In the early days of his presidency, Donald Trump has set into motion a series of actions that impact both abortion and reproductive healthcare access, both at home and abroad. This has sparked worries among advocates for reproductive rights who fear more restrictive measures in the near future.

While Trump has openly expressed his anti-abortion views, he has been rather vague about the specifics of any policies during his campaign, particularly when asked about a potential nationwide abortion ban. Nevertheless, advocates for reproductive rights, medical professionals, lawmakers, and legal experts have predicted that his administration would take steps to limit access to abortion services and other reproductive health options.

Mary Ziegler, a law professor at UC Davis who specializes in abortion law, points out that many of Trump’s actions resonate with established Republican tactics. She observes that the political climate often changes with the party that holds the presidency. However, she also notes that Trump has ramped up some of these initiatives, such as the Justice Department’s recent decision to restrict prosecutions against anti-abortion protesters blocking access to clinics. While significant changes have already occurred, Ziegler indicates that “we’re still in a wait-and-see phase” concerning what might come next.

Nancy Northup, the president and CEO of the Center for Reproductive Rights, stresses that even though Trump has not immediately pushed Congress for a national abortion ban, it would be naive to think this reflects a lack of intent. She states, “This administration is shaping up to be the most anti-abortion in U.S. history, especially with no federal constitutional protections in place. The actions taken so far suggest a strong anti-abortion agenda.”

Here are some significant actions taken by the Trump administration affecting reproductive healthcare access.

What actions has the Trump Administration taken domestically?

In his first week, Trump granted pardons to several anti-abortion activists who had been convicted under the Freedom of Access to Clinic Entrances (FACE) Act, a law established in 1994 aimed at safeguarding abortion clinics by prohibiting obstruction and threats against individuals seeking medical care. The next day, a top official in Trump’s Justice Department sent out a memo indicating that prosecutions under the FACE Act would only occur under “extraordinary circumstances” or when there are “significant aggravating factors,” effectively signaling a reduction in such prosecutions.

During the Biden administration, the Justice Department actively pursued numerous cases against individuals accused of violating the FACE Act. While Ziegler anticipates a decline in enforcement under a Republican president, this new directive openly suggests that these cases will not be prioritized.

Read More: The Influence of Trump’s Appointees on Abortion Policies

Northup highlights that among those pardoned by Trump were six individuals convicted of obstructing access to a reproductive health facility in Michigan, which is represented by the Center for Reproductive Rights. She comments, “This sends a strong message to anti-abortion extremists that the Trump administration will turn a blind eye to the blockades, violence, and threats that women face when trying to access clinics, along with the daily obstacles clinic staff encounter.”

Furthermore, Trump signed an Executive Order in his first week to enforce the Hyde Amendment, which prohibits federal funding for abortions. This order rolled back two of Biden’s Executive Orders that aimed to broaden access to reproductive healthcare and acknowledged abortion as a healthcare service.

Northup claims that Trump has woven anti-abortion ideologies into various policies he has enacted within his first month. She points out an Executive Order declaring that the U.S. will only recognize “two sexes, male and female.” Northup argues that this order undermines access to gender-affirming care and introduces personhood language, implying that personhood begins at conception. “They are subtly embedding the concept of personhood from fertilization into all federal policies, rather than recognizing rights that start at birth,” she explains.

Advocates for reproductive rights assert that Trump and his administration have made their anti-abortion position abundantly clear. Shortly after his inauguration, the federal website reproductive rights.gov—which had been launched during the Biden administration to provide information on abortion and reproductive healthcare—was taken down. That same week, Vice President J.D. Vance spoke at the March for Life rally in Washington, D.C., praising Trump as “the most pro-life president in our history” and lauding his actions on abortion during his first term, attributing credit for the U.S. Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade. Although Trump did not attend the rally, he shared a pre-recorded message affirming his support for anti-abortion activists.

What international actions has the Administration taken?

Experts indicate that one of the most impactful measures taken by Trump in his first month regarding global reproductive healthcare access is the suspension of foreign aid. Historically, the U.S. government has been a major contributor, providing over 40% of humanitarian aid tracked by the United Nations and standing as the largest single donor globally. For the fiscal year 2024, Congress allocated $575 million for family planning and $32.5 million for the United Nations Population Fund, which focuses on sexual and reproductive health, as reported by the Guttmacher Institute, a respected organization for research and advocacy in this field. Elizabeth Sully, a principal research scientist at the Institute, notes that this level of funding has typically enjoyed bipartisan support and remained stable for nearly a decade. Due to the Helms Amendment, which prohibits foreign aid funds from being used for abortions, this financial assistance had not been directed toward abortion services.

According to a Guttmacher analysis, these funds facilitate contraceptive care for 47.6 million women and couples annually and help prevent 17.1 million unintended pregnancies, potentially saving around 34,000 women and girls from pregnancy-related complications that could lead to death without such care. “Family planning is a vital life-saving measure,” Sully emphasizes.

However, due to the freeze on aid, international family planning initiatives that depend on U.S. support have been forced to halt their operations. The Guttmacher Institute estimates that over 3 million women and girls have already been denied contraceptive services due to this suspension. By the end of the full 90-day review period, the Institute predicts that around 11.7 million women and girls will miss out on contraceptive care, resulting in 4.2 million unintended pregnancies and 8,340 deaths from complications related to pregnancy and childbirth. On February 13, a federal judge instructed the Trump administration to temporarily lift the freeze on foreign aid, yet the administration’s lawyers defended the suspension, arguing that the judge’s order does not stop the State Department from halting foreign assistance programs. The future of the judge’s ruling regarding the resumption of these programs remains uncertain.

“What’s particularly challenging is the unpredictability of the situation,” Sully comments. “You might arrive at a clinic you’ve previously visited for injections or contraceptive pills, only to find it closed or lacking necessary supplies, with no indication of when services might resume.”

Dr. Sierra Washington, director of Stony Brook’s Center for Global Health Equity and a member of the International Federation of Gynecology and Obstetrics’ Committee on Safe Abortion, works in Mozambique. She expresses significant concern about the implications of the aid freeze, particularly given the crucial role of the U.S. Agency for International Development (USAID) in providing healthcare. She worries that the freeze could lead to a rise in HIV cases, unsafe abortions, and increased maternal mortality rates.

“It won’t be long before we see serious shortages of condoms and contraceptives across the healthcare system, which will inevitably result in more women experiencing unsafe abortions and complications during childbirth,” Washington warns. “It’s a genuine tragedy.”

“I doubt that the officials in the Trump administration understand the interconnectedness of global health issues, such as how condoms prevent HIV transmission, which knows no borders,” she adds, cautioning that a rise in HIV could eventually “reach the U.S. and affect global health.”

In his first week, Trump also reinstated the Global Gag Rule, which prohibits foreign organizations receiving U.S. aid from providing, referring to, or discussing abortion services. This decision was anticipated by many reproductive health specialists, as Republican presidents typically uphold it while Democratic leaders reverse it. During his first term, Trump expanded the policy to apply to all global health funding, not just those related to family planning, leading to “far-reaching impacts” beyond abortion care. The Guttmacher Institute reported that, in specific areas of Ethiopia and Uganda, the previously observed growth in contraceptive use halted or even regressed after the implementation of the Global Gag Rule during Trump’s first term.

“While the policy’s primary goal is to limit abortion, declines in family planning often result in more unintended pregnancies and, consequently, an increase in abortions,” Sully explains.

The Trump administration also announced that the U.S. would rejoin the Geneva Consensus Declaration, a non-binding agreement advocating for anti-abortion policies, which the U.S. had backed towards the end of Trump’s first term. This declaration has received support from over 30 nations, including Uganda and Hungary. Biden withdrew the U.S. from the declaration upon taking office.

What might be on the horizon for Trump?

Most experts interviewed by TIME anticipate that the Trump administration will continue to implement measures to restrict abortion and reproductive healthcare access.

One immediate concern that experts are closely monitoring is the administration’s position on mifepristone, a medication that has been FDA-approved for abortion for over two decades and is currently facing legal challenges from anti-abortion organizations. During his confirmation hearings as Secretary of Health and Human Services, Robert F. Kennedy Jr. provided vague responses regarding mifepristone, mentioning that the President had asked him to “study the safety” of the drug but had not taken a firm stance on its regulation.

Ziegler notes that whether the Trump administration will revoke the FDA’s approval of mifepristone entirely or reverse Biden-era policies that made it more accessible, such as allowing prescriptions through telehealth and mail, remains uncertain. Either decision would have a profound effect on abortion access nationwide; Northup emphasizes that the option to obtain medication abortions via telehealth and mail has been a “lifeline” for many patients since the Dobbs ruling.

Read More: How the Biden Administration Safeguarded Access to the Abortion Pill—and What Trump Might Do

Experts are also keenly observing whether the Department of Justice will invoke the Comstock Act, a 19th-century law that bans the mailing of abortion-related medications. Looking ahead, Ziegler suggests that Trump is likely to continue appointing conservative judges, as he did in his first term, who will have a considerable influence on abortion legislation, especially as numerous state-level restrictions are subjected to judicial review. Although the process of appointing judges and securing their confirmations takes time, the long-term implications could be significant.

“These judges will make critical decisions that will shape access to abortion, contraception, and various reproductive health services,” Ziegler asserts. “As the courts evolve, we may witness increasingly extreme outcomes concerning reproductive issues.”

While some had anticipated that the Trump administration would rapidly implement even more drastic measures regarding abortion following the President’s inauguration, Ziegler suggests that part of the delay may be due to Trump’s desire to cater to both his anti-abortion base and the majority of Americans who support abortion rights. Sully adds that, although Trump took office quickly, many key department leaders responsible for overseeing abortion-related policy changes, including those related to mifepristone and the Comstock Act, are still awaiting confirmation.

Read More: Why Abortion Rights Succeeded in Three States That Voted for Trump

Advocates urge that vigilance is crucial for upcoming developments. Northup emphasizes that Roe served as a protective measure during Trump’s first presidency, imposing limitations on the actions his administration could take regarding abortion. With Roe now overturned, the constitutional safeguards that previously restricted his authority are no longer in effect, she warns.

“Anyone concerned about access to abortion services—an overwhelming majority of people in the U.S.—should be on high alert for what this administration may try to do to limit access in states where abortion remains legal,” Northup concludes.