure of some hospital labor and delivery units. Additionally, after Texas banned abortion in 2021, the rate of sepsis shot up more than 50% for women hospitalized when they lost their pregnancies in the second trimester, and the number of blood transfusions during emergency room visits for first-trimester miscarriage shot up by 54%.

Safety from health center violence

Safety from health center violence

Since its 1994 passage with strong bipartisan support, the Freedom of Access to Clinic Entrances (FACE) Act has been critical in safeguarding both patients and providers from violence and harassment. Nonetheless, on January 23, 2025, President Trump pardoned 23 people convicted of violating the FACE Act, many of whom were serving prison sentences for offenses such as breaking into abortion clinics, stealing fetal tissue, and accosting pregnant patients. Several of those pardoned had physically blocked patients from entering a Michigan clinic represented by the Center for Reproductive Rights. Additionally, the Trump administration has stopped enforcing this important law for reproductive health care. Both Attorney General Pam Bondi and Assistant Attorney General for Civil Rights Harmeet Dhillon have instead committed to protecting crisis pregnancy centers (fake clinics designed to block patients from accessing abortion care).

Enforcement of the FACE Act is needed now more than ever. Since Roe v. Wade was overturned in 2022, there has been a sharp increase in violence against health centers, staff, and patients. According to the National Abortion Federation’s (NAF) statistics from that year, there was a 538% increase in people obstructing clinic entrances, a 913% increase in stalking of clinic staff, and a 133% increase in bomb threats in states that protect abortion rights. Abortion hostility post-Roe has forced many of these health centers (more than 70) to close their doors. As part of its commitment to hold the Trump administration accountable, the Center filed two Freedom of Information Act (FOIA) requests with DOJ regarding FACE Act pardons and enforcement practices. Now awaiting the government’s response, the Center is committed to publicly sharing any records received.

Data privacy rules

Data privacy rules

In February 2025, the Trump administration scrubbed the Department of Health and Human Services (HHS) website of any mention of data privacy and nondiscrimination protections for reproductive health care. Then in June 2025, the administration refused to defend the 2024 HIPAA Privacy Rule for Reproductive Health, which lessened the risk of pregnant patients being reported to law enforcement. Judge Matthew Kacsmaryk vacated the 2024 rule, meaning that it is not in effect nationwide. President Trump’s Department of Justice, led by abortion opponent Pam Bondi, declined to appeal and chose not to further defend the rule.

Unnecessary reporting by health care providers is frequently the driver for the criminalization of pregnant people. In the first two years after Dobbs, prosecutors initiated at least 412 cases charging pregnant people with crimes related to pregnancy, pregnancy loss, or birth; in 264 of the 412 cases, information was obtained or disclosed in a medical setting. Alarmingly, but unsurprisingly, low-income individuals comprise the majority of people subjected to criminal proceedings arising from their pregnancies.

As the government partners with private corporations, like wearable technology companies that track period data, and invests in new technology, like automated license plate readers that can track abortion care travel, additional concerns about surveillance follow. Already, the Trump administration has shared confidential medical records from the Medicaid program with immigration enforcement officials. Surveillance fears may scare people away from care even when it’s legal.

What’s next?

What’s next? Misuse of the Comstock Act.

The Comstock Act refers to a series of federal laws that prohibit the use of the mail and common carriers (such as today’s UPS and FedEx) to transport all medications and obstetrical supplies used in abortion care. Doctors and providers face up to 5 years in prison for one violation of the law, and up to 10 years for each subsequent violation. While Comstock has long been considered a “zombie law,” meaning it is not enforced but remains on the books, the administration is positioned to misuse this 1873 “purity” law to investigate patients and target providers for jail time.

It is critical that everyone can access safe health care without fear of criminalization or violence. The Center is dedicated to monitoring harmful agency actions, demanding answers, and holding the administration accountable under the law.