Erasure by Design: How HHS Restructuring Threatens Reproductive Justice

How dismantling care and civil rights infrastructure destroys reproductive justice at its roots.

By the Center for Racial and Disability Justice

The Trump administration’s proposed restructuring of the Department of Health and Human Services (HHS) is not a neutral act of bureaucratic efficiency. It is a direct assault on the reproductive freedom, health, and survival of disabled people who are pregnant or giving birth. Further, it will disproportionately impact those who are Black, Indigenous, and People of Color (BIPOC). Under the guise of government reform, this plan eliminates critical infrastructure that supports maternal health, disability rights, racial equity, and community-based care. It is a coordinated campaign of reproductive and disability oppression.

A Reproductive Justice Framework

Reproductive justice, as defined by scholars and activists of color, is the right to have children, not have children, and to parent children in safe and sustainable communities. It expands beyond the narrow legal framing of “choice” and centers the lived realities of those most impacted by systemic oppression. For BIPOC disabled birthing people, reproductive justice means access to culturally competent care, protection from coercive medical practices, the right to community living, and freedom from criminalization and surveillance.

This framework also recognizes that privacy-based legal protections, like those used to justify abortion rights, are insufficient for communities that depend on public support systems. BIPOC disabled birthing people are disproportionately reliant on programs like Medicaid, community clinics, and HCBS (home and community-based services), which are being dismantled in the HHS restructuring.

What the HHS Restructuring Does

The leaked reorganization plan proposes the elimination or defunding of:

• Healthy Start, family planning, autism and developmental disorder programs, and newborn screening, which are essential for early intervention and culturally responsive maternal and infant care.
• Infant and early childhood mental health services, trauma-informed care programs, and substance use treatment for pregnant and postpartum people, all of which support the emotional and psychological wellbeing of disabled and marginalized parents.
• Community services like Head Start, refugee and immigrant support, and rural health initiatives, which provide economic and social infrastructure for disabled parents of color.
• The Office for Civil Rights, which enforces anti-discrimination laws in healthcare, including Section 504 of the Rehabilitation Act and the Americans with Disabilities Act.
• The National Institute on Minority Health and Health Disparities, which supports research on racial and disability health inequities.
• The entire Administration for Community Living (ACL), which houses programs critical to community living, personal assistance, and parenting support for disabled people.

The restructuring also slashes funding for voting access for disabled people, adult protective services, elder justice initiatives, personal care assistant training, medical-legal partnerships, and culturally competent education for medical professionals.

Community Impact

These changes would be devastating for those at the intersections of race, disability, gender, and class:

Loss of Critical Perinatal & Maternal Health Supports

Programs like Healthy Start and family planning clinics provide vital care for disabled people of color during pregnancy and childbirth. Eliminating these programs increases the risk of maternal mortality and reduces access to reproductive health services, especially in rural and underserved areas. For example, Black disabled women already face a three- to four-times higher maternal mortality rate than their white counterparts. These cuts will only deepen those disparities.

Increased Criminalization & Family Separation

Cuts to mental health and substance use services remove non-punitive care options for parents experiencing crisis, trauma, or addiction. Without support, disabled birthing people are more likely to be criminalized, institutionalized, or have their children removed by the state; especially those who are BIPOC. The elimination of the minority fellowship program and peer-support services also means fewer providers with shared lived experience will be available to support healing and family preservation.

Dismantling of Legal Protections & Oversight

Removing the Office for Civil Rights and eliminating National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and other ACL programs strips disabled people of enforcement mechanisms to challenge discrimination in hospitals, clinics, and child welfare systems. It erodes the ability to parent safely and with dignity. It also makes it more difficult to track data on reproductive and disability-related discrimination — undermining accountability efforts across the board.

Erasure of Community-Based & Culturally Grounded Solutions

ACL and minority-serving institutions fund peer-led programs, research, and training that center the voices of disabled BIPOC communities. Eliminating these programs silences critical knowledge and further disconnects care from the communities it’s meant to serve. This includes research into systemic racism in obstetric care, culturally relevant and accessible midwifery models, as well as community doula training initiatives that specifically serve disabled and BIPOC birthing people.

Destruction of Community Living Infrastructure

By eliminating ACL, the administration guts support systems for parenting while disabled. This includes personal care services, housing advocacy, parenting classes, and peer mentoring. It increases reliance on institutional settings and state custody systems, especially for those already marginalized. It also directly undermines the Olmstead decision, which affirms the right of disabled people to live in the community with appropriate services and supports.

A Eugenic Logic

This is not austerity. It is ideological. The targeted elimination of services that support disabled and BIPOC people in making autonomous reproductive decisions reflects a eugenic logic — one that deems some lives more worthy of reproduction and parenting than others. By destroying the conditions for reproductive justice, this plan perpetuates cycles of violence, poverty, and state control. It is a modern-day manifestation of the same logic that upheld forced sterilizations, family separation, and institutional warehousing in the name of “public health.”

This is not bureaucratic streamlining. It is structural violence.

By decimating reproductive, disability, and civil rights infrastructure simultaneously, the Trump administration is orchestrating a wholesale abandonment of BIPOC disabled birthing people. This crisis demands an immediate response from disability rights, reproductive justice, and racial justice movements working in coalition.

We must name this for what it is: a coordinated campaign of reproductive and disability injustice, grounded in white supremacy, ableism, and patriarchy. And we must fight it with the same intersectional vision that built our movements in the first place.

We Must Respond

The disability, reproductive justice, and racial justice communities must act in coalition. We must:

• Demand reinstatement and protection of ACL, civil rights enforcement, and maternal health infrastructure.
• Defend the integrity of community-based services and reject institutional replacements.
• Invest in culturally responsive, peer-led, and disability-centered maternal health initiatives.
• Fight for a vision of care rooted in community, consent, and cultural responsiveness.
• Reject policies that treat disabled birthing people of color as disposable.

We are not collateral damage. We are the frontline. The future of reproductive justice depends on defending the right of all people — especially those most marginalized — to survive, thrive, and build families with dignity.

The Northwestern Pritzker Law Center for Racial and Disability Justice (CRDJ) is a first-of-its-kind center dedicated to promoting justice for people of color, people with disabilities, and individuals at the intersection of race and disability.

Learn more about CRDJ by visiting the Center for Racial and Disability Justice webpage.