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For the past couple of months, Donald Trump has been working hard to prove that, as he said during his debate with Vice President Kamala Harris, he is “a leader on IVF, which is fertilization.” And despite the jokes that ensued about Trump’s follow-up claim—“I have been a leader on fertilization”—Trump really has been trying. In August, he pledged to make IVF free to all Americans by requiring insurance companies or the federal government to cover it.
Trump’s debate statement puts him at odds with most of his party on IVF. Only two Republicans—Susan Collins and Lisa Murkowski—voted in favor of the Right to IVF Act, which came before the Senate for the second time this week and included provisions similar to Trump’s promise, requiring employer-sponsored insurance and certain public plans to cover the treatment. The former president’s emphatic interest in IVF also marks a striking pivot for a campaign that has remained mostly muted on reproductive health care, including on the issue of abortion rights. And his focus offers a window into his political calculus as he attempts to retake the presidency. If his party won’t budge on abortion, IVF allows him to signal to swing voters—particularly women—that his populist instincts are still in play.
Infertility is an issue that resonates with a large and growing number of American families, and the treatment has high and consistent support across partisan and demographic groups. One out of every 40 babies born in the U.S. in 2022 was conceived through IVF, compared with about one out of 65 a decade earlier. As awareness and use of fertility treatments rise, demand has begun to far outstrip supply. Roughly one out of every eight Americans experiences some form of infertility, and many LGBTQ couples and single people also turn to IVF to become pregnant. Yet few poor and rural areas in the U.S. have fertility clinics; in fact, 80 percent are in New York City. Even in areas where treatment is available, it can be prohibitively expensive. IVF costs an estimated $15,000 to more than $30,000 per cycle, and the average patient needs 2.5 cycles to become pregnant.
Trump’s campaign has provided few specifics on his IVF plan; his vice-presidential candidate, J. D. Vance, told NPR that “details get worked out in the legislative process.” But legislators in their own party don’t seem keen to make it happen: Several prominent Republican lawmakers expressed opposition to (or at least confusion about) Trump’s proposal, and even some of Trump’s most loyal congressional allies have stopped short of endorsing government-mandated coverage for the procedure.
However half-baked Trump’s free-IVF plan may be, his embrace of fertility rights stands in contrast with his more distant approach to abortion. Since 2022, when the Supreme Court’s Dobbs ruling paved the way for tighter abortion restrictions in 22 states and counting, Trump has faced intense backlash from women’s-rights advocates and health-care groups. In response, he has wavered on supporting a national abortion ban. In March, he voiced support for federal restrictions on the procedure, but during the recent presidential debate, he argued that abortion access should be left to the states. At the same time, he deflected questions about whether he would veto a ban if it came across his desk. But voters haven’t forgotten that “his fingerprints are stuck all over the Roe v. Wade reversal,” Susan Crockin, an adjunct professor specializing in reproductive-technology law at Georgetown Law, told me. Abortion will likely remain a losing issue for his campaign, she said: This spring, about two years after Dobbs, nearly two-thirds of Americans polled by Pew said abortion should be legal in all or most cases.
With IVF, unlike abortion, Trump is taking a clear stance that contradicts core conservative principles. Leaving abortion to the states at least aligns with the traditional Republican position to limit the federal government’s involvement in health care: Senator Mitt Romney similarly highlighted the importance of states’ rights in abortion during his 2012 campaign for the presidency. Trump’s free-IVF pitch flouts those principles, as well as the push among some conservatives to restrict IVF on moral grounds. To many anti-abortion and abortion-rights advocates alike, Trump’s proposal most resembles the Affordable Care Act mandate for employers to cover birth control and emergency contraception, a policy that Trump’s 2016 campaign derided. “This IVF plan is pure populism. It shows he’s not someone with a conservative worldview,” says Cole Muzio, the president of Frontline Policy Action, a conservative Christian group that has lobbied for anti-abortion measures in Georgia. (The Trump campaign did not respond to a request for comment.)
Whereas Trump’s evasiveness on abortion comes across as an attempt to please moderates and conservatives alike, his IVF stance strongly suggests which voters he’s most desperate to court. This year, the Trump campaign has been pointedly targeting white and suburban women, a crucial voting bloc in his previous presidential bids. College-educated white women, in particular, exhibit strong support for Kamala Harris, and they are also more likely to use fertility services than Black and Hispanic women or those without a bachelor’s degree. Although Trump’s promises are unlikely to sway staunch supporters of abortion rights, they might win back some swing-state voters who feel lukewarm about abortion and firmly support fertility care. Some early signs suggest that this strategy could pay off: In a September poll in Michigan, the battleground state where Trump announced his free-IVF plan, 29 percent of independent voters said they were more likely to support his 2024 campaign because of it.
This advantage might come at the expense of a different, but still key, Trump voting bloc: strong opponents of abortion. Although IVF access has broad support from Christian and self-identified pro-life voters, the former president’s recent statements have angered some anti-abortion advocates, who argue that life begins at conception and that discarding embryos during IVF is therefore akin to murder. His promises could dampen enthusiasm somewhat among white evangelicals, from whom Trump is projected to need overwhelming support in order to win the election. But Trump seems to have decided that he can afford to offend these Americans without losing their votes. As Peter Wehner argued in The Atlantic last month, many anti-abortion voters will likely continue to support Trump, even if begrudgingly. Muzio agreed. “This will be the difference between quietly going into the ballot box and casting your vote for him versus going to Sunday-school class and encouraging your friends to do the same thing,” he told me.
Although Harris has linked IVF and abortion access as part of a unified reproductive-rights platform, Trump has attempted to separate the two. He frames his free-IVF plan as its own pro-family issue, even tying it to a proposal for child tax credits. What remains unclear is whether this distinction is meaningful to voters. Last December, less than 1 percent of registered voters ranked abortion as the most pressing problem facing the country. But in an August poll of voters in three key swing states, a plurality of women said it was the single most important issue determining their vote for the presidency. In September, 14 percent of all voters said abortion was their No. 1 issue. Sidestepping it in favor of IVF is a gamble—one whose payout could well determine who moves into the White House next year.
