- Doctors in Michigan say they're hearing from patients who are fearful they'll lose access to abortion and birth control, even though voters enshrined reproductive rights in the state constitution.
- Even without a national abortion ban, a Trump administration could impact Michigan patients, possibly by restricting abortion pills and contraception access.
- Abortion rights opponents say those fears are overblown, and abortion rights issues will remain largely up to states.
The first patient Dr. Susan Ernst heard from after the election was a young woman in her 20s, asking to be sterilized.
“After Trump was elected president again, she's really concerned about access to reproductive health care, and she definitely wants to move forward with the sterilization,” said Ernst, the chief of gynecology and sexual health at the University of Michigan. “And she's 26 years old now.”
Nearly two dozen patients at University Health Service have requested “either sterilization, or just contraception in general,” and “specifically mentioned the election results as sort of the impetus to get them to reconsider what they're doing for contraception.”
That may seem counterintuitive in a state where voters enshrined some of the broadest reproductive rights in the U.S. into the state’s constitution.
But potential changes at the federal level could have implications in states like Michigan, even without a national abortion ban.
In Project 2025, a former Trump health official laid out a playbook for rescinding FDA approval for abortion pills, removing federal guidance that says ERs must provide abortions when needed to stabilize a pregnant woman, ending federal funding for Planned Parenthood clinics, and removing certain types of birth control from the Affordable Care Act’s contraception mandate, among other things.
“I think it's naive to say that abortion access is guaranteed in Michigan,” said Dr. Sarah Wallett, chief medical operating officer of Planned Parenthood of Michigan. “The impacts of this election could be very large, and I don't think that Michigan is absolutely protected.”
Trump has said abortion should be determined by the states
But abortion rights opponents in the state say those concerns are overblown and unfounded. They point to Trump’s repeated disavowal of Project 2025, and his statements about vetoing a national abortion ban (which he previously supported in his first term) in recent months.
“A national abortion ban was an election year fantasy,” said Genevieve Marnon, legislative director of Right to Life of Michigan. “Donald Trump said it many times on the campaign trail, that he is not interested in doing a national ban, and there is no pathway to a national ban.”
And there could be significant political risks to any policies that override voter-backed abortion policies at the state level, something Trump himself has seemed to acknowledge.
“I know that a lot of money and energy and effort was spent [by Democrats] trying to convince people that abortion was on the ballot,” Marnon said. “It just wasn't. It was about the economy.”
How restricting abortion pills could impact Michiganders
But even without a national ban, abortion rights opponents have laid out playbooks for how a Republican president could fundamentally alter abortion access nationwide. One of the most popular recent targets: medication abortion.
“Abortion pills pose the single greatest threat to unborn children in a post-Roe world,” said Roger Severino, Trump’s former director of the Office of Civil Rights at the United States Department of Health and Human Services (HHS), in a chapter of Project 2025 focused on revamping HHS.
More than half of all abortions performed in Michigan last year were medication abortions, meaning the patient took pills to end their pregnancy, as opposed to a procedure. Medication abortions account for more than 60% of abortions nationally.
Project 2025 calls for the FDA to “reverse its approval of chemical abortion drugs” entirely, or “at a bare minimum” impose significant restrictions on their use.
That would mean fewer abortion patients would be able to get care, Wallett said, because there just aren’t enough health centers and qualified providers to treat every patient through procedural abortions alone.
“It would require an enormous amount of resources and rebuilding of infrastructure. And that's for Michiganders, too,” Wallett said. “There isn't space to do all of those procedural abortions, if something changed immediately.”
Severino’s plan also calls for no longer allowing abortion pills to be mailed, and restoring an in-person dispensing requirement. That would mean Michigan patients would no longer be able to virtually meet with a doctor to get a prescription for medication abortion.
“There are other providers in many, many states who mail this medication to people, especially to people who don't have the resources to travel to a clinic,” Wallett said.
Severino references the Comstock Act as the legal basis for this ban. It’s an anti-obscenity law from 1873 that was once used to prosecute anything from an “intent to mail magazines that detailed birth control methods, to the mailing of condoms and medical textbooks with illustrations of human anatomy, and even the mailing of letters discussing dating among unmarried people,” according to KFF.
But the Comstock Act could be interpreted even more broadly to ban the mailing of any “article or thing designed, adapted, or intended for producing abortion,” according to abortion rights advocates.
While that would be almost impossible to enforce, even “threatening that type of enforcement could create a chilling effect for providers,” said Candace Gibson, director of state policy at the Guttmacher Institute, a progressive reproductive health policy organization.
“Because then they have to think through, as providers have done during this last couple of years, what are the legal risks they may face if this is something that moves forward.”
For now, though, abortion rights advocates, doctors and patients just have to live with uncertainty. Maybe everything will change — or maybe nothing will.
“The thing that we're trying to grapple with is, how far is the Trump administration going to go, in terms of access to sexual and reproductive health care?” Gibson said. “Because we know from the first administration that there was incredible damage done to access.”
