After Donald Trump was re-elected to a second term as president of the United States, the alarm over reproductive health-care access that began after the Supreme Court’s 2022 overturn of Roe v. Wade came to a head. Clinicians, prescribers, and pharmacies reported a surge in purchases and requests for abortion pills, emergency contraception, and birth control.

Many people are scared, Rewire News Group Senior Reporter Garnet Henderson said in a recent TikTok video—and this is when a lot of misinformation can spread online.

To better understand how the reproductive health-care landscape could change under the Trump administration, RNG spoke to half a dozen experts about what they’re anticipating and how people can prepare before January 20.

What’s at stake

It’s hard to know what exactly the next four years will bring, experts said. But they agreed the U.S. will likely see further restrictions—if not a complete ban—on abortion, significant undermining of the nation’s federally-funded family planning program, and threats to reproductive health-care coverage for both government-funded and private insurance plans.

The previous Trump administration’s policies and proposals outlined in Project 2025 documents could provide some clues, said Brigitte Amiri, deputy director of the American Civil Liberties Union Reproductive Freedom Project.

Trump could pose the largest national threat to abortion care without Congress ever introducing a law, Amiri said. Trump’s allies have said the president-elect could instead direct his justice department to enforce the Comstock Act, despite Trump’s previous claims that he would not sign a federal abortion ban into law. First passed in 1873, the Comstock Act restricted the transmission of “obscene” material, which could include abortion pills and information about abortion, through the mail. Any Trump administration attempt to enforce the anti-vice law would effectively ban abortion nationwide, Amiri said.

With a Republican-controlled Congress, it is possible that a national abortion ban could be drafted, passed, and signed into law—all without invoking Comstock—though experts debate on the likelihood of this scenario. If Congress enacts a national ban, Amiri said, “it will override a state constitutional protection for abortion, including those recently passed in Missouri and Michigan, and Ohio and Arizona.”

An expected overhaul of Title X, a federal grant program that funds family-planning clinics nationwide, could pose another major threat. Congress could slash funding to the entire program, making it significantly harder for existing clinics to operate. Trump could also re-institute policies from his first administration—including rules requiring providers be physically separated from any abortion activities; banning clinicians from discussing or referring patients for abortion care; and allowing anti-choice pregnancy centers to apply for grants.

“We’re gonna see Title X completely reshaped into a form that will no longer actually support any of the people that it was supposed to support,” said Robin Marty, author of The New Handbook for a Post-Roe America and executive director of WAWC Healthcare, a reproductive health clinic in Tuscaloosa, Alabama. (Marty previously worked as a reporter for RNG).

Marty added there could also be changes to a different grant program responsible for creating state maternal health task forces.

Some experts also voiced concerns about broader challenges to regulatory oversight of federal agencies, public health, and insurance coverage that could negatively impact reproductive care under a Trump administration. Other attacks on reproductive health could come from rolling back federal rules and existing interpretations of law. Amiri said a Trump administration could change its interpretation of the Emergency Medical Treatment and Active Labor Act.

Trump could also gut reproductive health care that the Affordable Care Act (ACA) must cover, making things like contraception less likely to be covered by insurance, more expensive, and less accessible, experts said.

Privately insured patients may not feel the rollback of reproductive health-care coverage mandates for some time, Marty said. Some private plans may elect to cover those services despite the removal of a mandate. But those under government-funded plans and programs, including Medicaid, could lose coverage much more quickly, she said.

“I think we’re also likely to see more attacks on the FDA and how they regulate and approve drugs related to contraception and abortion,” Henderson added in her TikTok video.

For states with restrictive abortion laws and reproductive health-care deserts, Marty said, any one of these efforts could have devastating consequences for the health-care system.

With a Republican-controlled Congress and a President Trump, Marty added, state legislatures could further restrict and criminalize reproductive health-care services. And despite experts’ planning and predictions, there could be unexpected legislative and regulatory curveballs.

“We were surprised by things in the last Trump administration,” Amiri said. “And I’m certain that that will be the case in this Trump administration as well.”

Still, people can take some steps ahead of Trump’s presidency.

Abortion care

Even before Roe was overturned in Dobbs v. Jackson Women’s Health Organization, abortion access varied widely among states. But experts expect to see further restrictions under Trump.

I Need An A offers the most up-to-date, state-by-state look at abortion access—including how to obtain medication and procedural abortions, and how much they might cost. Plan C also explains what legal risk accompanies each option. People can also turn to some online forums for accurate information about abortion and advice on accessing care.

“The abortion Reddit is quite frankly, in my opinion, the most important development post-Dobbs,” Marty said.

Public platforms like Aid Access and Red State Access link people who live in restrictive states or cannot otherwise access in-person care to abortion pills provided by mail. Like Plan C, they routinely connect patients to information about and access to abortion medication.

Medication abortions typically follow a regimen that includes two different drugs: mifepristone and misoprostol. Mifipristone is taken first and works by stopping a pregnancy from growing. It is then followed by one or multiple doses of misoprostol, which causes the uterus to contract and expel the pregnancy. It is possible to have an effective medication abortion with misoprostol alone.

Dr. Nisha Verma, an OB-GYN and complex family planning specialist providing clinical care in Georgia and Maryland, said providers have seen a rise in self-managed abortion in the wake of growing state-level restrictions.

“Ordering medications and managing your abortion from these reliable sources—like Plan C, like Aid Access—that is safe and effective in many cases, and there are resources for people if questions come up,” Verma said.

Red State Access connects pregnant patients to no-cost community pill networks in restrictive states. Community pill networks typically provide abortion pills for free, Marty said.

“But it does not always come neatly,” Marty said. “It won’t necessarily be in the blister packs that you’re used to.” When that happens, patients can look up the pills they receive online to make sure they received the right medication.

Some pill providers, including Aid Access, allow patients to order abortion pills even if they are not pregnant. Experts told RNG that such policies could allow individuals to store one or more doses of abortion medication for future use.

Properly storing medication—whether for abortion, contraception, or routine health management—is essential to preserving their effectiveness, according to Henderson. Pills should be stored away from warm, moisture-rich environments like bathrooms, she said. Good storage options could include a bedside drawer, a closet, or a cabinet not typically exposed to heat or moisture, according to MedlinePlus.

Emergency contraception

It may also be wise to keep a few doses of emergency contraception on hand, experts told RNG.

As of publication, emergency contraception is legal, though some states have made it easier for pharmacists to refuse to sell it to patients and allow insurance plans to deny coverage for it. The most common kinds of emergency contraception—pills—are available in all 50 states.

Hormonal emergency contraceptive pills often referred to by the brand name “Plan B” are available without a prescription and are sold at pharmacies and online. It is also available through some telehealth apps, like Nurx. Planned Parenthood recommends taking Plan B pills within 72 hours of unprotected sex.

But this form of emergency contraceptive is not appropriate for everyone: Some research has found that Plan B may be less effective in people who weigh more than 155 pounds.

A non-hormonal emergency contraceptive pill, commonly referred to by the brand name ella, is more effective than Plan B and works best for people who weigh up to 195 pounds. It can be taken up to five days after unprotected sex, but requires a prescription and may impact breastfeeding for a short period of time, according to Planned Parenthood.

It’s also important to be conscious of how much emergency contraception people purchase for preventative reasons, Henderson said.

“There are people who need Plan B today, tomorrow, the next day,” she said. “They need it right now.”

Copper and hormonal intrauterine devices (IUDs) can also be used as emergency contraception for people of any weight if they are inserted within five days of unprotected sex, according to Medical News Today. But a medical professional needs to place it, which means patients could face barriers including cost, appointment availability, and future efforts to restrict access.

Other contraception

Concerns about future access to birth control after Deanda v. Becerra have prompted some social media users to recommend getting longer-acting forms of birth control, like IUDs.

“It’s a great option for a lot of people,” Henderson reported. “It’s not the only option, and it’s not the best option for everyone.”

While the fate of birth control access under Trump is still unclear, there are a range of contraceptive options still currently available. Experts told RNG it’s important to carefully consider what options might be best and consult a medical professional where appropriate.

Folks looking to access more permanent birth control methods, including tubal sterilization (which is supposed to be covered under the ACA) and vasectomies, will require care by a health-care provider. This could be costly—up to $6,000—and difficult to schedule before Trump takes office. But the procedures are among the most effective long-term methods of preventing pregnancy.

Longer-acting options include IUDs, which last between three and ten years depending on the type, and the birth control implant, which is FDA-approved to last up to three years. Some research suggests the implant could be effective for up to five years. All of these options have to be placed by a health-care provider, which could make them more difficult to access.

Providers have reported a surge in requests for longer-term pregnancy prevention options. And if the Trump administration guts protections afforded by the Affordable Care Act or repeals the legislation altogether, it’s possible that the costs associated with placing IUDs and implants could make the option unaffordable for many patients.

Another thing to consider, Marty said, is that you may want or need to remove longer-acting contraception before it expires. Providers’ willingness to help you do so could vary.

A host of shorter-term options—pills, patches, rings, and shots—could be easier to access ahead of Trump’s inauguration. But many require a prescription. More than 30 U.S. states and territories allow pharmacists to prescribe contraceptives, and you can ask your provider or pharmacist to write a prescription to receive a year’s supply of contraceptives at once, though that varies by state and insurance coverage.

If you can’t easily access a prescriber, see a clinician in person, or get an appointment with one, many of these options can be accessed via telehealth, though it may be more costly. Some popular options include the Nurx, Pandia Health, and Planned Parenthood Direct platforms.

One birth control pill, Opill, is available without a prescription, and typically costs $15-20 per pack. This form of oral contraceptive is safe and effective. Those who don’t have access to a prescriber and are concerned about the potential side effects of OPill can complete a self-screen to evaluate their individual risk.

Many of these options can be costly, even with insurance coverage. But there are reproductive health clinics and pharmacies across the country that can help low-income and or uninsured patients get affordable access. Some, like Converge, offer telehealth options where patients can get care and order reproductive health kits that include emergency contraception. (Converge currently offers telehealth services only to patients in Mississippi, but told RNG it plans to expand into Tennessee in early 2025.)

Talking to a provider

For people who need to work with a medical provider to obtain services, the prospect of bringing up future access to reproductive care can be daunting. But these conversations are fairly common and shouldn’t be avoided if you’re concerned about privacy and access to care, experts said.

“You’re allowed to ask your doctor questions,” Henderson said in her video. “You’re allowed to ask them what their attitudes are about abortion and birth control. And you’re allowed to ask them what they’re putting in your chart.”

That sentiment was echoed by Marty, whose book on navigating the fall of Roe includes questions to ask potential providers. She said asking a clinician about whether they’d be willing to proactively prescribe emergency contraception could be a great way to ascertain whether you can trust them.

“If they’re gonna balk at that, then that’s a red flag,” she said.

Patients aren’t alone in their concern for what a future Trump administration could mean for abortion care and other forms of reproductive health access. Clinicians are having conversations with each other—and patients—about ways to protect health information and preserve reproductive health-care access amid growing restrictions.

In mid-November, the American College of Obstetricians and Gynecologists (ACOG) published new guidance, which Verma helped author, outlining steps OB-GYNs can take to better protect patients who may have self-managed an abortion. That’s because the biggest risk to patients in wake of Dobbs is not a medical complication.

“The greatest risk is actually legal risk and risk of criminal prosecution,” Verma said. “We come out very clearly in this guidance, recommending that our members really avoid practices that could lead to criminalization of patients for actions taken during pregnancy, including self-managing an abortion.”

As part of her work as an ACOG senior advisor for reproductive health policy and advocacy, Verma has educated both providers and patients about what a harm-reduction approach to criminalization risk could look like in practice, including ways to chart symptoms and care plans without including unnecessary details about what preceded the encounter.

And when in doubt, multiple experts told RNG, you don’t have to disclose information that could be used against you. In most cases, doctors cannot tell the difference between miscarriages and self-managed abortions, they said.

Verma said she worries that the fear of criminalization could deter the relatively small number of patients who do need some kind of follow-up care after a self-managed abortion from seeking it out. She wants to reassure them that they should get services if they need it. If patients “are in a setting where they don’t feel comfortable, or don’t know how the health-care team would react, or don’t know if it’s safe, they don’t have to disclose that information,” she said.

Protecting your privacy

Reproductive health-care providers are not the only ones who can take steps to protect patient privacy in the years to come. Everyday people can too, said Daly Barnett, a staff technologist at the Electronic Frontier Foundation (EFF).

Barnett recommends that individuals understand their unique privacy and security risks, and develop a plan to help mitigate them. A good place to start, she said, is EFF’s Abortion Access Playlist, which helps individuals develop threat models and tailor security strategies. The Digital Defense Fund has similar resources available on its website.

“There’s no one-size-fits-all security solution, so the best thing anyone can do is prepare now and figure out what will work best if you need those contingency plans,” Barnett said.

Barnett suggested people get into the habit of taking steps to communicate more securely and compartmentalize sensitive activities online. That could mean using encrypted messaging platforms to communicate, using a privacy-minded browser to access the internet, and, when practical and affordable, adding additional privacy protection tools like VPNs. Digital Defense Fund has a list of free and low-cost VPNs.

But, Barnett said, it’s important to understand that no privacy or security-enhancing tactic is perfect, so the best practice is to develop and employ good digital hygiene strategies. Without sweeping federal data privacy legislation, she said, individuals and communities are left to combat that “existential threat” alone.

One aspect of reproductive health privacy coming under renewed focus is the safety of using period tracking apps. After the Supreme Court rendered its decision in Dobbs, both privacy experts and social media users debated whether people could safely use any app to track their periods. That conversation has been revived as people who can become pregnant prepare for a second Trump administration.

Both Barnett and Henderson said you don’t necessarily need to delete period tracking apps to preserve your security. In fact, Henderson said, for those concerned about abortion access, a well-tracked cycle could be essential to identifying pregnancy as early as possible. But it doesn’t mean that all apps are created equal.

The mobile app Euki is well-known for its multi-layered approach to protecting privacy, in part because it stores data on individual devices and allows users to require a pin to open the app. It’s largely considered the most secure of the available apps, experts told RNG. Among the more widely-known apps, Clue is a good option because it doesn’t share your data, Henderson said. It does store your data in the cloud, she said, which could introduce added risk.

Regardless, the tangible digital security and privacy methods will only get people so far.

Your reproductive health information is as secure as the people you choose to share it with, Barnett said. In the coming months and years, folks will have to find ways to identify and confirm those with whom they entrust their reproductive health information.

“Digital privacy is a team sport,” Barnett said. “You have to entrust others in your community to keep each other safe.”