WASHINGTON (AP) — Abortion opponents say there is still much work to be done to further restrict access to abortion when Republican Donald Trump returns to the White House next year.
They point to federal guidelines issued by Democratic President Joe Biden’s administration on emergency abortions, which require hospitals to provide them to women whose health or lives are at risk, and the easing of prescription restrictions on abortion pills that have allowed women to do so to order these medications online at the touch of a button.
“Now the work begins to dismantle the Biden-Harris administration’s pro-abortion policies,” the powerful anti-abortion lobby Susan B. Anthony List said in a statement Wednesday. “President Trump’s pro-life achievements in his first term are the foundation for his second term.”
The group declined to release details about what it specifically plans to undo. But abortion rights advocates are preparing for more abortion restrictions once Trump takes office. And some women are affected too, because online orders for abortion pills escalate sharply in the days after Election Day.
Trump said abortion is an issue for the states, not the federal government. Nevertheless, he made clear during the campaign that he appointed Supreme Court justices who were in the majority in striking down the nation’s right to abortion. And there are things his administration can do, from selecting judges to issuing regulations to promoting an anti-abortion agenda.
Trump is unlikely to mandate emergency abortions in hospitals
The Trump administration is expected to withdraw Biden’s controversial directive requiring emergency rooms to perform abortions if necessary to stabilize a woman’s health or life. The Biden administration had argued that the decades-old federal law requiring hospitals to offer stabilizing treatment to patients in return for Medicare funding also applies in cases where an abortion might be necessary.
Since the Supreme Court struck down the country’s right to abortion in 2022, there have been increasing reports of women in threatening situations being sent home or left untreated by hospitals. In some cases, hospitals said state abortion bans prevented them from terminating a pregnancy.
“We’re seeing pregnant people’s lives being put at risk,” Fatima Goss Graves, president and CEO of the National Women’s Law Center, said Wednesday. “We see women who have become infertile and have sepsis,” and we are now hearing reports of death.
Even if a Trump administration abandons the law’s guidance, Goss Graves said, advocacy groups like hers will continue the legal battle for the Biden administration’s interpretation of the law.
Some doctors and hospitals have also said federal guidelines give them protection when performing emergency abortions in states like Idaho and Texas, where the risk of prosecution for performing an abortion depends on their decision-making.
Trump has said he supports exceptions for cases of rape and incest, as well as when a woman’s life is in danger. But he hasn’t gone so far as to say he supports exceptions when a woman’s health is at stake.
In sporadic but grave cases, abortions may be necessary to prevent organ loss, severe bleeding, or threatening infections for pregnant women. In cases such as ectopic pregnancy, premature rupture of membranes, and placental abruption, a fetus may still be alive, but continuing the pregnancy may be harmful. Doctors have argued that the legal gray area has left them in a bind.
In Idaho, for example, a hospital resorted to air transporting women out of the state after a strict abortion ban was enacted that only allowed abortions to prevent a woman’s death.
The Biden administration sued Idaho, saying the state law conflicts with federal law that requires hospitals to provide patients with stabilizing treatment, which can include abortions. The state has changed its law to allow abortions for ectopic pregnancies, but it still leaves out other threatening scenarios. The Supreme Court declined to take up the matter earlier this year, issuing a restricted order clearing the way for hospitals to perform emergency abortions while the case was heard by lower courts.
However, enforcement of the federal law is on hold in Texas, which has thrown the Biden administration’s policies on emergency abortions into question.
Under the Trump administration, a patchwork of state abortion laws will remain in effect. Voters in Florida, Nebraska and South Dakota rejected constitutional amendments on Tuesday and left the bans in place.
However, in Missouri on Tuesday, voters approved a ballot measure to repeal one of the strictest bans in the country. Abortion law changes also passed in Arizona, Colorado, Maryland and Montana. Nevada voters also approved an amendment but must pass it again in 2026 for it to take effect.
Problems with access to abortion pills will continue under Trump
The ease with which women could obtain abortion pills could also be reconsidered under Trump.
During the COVID-19 pandemic, the Food and Drug Administration made it easier to obtain abortion pills, including mifepristone, and allowed women to access the drugs via telemedicine. The agency has confirmed the drug’s safety up to 10 weeks of pregnancy and said 0.32% of patients experience side effects.
Anti-abortion advocates have disputed this, arguing the drugs are not safe and sound and at least not suitable for simple access without personal supervision from a doctor.
Although the Supreme Court upheld access to the drug earlier this year, abortion opponents and conservative states have renewed their challenge in lower courts.
Some women are worried. Telehealth company Wisp saw an immediate 600% escalate in abortion pill orders between Election Day and the following day. In states like Florida and Texas, where the drug cannot be legally shipped, the company saw a nearly 1,000 percent escalate in orders for the morning-after pill, also known as emergency contraception.
The company fulfills about tens of thousands of orders a month for reproductive products, including birth control pills and abortion pills, CEO Monica Cepak told the Associated Press.
Today, women typically take a two-step course of mifepristone and misoprostol to complete a medical abortion. Cepak said the company will “keep a close eye” on mifepristone under a Trump administration and is prepared to switch to misoprostol-only therapy if a restriction on mifepristone is implemented.
But Trump could be a wild card in this matter, said Mary Ziegler, a law professor at the University of California at Davis and an expert on reproductive health issues. In the final months of the campaign, he moved away from a tougher stance on abortion — even saying he wouldn’t sign a statewide abortion ban if it came to his desk.
Although he enjoys mighty support from anti-abortion groups, he is willing to break with allies if he wants.
“I don’t think we have a clear idea of what he would do,” Ziegler said.
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Associated Press writer Lindsay Whitehurst contributed to this report.
