As a presidential candidate, Donald Trump vowed to restrict access to abortion. As president, he’s started doing just that – and more, pursuing a far-reaching strategy to reshape the federal government’s position on reproductive rights.

Some of Trump’s actions so far are in line with those of his Republican predecessors: he has nominated federal judges who oppose abortion, and reinstated a Reagan-era policy that withholds funding from abortion providers overseas.

But an examination of Trump’s actions on abortion during his first year in office shows the beginning of a broader agenda at home and abroad. His administration has proposed cuts or eliminated funding for major family planning programs, and filled key government posts with officials opposed not just to abortion, but contraception and sex outside of heterosexual marriage. The administration has taken some steps with little warning or attention, like the decision this summer to cut off funding for family planning research grants, citing “changes in program priorities.”

“There’s certainly been other anti-abortion presidencies and administrations, and so that’s not what’s new here,” said Heather Boonstra, director of public policy at the Guttmacher Institute, a reproductive health and rights group that had some of its federal funding cut this summer. “What’s new is just the expansiveness, and the way that the attacks are coming at so many different directions.”

The Trump administration’s actions come at an especially polarized political moment. As Congress enters a midterm election year and Republicans fight to maintain narrow majorities in both the House and Senate, opposition to abortion has become a key point for the party — and Trump’s support has helped motivate anti-abortion advocates and supporters alike.

“It’s just very encouraging for people to know that we’ve got a president who is standing with us and fighting with us,” said Carol Tobias, president of the National Right to Life Committee, the nation’s oldest and largest anti-abortion organization. She added: “The administration is taking every opportunity they can — through policy, executive orders, resolutions — to promote a respect for human life, and they are doing what they can under the current law to protect unborn babies.”

Tobias and other advocates say that the Trump administration has helped take the fight against abortion to the federal level, after years of battling mainly in state legislatures.  

Since the landmark 1973 Supreme Court decision in Roe v. Wade determined that women have a right to an abortion, anti-abortion groups have worked to chip away at abortion access. Their strategy, these groups have said, has been to make abortion largely inaccessible state-by-state, while creating legal precedents that might one day help overturn Roe.

The advocates have had considerable success. In the last two decades, more than 900 anti-abortion measures were passed at the state level, according to NARAL Pro-Choice America, an advocacy group that tracks legislation. Today, 43 states prohibit abortions after a specified point in a woman’s pregnancy, 27 states require women to wait a certain amount of time before seeking the procedure, and 18 mandate that women attend counseling before receiving an abortion, according to the Guttmacher Institute. 

Meanwhile in the White House, previous presidents who opposed abortion lent their support to the cause with a few major policies. President Ronald Reagan, for example, introduced the Mexico City policy, which bans overseas groups that receive U.S. aid from providing abortions or information about the procedure. Democratic presidents rolled the policy back, and Republican presidents reinstated it.  

Trump didn’t just reinstate the Mexico City policy. On his third day as president, he expanded the policy in a memorandum, applying the restrictions beyond U.S. family planning funds to all U.S. global health assistance, which totals $10 billion.  

The Trump administration also cut funding for the United Nations Population Fund, which supports reproductive and maternal health programs in more than 150 countries, as other past Republican presidents have done. But then it went a step further, proposing to sever all funding for international family planning for the upcoming fiscal year — the first attempt by a sitting president to completely do away with those programs, according to the Guttmacher Institute. 

President Trump’s proposed budget for 2018 zeroes out the family planning funding, which provides women in developing countries with contraceptive services and supplies to avoid unintended pregnancies and unsafe abortions. In 2017, this spending totaled $607.5 million.

While much of the action so far has come from the White House, going forward, advocates on both sides of the issue expect the Department of Health and Human Services (HHS) to play a large role. The agency has authority over how much states receive in funding for family planning, the Medicaid program, and key government offices, including the Administration of Children and Families.  

In September, HHS released a draft strategic plan outlining the department’s goals through 2022. In a change from the Obama administration, that document introduced a different definition of life, stating that its programs would be dedicated to “serving and protecting Americans at every stage of life, beginning at conception.” 

Abortion-rights advocates are bracing for what they expect will be significant changes to HHS’s Title X program, which provides grants for family planning and preventive health services, such as pregnancy and contraceptive counseling, testing for HIV and other sexually transmitted diseases, and cancer screenings. 

Last year, Title X-funded health providers spent more than $286 million serving more than four million Americans seeking family planning services. Most were young, low-income women, many of whom relied on these clinics as their sole source of care, according to the program’s 2016 annual report. 

Under Trump, the program is overseen by Teresa Manning, once a lobbyist for the National Right to Life Committee, who has said she opposes federal involvement in family planning. In 2003, at a panel on the future of the anti-abortion movement, she said, “Family planning is something that occurs between a husband and a wife and God, and it doesn’t really involve the federal government,” and referred to abortion as a “legalized crime.” Manning has also said that birth control “doesn’t work,” and wrote that making the morning-after pill available over the counter was “immoral, since the pill “can act to destroy the human life already conceived.”

Manning’s office has yet to announce the terms for 2018 Title X grants, which will set the year’s requirements for providers seeking family planning funds.  

HHS officials did not return multiple calls and emails seeking a comment for this story. 

“If you get a real ideologue who feels extremely strongly about the ills of family planning … they can really disrupt and destroy the program, even if the program did not get a funding cut,” said Duff Gillespie, a professor of population, family and reproductive health at Johns Hopkins University. “And those funds will be reallocated to something else. So, it’s not a funding issue per say. It’s strictly an ideological issue.” 

Over the past year, the Trump administration has chosen some lesser-known targets, which have so far received little public attention. Starting this summer, it informed at least two groups researching family planning that they would no longer receive federal funding.

The University of California at San Francisco (UCSF) learned in July that its three-year grant, issued in 2016, would end two years early. That grant had focused on counseling women on the contraceptive methods most aligned with their values and personal preferences, as opposed to the preferences of a specific clinic or provider. In total, the university lost $800,000 in funding. The letter, signed by Manning and obtained by FRONTLINE, cited “changes in program priorities.”

“That was certainly a surprise to us, and quite frankly, devastating to hear that whether women’s needs are being met in a contraceptive counseling encounter is not a priority of the federal government,” said Christine Dehlendorf, a family physician and associate professor at UCSF’s School of Medicine. 

The Guttmacher Institute received notice, dated the same day, that its five-year grant to examine the impact of publicly funded family planning had been cut two years early — a loss of $800,000, according to Kinsey Hasstedt, a senior policy manager at the organization. Hasstedt said the institute had applied for and received that funding consistently since 1994, under both Republican and Democratic presidents.

Also this summer, HHS’ Office of Adolescent Health cut funding for its Teen Pregnancy Prevention Program, terminating more than 80 five-year grants two years early. Created by Congress in 2010, the initiative aimed to reduce teen pregnancies through “evidence-based programs.”

The teen birth rate has declined steadily since 2008, dropping to its lowest level in nearly 70 years in 2014, according to federal data. 

HHS defended the cuts, saying the programs were not as successful as the Obama administration claimed. “The very weak evidence of positive impact of these programs stands in stark contrast to the promised results, jeopardizing the youth who were served, while also proving to be a poor use of more than $800 million in taxpayer dollars,” it said in an emailed statement to CNN in August.  

The cuts came after the appointment of Valerie Huber as chief of staff for the Office of the Assistant Secretary of Health, which administers the Office of Adolescent Health. Huber spent three years managing Ohio’s abstinence education program, then went on to lead Ascend, a national abstinence education group.  

In November, the Office of Adolescent Health, together with the Administration for Children and Families, announced a $10 million project to research teen pregnancy prevention and “sexual risk avoidance” programs, which aim to persuade teens to abstain from sex. 

There are also proposed plans to fund a sexual risk avoidance education program that “teaches participants how to voluntarily refrain from non-marital sexual activity” and “teach the benefits associated with self-regulation,” as well as “healthy relationships, goal setting, and resisting sexual coercion … without normalizing teen sexual activity,” according to a document issued by the department in October.

“We’re starting to see a kind of resurgence of this abstinence-only mantra,” said Boostra of the Guttmacher Institute. “And in the end, it ignores those young people who are already sexually active.”

She cited a federal study of nearly 50 years’ worth of data, which found that almost all Americans had sex prior to marriage. “It’s just really out of touch with reality, and therefore doesn’t prepare young people for their sexual lives,” she added.

The administration’s views have materialized in some unexpected places. In September, the director of HHS’ Office of Refugee Resettlement, E. Scott Lloyd, a Trump appointee who opposes abortion, tried to prevent an unaccompanied immigrant teen in federal custody from terminating her pregnancy. The ACLU intervened on behalf of the 17-year-old girl, identified only as “Jane Doe,” and won. The girl ultimately had an abortion.

Lloyd retains authority over unaccompanied immigrant minors who are pregnant, and may have intervened in other cases, according to The Washington Post. In emails discovered during the ACLU lawsuit, Lloyd asked for and received detailed updates on the cases of pregnant girls in federal custody, including whether they had asked to have an abortion.

“Obviously there is a pro-life ideology in the Department of Health and Human Services within the administration,” said Kristan Hawkins, president of Students for Life, the nation’s largest youth anti-abortion organization, with more than 1,000 groups on campuses across the country. “They’re working diligently to try to reverse some of the things that happened during the last eight years of the Obama administration.”

The Trump White House has also backed anti-abortion legislation in Congress.

In March, Vice President Mike Pence cast the tie-breaking vote in the Senate to revoke an Obama-era rule that prohibited states from defunding health care providers because they provide abortions. Trump later signed the measure. And in October, after the House passed a bill banning abortion after 20 weeks, the White House issued a statement saying it “applauds the House of Representatives for continuing its efforts to secure critical pro-life protections” — and that Trump would sign the bill if it passed.

For abortion opponents, the biggest hurdle now is the Senate. “The administration has picked up the tab in a lot of areas where Congress hasn’t been able to make gains,” said Mallory Quigley, a spokesperson for the Susan B. Anthony List, which supports anti-abortion candidates. Quigley said her group is focused on helping elect anti-abortion candidates in the 2018 midterms so that Trump will have more legislation to sign.

Abortion supporters say the full impact of the changes has yet to be felt — and fear the worst is yet to come. “Up until now, they’ve been dismantling and repealing and trying to reshape,” Boostra said about the administration. “But now, they’re starting to lay out where they want those monies to go and what they would like to do.”

This story has been updated to clarify the time period during which the Guttmacher Institute received federal funding.

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