Project 2025 promotes an exclusive pro-life agenda and makes many claims about abortion that are not supported by references and appear to be in conflict with known facts. The authors state the Department of Health and Human Services “should create and promote a research agenda that supports pro-life policies and explores the harms, both mental and physical, that abortion has wrought on women and girls”. (Dans & Groves, 2023, p. 461) The authors refer to the CDC’s surveillance of abortion as “woefully inadequate” and acknowledge state reporting is voluntary and three states do not provide data (California, Maryland, and New Hampshire). (p. 455) While this information is accurate, the authors omitted the state of New Jersey that also does not provide data on abortions. After acknowledging the difficulty in accurately determining the number of abortions and related complications, two pages later the authors state “Abortion pills pose the single greatest threat to unborn children in a post-Roe world. The rate of chemical abortion in the U.S. has increased by more than 150 percent in the past decade; more than half of annual abortions in the U.S. are chemical rather than surgical”. (p. 457) The authors also state the complication rate for chemical abortion is four times higher than surgical abortion (p. 458). These claims are not supported by in text references or any of the 87 citations in the reference section for this chapter.
The author of the chapter on Health and Human Services passes final judgement on mailing of chemical abortifacients with the statement “Allowing mail order abortions is a gift to the abortion industry that allows it to expand far beyond brick-and-mortar clinics and into pro-life states that are trying to protect women, girls, and unborn children from abortion”. (Dans & Groves, 2023, p. 459) One of the author’s strongest recommendations for reducing access to abortion is “Policymakers should end taxpayer funding of Planned Parenthood and all other abortion providers and redirect funding to health centers that provide real health care for women. The bulk of federal funding for Planned Parenthood comes through the Medicaid program”. (p.471- 472). Policies implemented by the current administration since the beginning of the year indicate agreement with the Project 2025 recommendations on this issue. On January 9, 2025, H.R.271 – Defund Planned Parenthood Act of 2025 was introduced in the House of Representatives by Minnesota Republican Michelle Fischbach. The bill would restrict Planned Parenthood’s federal funding (through Medicaid) for one year and prohibit funding unless they certify they will not provide abortion services except in cases of rape, incest, or endangerment of the mother’s life. (H.R. 271, 2025) While there has been no action on this bill, the recent passage of the One Big Beautiful Bill Act included the same provision in section 71113, Federal Payment to Prohibited Entities. (H.R. 1, 2025) Cuts have also been made to the Title X Family Planning Program which is dedicated to funding family planning services, research, and training. On March 31, 2025, the current administration began temporarily withholding funding for some Title X grants because the recipients allegedly did not comply with the administration’s recent DEI prohibitions. Not coincidentally, all grants to Planned Parenthood and their affiliates were included among these recipients. A lawsuit has been filed by the National Family Planning and Reproductive Health Association alleging the actions by the Department of Health and Human Services are unlawful. (DeBoth & Napili, 2025)
These cuts in funding make clear the current administration’s intent to severely limit abortion services. The problem is both Planned Parenthood and Title X grant recipients provide many services unrelated to abortion. Funding cuts will limit provision of these services as well, preventing many women, teens, and families from receiving basic health care. While services vary by clinic, Planned Parenthood provides the following resources: preventive care; vaccinations; testing and treatment for sexually transmitted infections; evaluation and treatment of sexual and reproductive concerns; prenatal and postpartum care; pregnancy testing and planning; mental health care; HIV services; and a range of birth control education and options. (Planned Parenthood, n.d.) Title X grant recipients provide a wide array of family planning services similar to those of Planned Parenthood with the exception of any services related to abortion. Title X also collaborates with the Teen Pregnancy Prevention Program, which is evidence based and provides grants for programs and evaluation of innovative approaches to preventing teen pregnancy. (DeBoth & Napili, 2025; Office of Population Affairs, 2024)
Keeping in mind the limitations of the abortion tracking system in the United States, what is known about prevalence and mortality? A total of 613,383 legal abortions were reported to the CDC in 2022. The percentage of this total by age group was 0.2% for women under the age of 15, 5.6% age 15-19, 28.3% age 20-24, 28.2% age 25-29, 20.6% age 30-34,10.7% age 35-39, and 3.6% age over 40. The percentage of abortions by weeks of gestation was 40.2% at less than six weeks, 38.4% at seven to nine weeks, 14.2% at 10-13 weeks, 3% at 14-15 weeks, 1.6% at 16-17 weeks, 1.5% at 18-20 weeks, and 1.1% greater than 21 weeks. The percentage of abortions by method was 35.5% surgical less than 13 weeks, 53.3% chemical less than 13 weeks, 6.9% surgical greater than 13 weeks, and 4.3% chemical greater than 13 weeks. There were five reported deaths determined to be abortion related in 2021, the last year that this data was reviewed. This is a rate of 0.46 per 100,000 abortions. The case fatality rates for abortion have remained low since data tracking by the CDC began in 1973. The number of deaths per 100,000 abortions was 2.09 between 1973-1977 and has been less than one since 1978. For the reporting period 2013-2021 there were 0.46 reported fatalities per 100,000 abortions and during this same time frame the total number of abortions decreased by 5%. (Ramer et al., 2024)
Now that we have examined voluntary reported rates of abortion in the United States let us take a look at potential complications of both surgical and chemical abortion. While complications are dependent on the type of abortion and stage of pregnancy, overall rates of complication are low with estimates of major complications (requiring admission to a hospital, surgical intervention, or blood transfusion) less than 0.3% and minor complications (bleeding that stops on its own or continued pregnancy) less than 4%. Legal induced abortion is safer than childbirth. As stated in the previous paragraph, the number of deaths from abortion in 2021 was 0.046 per 100,000 abortions. This compares to 32.9 deaths per 100,000 live births from complications of childbirth in that same year. Serious infection after chemical abortion is rare with rates ranging from 0.01-0.5%. Uterine aspiration can be necessary after both chemical and surgical abortion due to retained tissue although this is uncommon with rates estimated between 1-4%. (Hoyert, 2024; Jung et al., 2023)
As stated in the opening paragraph of this piece, the authors of Project 2025 make claims regarding abortion without providing supporting references. Let us see how they hold up to actual facts. The first claim is that the rate of chemical abortion has increased 150% in the past decade. Keep in mind that abortion reporting is voluntary, four states do not report any abortion statistics, and only 39 states report data on chemical abortion. The CDC estimated early medication abortion (less than 10 weeks) increased 129% between 2013 and 2022 (an increase from 23.6% of all abortions to 54%) with only a 4% increase between 2021 and 2022. Remember that the number of total abortions between 2013 and 2022 actually decreased so while 129% sounds like a gigantic increase it is actually a shift from more surgical abortions to more chemical abortions and not an increase in the total abortion rate. This is actually positive in terms of safety. It means a larger proportion of women are terminating pregnancy before 10 weeks and using chemical rather than surgical methods, both of which lower risk of complications. (Ramer et al., 2024) I am not sure where the Project 2025 figure of 150% came from since it was not referenced. Even if it were accurate the way it was presented is misleading. The second claim from Project 2025 is that half of all abortions are now chemical and this is true however as I have just stated, this is actually positive from a safety perspective.
The third claim by Project 2025 that I referenced in the opening paragraph is that chemical abortion has a complication rate four times higher than surgical abortion. In conducting a literature search, I found a study that included this sentence in the abstract: “The overall incidence of adverse events was fourfold higher in the medical compared with surgical abortion cohort”. This study was published in 2009 and the results were based on data collected between 2000 and 2006. It was conducted in Finland and published in the journal Obstetrics & Gynecology. A general search only allows access to the abstract. In order to read the full article, you must have access to a database that subscribes to the journal which is usually a medical facility or college/university. The author of the chapter in Project 2025 that includes this information is a Harvard educated attorney and earned a Master of Public Policy at Carnegie Mellon University and a Bachelor of Business Degree from the University of Southern California. He currently serves as the Vice President for Domestic Policy at the Heritage Foundation. While he may have had access to the complete article, it appears he did not read it.
In the Finland study the researchers identified seven categories of complications from both chemical and surgical abortion. Only two of these categories accounted for the dramatic difference in side effects between chemical and surgical abortion. The first category was hemorrhage, which occurred in 15.6% of those receiving chemical abortion and 2.1% for surgical abortion. The researchers did not clearly define hemorrhage and later in their discussion stated that they were not surprised by this finding since bleeding, lasting approximately two weeks, is associated with chemical abortion. In their conclusions they stated both methods of abortion were associated with a low level of serious complications. The second category of complications with a significantly higher rate in chemical abortion was incomplete abortion with surgical evacuation at a rate of 5.9% for chemical versus 0.4% for surgical abortion. (Niinimäki et al., 2009) Three physicians from the United States wrote a letter to the editor that was published six months later. The physicians represented the Medical Abortion Initiative in North Carolina, and the Departments of Obstetrics and Gynecology from both Columbia University in New York and Boston University in Massachusetts. These physicians stated the previously published rate of blood transfusion following use of medical abortion was 0.1 – 0.4%, substantially lower than the Finland study. They stated the authors of the study did not define hemorrhage. They contacted one of the researchers from the study and learned that even if a woman was experiencing normal bleeding after chemical abortion, if she returned to the clinic for reassurance it was counted as a complication due to hemorrhage. The physicians also pointed out the authors did not define incomplete abortion, with prior literature reporting much lower rates between 0.5 – 2.8%. They concluded their letter by stating medical abortion is very safe and complications need to be clearly defined when making comparisons between medical and surgical abortion. (Fjerstad et al., 2010)
The Project 2025 author who made these claims appears to have just read the abstract of this one research study and printed it as fact with no supporting data, in a professional document making recommendations to the President of the United States regarding women’s reproductive health care. Aside from the fact that the data are between 19-25 years old and the study was conducted in a different country with a different health care system and different medical practices, the study had significant limitations that made the data inaccurate. This is why it is so important to read the entire study rather than relying on the abstract to evaluate whether the information is accurate and or useful. Since I am not acquainted with the author that made these claims, I am unable to speak to his reasoning for including inaccurate data but since he is an extremely well-educated man his decisions are perplexing.
Now that we have examined some factual information about abortion rates and complications, I would like to return to the recent policy decisions that will cut funding for Planned Parenthood and other agencies that receive federal funding for providing abortion services. If these agencies are required to certify they only provide abortion services for women whose lives are endangered by continued pregnancy or who are victims of rape and incest, how are these determinations made? Since Roe v. Wade was overturned in June of 2022, decisions about abortion are made at the state government level and there is obviously significant variability among states. In Florida two physicians must certify in writing that termination of pregnancy is necessary to save a woman’s life or “avert a serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant woman other than a psychological condition”. It is disconcerting that state statutes dismiss a woman’s psychological health when dictating medical decision making. In cases of rape and incest, when a woman schedules or arrives for her appointment, she must provide documentation of “a restraining order, police report, medical record, or other court order or documentation providing evidence that she is obtaining the termination of pregnancy because she is a victim of rape, incest, or human trafficking”. (Florida Statues, 2024, 390.0111, d) The statue also states that abortion cannot be performed on a minor (under age 18) without written and notarized consent from a parent or legal guardian. (390.1114, 5, a)
If the federal government requires certification from agencies that they meet the new terms for grant funding of abortion services, does this override individual state’s current statutes? Legally, the burden of proof for rape, incest, and domestic sex trafficking is on women, and historically the odds are stacked against us. Women are often disbelieved, humiliated, and retraumatized by the legal system. A perfect example of this is demonstrated in comments made by Missouri Republican Senator Todd Akin in 2012. He stated “First of all, from what I understand from doctors, [pregnancy from rape] is really rare. If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.” (Carroll, 2012) Akin comments on rape With false beliefs like this is it any wonder women have such difficulty legally proving sexual violation from men? If women are victims of intimate partner violence, incest, or domestic sex trafficking, their partners/parents/traffickers may prevent them from scheduling and attending medical appointments alone and control what is said during appointments, limiting women’s access to abortion services. Many states currently allow minors to access reproductive health care, including abortion services without parental consent. Will the new federal legislation override this in all states? These are important questions with profound impact on women’s reproductive rights that have not been openly addressed.
As already discussed, the authors of Project 2025 insist on a pro-life, anti-abortion agenda. In addition, they also appear to support only natural methods of birth control. The author of the chapter on Health and Human services states the CDC should “update its public messaging about the unsurpassed effectiveness of modern fertility awareness-based methods (FABM’s) of family planning and stop publishing communications that conflate such methods with the long-eclipsed “rhythm” or “calendar” methods”. (Dans & Groves, 2023, p. 455) The author further states “CDC should fund studies exploring the evidence-based methods used in cutting-edge fertility awareness. FABMs (fertility awareness-based methods) are highly effective and allow women to make family planning choices in a manner that meets their needs and reflects their values. (p. 485) There are no references in the text to support either claim. A recent review article, comparing natural to hormonal contraceptives states natural contraceptives have a high rate of failure and require extensive training for women prior to use. The authors of this study also state for women who have irregular menses, the fertility window is much larger eliminating natural contraceptives as an acceptable option. Natural methods of contraception described in the article include withdrawal, calendar (rhythm) method, Billings ovulation method, symptothermal method, and fertility monitor. The authors state many studies on natural contraceptives are poorly done making it difficult to evaluate their effectiveness with failure rates ranging from 3% to 84%. Their review of the literature indicated if used properly hormonal contraceptives are the most effective form of pregnancy control and are well tolerated by most women. (Genazzani et al., 2023)
What would be the economic impact of the Project 2025 recommendations and the current administration’s decisions to dramatically reduce or eliminate access to abortion services and effective methods of contraception? A recent estimate of the costs for prenatal care, labor and delivery, and postpartum care in the United States came to roughly $19,000.00 with out-of-pocket expenses around $3,000.00. (Rae et al., 2022) An estimate of the costs of raising a child to the age of 18 in the United States with the 2025 economy came in at $297,674. This estimate includes costs for rent, food, daycare, clothing, transportation, health insurance premiums, and the value of federal tax credit. This is an increase of 25% in the last two years. (Davis, M., 2025) This brings our total expenses to $316,674.00 per child. As mentioned already, there were 613,383 legal abortions reported in 2022 and we know due to voluntary reporting this is a significant underestimation. If all of these pregnancies were carried to term the total cost for pregnancy, labor and delivery, postpartum care, and raising a child to the age of 18 would be roughly 194 billion dollars. Who pays for this? Some families could afford these expenses, but many could not prompting their use of federal and state aid for housing, food, education, and medical care. Can the United States economy support this? Have the authors of Project 2025 or the current administration directly addressed this major flaw in their plan to eliminate abortion services? The answer is no. The recently passed One Big Beautiful Bill Act cuts funding for: the Supplemental Nutrition Assistance Program (SNAP) formerly known as food stamps; housing; employment; and Medicare and Medicaid (including reproductive health services for women and primary health care for women, children, and families). (H.R. 1, 2025) These cuts disproportionately affect women, particular women of color and those of lower socioeconomic status. The Project 2025 recommendations and recent administrative policies appear to be all talk and no walk with the potential to have catastrophic consequences.
The authors of Project 2025 state “Alternative options to abortion, especially adoption, should receive federal and state support”. (Dans & Groves, p. 6). I am not sure what other alternative options they are referring to but adoption itself is not the answer. The adoption process can be lengthy and numbers are too low to accommodate a large influx of babies entering the system. In 2022, roughly 79,000 adoptions took place in the U.S. Around 53,500 of these adoptions were from the foster care system. There are over 100,000 children in the foster care system waiting for adoption. In 2022 over 200,000 children entered the foster care system with around 70% of those being infants. The average time spent in the foster care system prior to adoption is two to five years and some children are never adopted. An estimated $10.6 billion in federal funding was spent on foster care services in 2023. (Drumm et al., 2025; Adoption Network, n.d.)
Despite the financial unfeasibility of prohibiting abortion, the effects on women’s and children’s physical health, mental health, and wellbeing would be devastating. Women who are forced to carry an unintended pregnancy to term and either give the baby up for adoption or decide to raise the child may suffer a range of medical and psychological symptoms that can negatively impact their functioning in all aspects of their lives including parenting. Children who grow up in homes with limited access to resources, parents with disabilities, or those in foster care can have lifelong medical and mental health complications. The landmark Adverse Childhood Experience Study (ACE) looked at the effects of childhood psychological, physical or sexual abuse, substance use, mental illness, criminal behavior, and violence toward mothers in the home on health and mental health in later life. Higher numbers of adverse experiences increased risk of health and mental health complications in adulthood including smoking, obesity, depression, attempted suicide, substance use disorders, and high-risk sexual behaviors leading to sexually transmitted infections. There was also an increased risk of heart disease, cancer, stroke, chronic respiratory problems, and diabetes. (Felitti, V. et al., 1998) In addition to loss of function and lower quality of life, there is significant financial burden for medical and mental health care.
The authors of Project 2025 and the current administration’s anti-abortion agenda not only affect women in the United States but globally as well. As stated in Project 2025, “USAID now aggressively promotes abortion on demand under the guise of “sexual and reproductive health and reproductive rights,” “gender equality,”, and “women’s empowerment” and advocates for those who claim minority status or vulnerability.” Project 2025 also states “The U.S. government should not and cannot promote or fund abortion in international programs or multilateral organizations”. (Dans & Groves, pp. 192 & 259) The current administration has closed the U.S. Agency for International Development (USAID) and while a primary target may have been abortion, this is a small portion of how USAID funds are used. These funds are also used for education for children, basic healthcare, HIV prevention and treatment, crises in the Congo and Ukraine, maternal and child health including women’s reproductive health care, supplying lifesaving medications, food, and water, and protecting women and children. (Oxfam America, 2025) The loss of this funding will affect millions of children, women, and men in countries that are struggling to provide basic needs. What is the real reason for these cuts?
Photo by Kathy Kroening. Wailua Falls, Kauai, Hawaii. December 2012.
Under the guise of making America great again, the current administration and the Conservative Movement have set in motion a fast-moving river of change. There is big talk about beautiful benefits and concealing consequences. Waterfalls are beautiful, with their mist and spray that capture bits of sunlight creating rainbow bursts as water cascades to the pool below. But don’t be fooled by what is happening on the surface because the intense flow of water is gradually eroding the riverbed below, taking large amounts of anchoring sediment with it. Recent decisions made by the current administration will disproportionately affect women’s health and well-being. The erosion of women’s rights is reflected in the denial of a woman’s right to bodily autonomy, to make decisions about what happens in and to her body. This is one of the most basic unalienable human rights. It may seem like a minor setback to some, but momentum is against us. Keep in mind these policy changes are stripping rights we already possess creating a slippery slope. Which of our rights will be targeted next? What is the underlying agenda? It is imperative that we come together as a community of women to advocate for what we have and what we need, both of which are being threatened. Solidarity, resilience, innovation, and creativity will lead us forward.
Up next, a look back at women making history. Until next time sisters stay safe, be well, be kind to yourself, support each other, and spread the love.
Photo by Kathy Kroening. Seattle, WA. May 2025
References:
Adoption Network. (n.d.) Adoption Statistics. https://adoptionnetwork.com/adoption-myths-facts/domestic-us-statistics/
Carroll, L. (2012) Doctors Appalled over Rep. Akin’s Comments that “Legitimate Rape” Prevents Pregnancy. NBC News. https://www.nbcnews.com/health/health-news/doctors-appalled-over-rep-akins-comments-legitimate-rape-prevents-pregnancy-flna954572
Dans, P., & Groves, S. (Eds.). (2023). Project 2025 Mandate for Leadership: The Conservative Promise. The Heritage Foundation. https://www.documentcloud.org/documents/24088042-project-2025s-mandate-for-leadership-the-conservative-promise/
Davis, M. (2025). It Costs an Additional $297,674 to Raise a Child Over 18 Years, Up 25.3%. Lendingtree. https://www.lendingtree.com/debt-consolidation/raising-a-child-study/
DeBoth, A. & Napili, A. (2025). Title X Family Planning Program. (CRS Report No. IF10051, Version 28) https://www.congress.gov/crs-product/IF10051
Defund Planned Parenthood Act of 2025, H.R. 271, 119th Cong. (2025-2026) https://www.congress.gov/bill/119th-congress/house-bill/271
Drumm, A. R., Davi, N., & Hanlon, R. (2025). Adoption by the Numbers: 2021 & 2022. National Council For Adoption. Alexandria, VA. https://adoptioncouncil.org/wp-content/uploads/2025/03/Adoption-by-the-Numbers-2025.pdf
Felitti, V., Anda, R., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., Koss, M., & Marks, J. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258. https://www.ajpmonline.org/article/s0749-3797(98)00017-8/pdf
Fjerstad, M., Westhoff, C., & Lifford, K. (2010). Immediate Complications After Medical Compared with Surgical Termination of Pregnancy [Letter to the Editor]. Obstetrics & Gynecology, 115(3), p. 660.
Florida Statutes. (2024). Termination of Pregnancies. 390.0111. http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0300-0399/0390/0390.html
Genazzani, A., Fidecicchi, T., Arduini, D., Giannini, A., & Simoncini, T. (2023). Hormonal and Natural Contraceptives: a review on efficacy and risks of different methods for an informed choice. Gynecological Endocrinology, 39(1), 1-13. https://pubmed.ncbi.nlm.nih.gov/37599373/
Hoyert, D.L. (2023) Maternal Mortality Rates in the United States, 2021. NCHS Health E-Stats. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2021/maternal-mortality-rates-2021.htm
Jung, C., Oviedo, J., & Nippiti, S. (2023). Abortion Care in the United States – Current Evidence and Future Directions. New England Journal of Medicine Evidence, 2(4), 1-10. https://evidence.nejm.org/doi/full/10.1056/EVIDra2200300
Niinimäki, M., Pouta, A., Bloigu, A., Gissler, M., Hemminki, E., Suhonen, S., & Heikinheimo, O. (2009). Immediate Complications After Medical Compared with Surgical Termination of Pregnancy. Obstetrics & Gynecology, 114 (4), 795-804. https://pubmed.ncbi.nlm.nih.gov/19888037/
Office of Population Affairs (2024). Title X Program Guidelines. https://opa.hhs.gov/sites/default/files/2025-03/title-x-program-handbook-dec-2024.pdf
One Big Beautiful Bill Act, H.R. 1, 119th Cong. (2025-2026) https://www.congress.gov/bill/119th-congress/house-bill/1
Oxfam America. (2025). What USAID Does and the Impact of Trump’s Cuts on Foreign Aid. https://www.oxfamamerica.org/explore/issues/making-foreign-aid-work/what-do-trumps-proposed-foreign-aid-cuts-mean/
Planned Parenthood (n.d.) Our Services. https://www.plannedparenthood.org/get-care/our-services
Rae, M., Cox, C. & Dingel, H. (2022) Health Costs Associated with Pregnancy, Childbirth, and Post-partum care. Health System Tracker, Peterson Center on Healthcare and Kaiser Family Foundation. https://www.healthsystemtracker.org/brief/health-costs-associated-with-pregnancy-childbirth-and-postpartum-care/
Ramer, S., Nguyen, A.T., Hollier, L.M, Rodenhizer, J., Warner, L., & Whiteman, M.K. (2024). Abortion Surveillance — United States, 2022. MMWR Surveillance Summaries, 73(7):1–28. https://www.cdc.gov/mmwr/volumes/73/ss/ss7307a1.htm?s_cid=ss7307a1_w
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