Harris v. Trump: Records and Positions on Reproductive Health
The 2024 election is the first Presidential election since the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization, and abortion access and reproductive health more broadly, are front and center in this election (Figure 1). The two candidates, Vice President Kamala Harris (D) and former President Donald Trump (R) have widely different positions on reproductive health. Vice President Harris has been and is an outspoken leader and advocate for reproductive freedom, while former President Trump celebrates the overturning of Roe v Wade, which ended the constitutional right to abortion and allowed states to completely ban or severely restrict abortion access. The candidates’ Vice-Presidential running mates, Governor Tim Walz (D) and Senator JD Vance (R) also have divergent records on reproductive health issues. Governor Walz points to his support for Minnesota’s Protect Reproductive Freedom Act, which codified abortion rights in the state, as well as his family’s own experience with fertility care. Senator Vance has expressed support for a national abortion ban via the Comstock Act and voted against a Senate bill that would have established a national right to IVF, a position that his running mate, Donald Trump, has said he supports.
While abortion is the most prominent health care campaign issue, the election could also have large implications for contraceptive care and maternal health. This brief summarizes the positions, records, and potential priorities of the two major party candidates for the 2024 Presidential election on three major issues in women’s health policy – abortion, contraception, and maternal health. The information presented is derived from the candidates’ records from their time as elected officials, their proposals or statements, and the Democratic and Republican party platforms. We have also included discussion of proposals from the Heritage Foundation’s Project 2025. While former President Trump has distanced himself from this proposal, its authors are influential in Republican circles and include several individuals who served in the Trump Administration. A separate side-by-side from KFF compares the candidates’ positions across a broad range of health care issues.
Abortion
Abortion access is one of the most prominent issues in the 2024 election, and the candidates have widely divergent records and positions. Vice President Harris has been an outspoken advocate for reproductive freedom and has endorsed the restoration of the prior federal standard under Roe v. Wade, which would guarantee a right to abortion until the point of fetal viability. In contrast, Trump expresses his support for letting states set their own abortion policy, including banning abortion, as allowed under the Dobbs Supreme Court ruling.
Vice President Harris has been vocal in her disagreement with the Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade and allowed states to set their own policy on abortion legality. In stark contrast, Trump has repeatedly taken credit for the overturning of Roe and giving states decision-making authority on abortion because he appointed three conservative justices to the Supreme Court with the explicit goal of overturning Roe. Since the Dobbs ruling, 14 states have banned abortion with very few exceptions and several other states have limited abortion availability to very early in pregnancy.
Abortion Access
Vice President Harris has been the leading voice for the Biden/Harris Administration on reproductive health and has said she supports restoring the protections of Roe v. Wade and eliminating the filibuster to do so. In the wake of the Dobbs ruling, the Biden-Harris administration has tried to limit the impact of the bans through executive actions as well as in the courts. This includes reiterating federal protections for abortion care under EMTALA in cases of pregnancy-related emergencies, reinforcing requirements for pharmacies to fulfill their obligation to provide access to reproductive health pharmaceuticals, enforcement of non-discrimination policies for health care providers, promulgating policies to strengthen data privacy to protect those seeking reproductive health care, and defending the FDA decision to approve mifepristone (one of the drugs used in the medication abortion regimen) and changes in how the drug can be dispensed. Vice President Harris opposes the Hyde Amendment, which limits federal spending on abortions to cases of rape, incest, or life of the pregnant person.
In 2016, Trump ran on the promise that he would appoint Supreme Court judges that would overturn Roe v. Wade, a promise he kept. Most recently, he has stated that he believes that abortion regulation should be left up to states and tweeted that he would veto a federal ban. At times earlier in the campaign he has suggested that he would support some type of federal standard, such as 15 or 16 weeks gestation, that would apply in all states. He has said that he believes in exceptions for cases of rape, incest, and life of the mother. Despite stating that he believes that abortion bans or limits at 6 weeks are “too early,” he also said he will vote against the ballot initiative that would expand abortion legality in Florida, where he resides (currently limited to six weeks of pregnancy). In terms of penalties for violation of bans or gestational limits, he has said that they should be also decided by states, even leaving open the possibility of allowing states to prosecute people in states with bans if they obtain abortions.
Trump has repeatedly stated that Democrats support abortion up to and after birth, which is false. There are no abortions at birth or after. During the 2016 campaign, he pledged to make the Hyde Amendment abortion funding ban a permanent law.
Medication Abortion
Medication abortion pills account for the majority of abortions in the U.S. The Biden-Harris Administration has implemented policies that expand access to medication abortion, particularly via telehealth, and has been fighting lawsuits brought by anti-choice clinicians and policymakers to further restrict abortion access. Former President Trump’s statements about medication abortion have been inconsistent, at times suggesting he would not block their availability and at other times suggesting the opposite. His support for leaving abortion policy to the states allows states to prohibit access to all abortions, including medication abortion. Project 2025—the detailed conservative policy treatise that was spearheaded by many former Trump Administration leaders—is clear in its opposition to the FDA’s approval of mifepristone and endorses the Comstock Act, which would effectively prohibit the mailing and distribution of abortion pills.
The Comstock Act is an existing 1873 anti-vice law banning the mailing of obscene matter and articles used to produce abortion. The Biden-Harris Administration’s Department of Justice maintains that the Comstock Act should not be interpreted literally and therefore has not enforced it. Based on over a century of Federal Court rulings, they determined the Comstock Act only applies when the sender intends for the material or drug to be used for an illegal abortion, and there are legal uses of abortion drugs in every state and no way to determine the intent of the sender. However, that would not preclude an Administration that is hostile to abortion from doing so. Former President Trump has not articulated his stance on enforcement of the Comstock Act, but some Republican leaders, including his running mate Senator Vance, have called for enforcement of the law and a halt on the mailing of all abortion medications and supplies within the country (which would be a de facto national ban) and even limiting access in states that currently allow abortion without restrictions.
Pregnancy-Related Emergency Care
Health exceptions to abortion bans is an issue that Vice President Harris has spoken about extensively. In addition to reiterating the federal EMTALA requirements for hospitals to provide health-stabilizing emergency care that includes abortion in cases of pregnancy-related emergencies, the Biden-Harris administration defended their policy in a case that reached the Supreme Court. This challenge was spearheaded by Republican-led states that ban emergency abortion care, even when it is the standard of care to preserve or stabilize health. President Trump says he believes in exceptions for “life of the mother.” Project 2025 authors say that emergency abortion denials are not a problem and call for the reversal of the Biden-Harris Administration’s EMTALA guidance and withdrawal of lawsuits challenging state abortion bans without health exceptions.
Contraception
Access to contraception has emerged as another health care issue in this year’s election where Vice President Harris and former President Trump have different records. Vice President Harris’ call for reproductive freedom includes access to contraception, and her support on this issue extends back to her time before she became Vice President. Since the Dobbs decision, the Biden-Harris Administration issued executive orders reiterating support for contraception and directing various federal agencies and regulators to assure that access to the full range of contraceptive services and supplies is safeguarded. Trump’s Administration issued multiple regulations that placed restrictions on the availability of funding for contraception. During his campaign, he initially expressed that states could restrict access to contraceptives, but shortly afterwards, also said that he would not support this.
Right to Contraceptives
Vice President Harris is a strong supporter of contraceptive care, including coverage of over-the-counter methods, encouraging broader access under Medicare and at colleges and universities, and for the proposed federal Right to Contraception Act, which is pending in Congress. Although Trump has not spoken extensively about contraception during this campaign, the Republican party platform states support for “access to birth control;” however, there is no detail on the policies that they would implement to promote access. The majority of the Republican members of Congress (including Senator Vance) either opposed or abstained from voting on the Right to Contraception Act. Project 2025 characterizes some emergency contraception pills—a contraceptive that prevents pregnancy after sex by preventing or delaying ovulation, as a “potential abortifacient.”
Title X Federal Family Planning Program
While in office, Trump’s Administration rewrote the rules governing the federal Title X program, the federal family planning program that supports contraceptive access for people with lower incomes. Title X funds have never been used to pay for abortion services, but Trump’s Administration rewrote the regulations to disqualify family planning clinics from participating in the program if they also offered abortion services (with separate funding); additionally, they prohibited participating clinics from offering referrals to abortion services at other clinics to pregnant patients seeking abortion information. These changes resulted in a reduction of about 1,300 of the 4,000 sites participating in the network of clinics receiving federal support from the Title X program. His Administration also provided federal family planning funding through Title X funds to clinics that did not provide contraceptive methods, which had been a requirement of the program until that time. The Biden-Harris Administration reversed the Trump Administration changes to the program. Project 2025 calls for the restoration of the Trump-era rules and focusing the program on fertility-awareness based methods (FABM).
Medicaid and Family Planning
For decades, the Medicaid program has required coverage for family planning services, including contraceptives. The Biden–Harris Administration has reiterated support for this policy as well as the program’s “free choice of provider” policy which commits to inclusion of all qualified providers (including Planned Parenthood) that offer both contraception and abortion services, although federal Medicaid funds are not used for abortion care. Former President Trump allowed federal Medicaid funds to be used in a Texas Medicaid program that excluded Planned Parenthood and did not cover the full range of contraceptives, excluding emergency contraception. Eliminating Planned Parenthood from Medicaid provider networks has long been a priority of some Republican lawmakers and conservative organizations and is reiterated by Project 2025.
Contraceptive Coverage and the ACA
Private insurance coverage for contraceptives and other evidence-based preventive services such as cancer screenings and prenatal care is required under the ACA and has been championed and expanded by the Biden-Harris Administration. While President, Trump issued regulations that expanded facilitated employer claims to an exemption from the contraceptive coverage requirement, allowing employers with religious or moral objections to completely exclude contraceptives from their employee health plans.
The outcome of a pending federal lawsuit, Braidwood Management Inc v Becerra, which specifically challenges the ACA preventive services requirements, could put contraceptive coverage at risk. The Biden-Harris Administration is defending the ACA requirement and fighting the case. Former President Trump has not publicly voiced an opinion on the case, but Project 2025 calls for the federal government to issue new requirements for contraceptives and other women’s preventive services because of the pending case.
Maternal Health
In recent years, there has been increased awareness and attention to the poor state of maternal health in the U.S., particularly stark racial and ethnic disparities in mortality and morbidity, as well as limited access and coverage for fertility assistance, particularly in vitro fertilization (IVF), under private insurance and Medicaid. While in the Senate and as Vice President, Harris has been a champion on improving maternal health, with a particular focus on eliminating persistent racial and ethnic disparities. Recently, has called for insurance coverage of IVF.
Equity, Quality, and Access to Care
Vice President Harris has a history of advocating for improvements in maternal health and care. As Senator, she sponsored the MOMNIBUS, a package of bills aimed at improving quality of and access to maternity care. After becoming Vice President, the American Rescue Plan Act (ARPA) of 2021, which the Administration supported, allowed states to extend postpartum coverage under Medicaid from 60 days to 12 months. Since it took effect, nearly all states have adopted the extension.
The Biden-Harris Administration has also taken other actions, including the launch of a maternal mental health hotline and a new Medicaid payment model for better coordinated maternity homes. Their Maternal Health Blueprint presents future priorities, such as coverage for a broader range of services, improving data collection, diversifying the maternity workforce (including with midwives and doulas), and improving treatment of pregnant people, particularly communities of color.
Trump also issued a maternal health plan near the end of his term that called for action on many of the same issues, including more research and technological investments in maternal health. The former President signed federal legislation that provided funding for maternal mortality review committees. The Project 2025 document supports broader access to doulas, as long as no federal funds support training related to abortion care.
Fertility Assistance and IVF
In February 2024, the Alabama Supreme Court ruled that embryos created through in vitro fertilization (IVF) are “unborn children” under the state’s law. Since the state court’s ruling, both Vice President Harris and former President Trump have expressed their support for IVF care. Trump has also said that if elected, his administration would provide access to full coverage of IVF services by requiring insurance companies or the government to pay, but he has not provided any details on how this would be funded or operationalized.
Both party platforms express support for IVF, however the Republican platform also invokes the 14th Amendment, which can be used to promote fetal personhood policies that could threaten and criminalize IVF care. Additionally, the Project 2025 authors refer to embryos as “aborted children” and oppose research using embryonic stem cells (which can be derived from the IVF process). Senators in both parties introduced federal legislation related to IVF. The Democratic-sponsored proposal would have established a federal right to IVF as well as other fertility assistance services, while the Republican-backed bill would have prohibited states from banning IVF care. Both bills failed to pass.
Paid Leave
Despite strong public support, the U.S. is one of the few industrialized nations that does not have national requirements for paid family leave for most workers. Vice President Harris supports guaranteeing 12 weeks of paid leave for new parents, caregivers, cases of domestic violence, or military deployment. The Republican Party platform does not address paid leave. During former President Trump’s time in office, he signed the 2020 National Defense Authorization Act, which provided 12 weeks paid parental leave to federal employees for the birth or arrival of a child.