Anti-abortion advocates are pressing Trump for more restrictions as sales of abortion pills rise

WASHINGTON (AP) — Anti-abortion advocates say there is still work to be done to further restrict abortion access to abortion when Republican Donald Trump returns to the White House next year.

They point to the federal guidelines used by the Democratic party government President Joe Biden released around emergency abortionsrequiring hospitals to provide them to women whose health or life is at risk, and relaxing prescribing restrictions for abortion pills allowing women to order the medication online with the click of a button.

“Now the work begins to dismantle the Biden-Harris administration’s pro-abortion policies,” the Susan B. Anthony List, the powerful anti-abortion lobby, said in a statement on Wednesday. “President Trump’s pro-life achievements in his first term set the stage for his second term.”

The group declined to release details of what specifically they want to undo. But abortion rights advocates are bracing for further abortion restrictions once Trump comes to power. And for some women, there are also many women who order abortion pills online in the days after election day.

Trump has said abortion is a problem for the states, not the federal government. Yet he pointedly noted during the campaign that he had appointed Supreme Court justices who were in the majority in challenging the nation’s right to abortion. And there are things his administration can do, from electing judges to issuing regulations and advancing an anti-abortion agenda.

Trump is unlikely to demand emergency abortions in hospitals

The Trump administration is expected to rescind Biden’s controversial directive requiring emergency rooms to perform abortions when necessary to stabilize a woman’s health or life. The Biden administration had argued that the decades-old federal law, which requires hospitals to provide stabilizing treatments for patients in exchange for Medicare funding, also applies in cases where an abortion might be necessary.

There are reports of women being sent home or left untreated by hospitals in dangerous scenarios spread across the United States since the Supreme Court overturned the nation’s right to abortion in 2022. In some cases, hospitals said state abortion bans prevented them from terminating a pregnancy.

“We’re seeing the lives of pregnant people at risk,” Fatima Goss Graves, president and CEO of the National Women’s Law Center, said Wednesday. “We see women who have become infertile, who have had sepsis and we are now hearing reports of deaths.”

Even if a Trump administration were to abandon the law’s guidelines, Goss Graves said advocacy groups like hers will continue a legal fight for the Biden administration’s interpretation of the law.

Some doctors and hospitals have also said federal guidelines give them protection in performing emergency abortions in states such as Idaho and Texas, where the threat of prosecution for performing an abortion influences 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 exemptions when a woman’s health is at stake.

In rare but serious scenarios, abortions may be necessary to prevent organ loss, significant bleeding, or dangerous 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 gotten them into trouble.

In Idaho, for example, a hospital resorted to airlifting women out of the state after a strict abortion ban was passed, which only allowed abortions to prevent a woman’s death.

The Biden administration sued Idaho, arguing that the state law violated federal law requiring hospitals to provide stabilizing treatments, which could include abortions, for patients. The state changed its law to allow abortions for ectopic pregnancies, but other dangerous scenarios are still not taken into account. The Supreme Court declined to take up the issue earlier this year, issuing a limited injunction that cleared the way for hospitals to perform emergency abortions while the case worked its way through the lower courts.

However, enforcement of the federal law has been suspended in Texas, which questioned the Biden administration’s guidance on emergency abortions.

Under the Trump administration, a patchwork of state abortion laws will remain in place. Voters in Florida, Nebraska and South Dakota rejected constitutional amendments on Tuesday, leaving the ban in place.

In MissouriHowever, voters on Tuesday approved a ballot measure to overturn one of the nation’s strictest bans. Abortion rights amendments have also passed in Arizona, Colorado, Maryland and Montana. Nevada voters also approved an amendment, but they will have to approve it again in 2026 for it to take effect.

Challenges to access to abortion pills will continue under Trump

The ease with which women could obtain abortion pills could also be subject to reconsideration under Trump.

During the COVID-19 pandemic, the Food and Drug Administration made it easier to obtain abortion pills, including mifepristone, allowing women to access the medication through telehealth. The agency has approved the drug’s safety through 10 weeks of pregnancy, saying side effects occur in 0.32% of patients.

Anti-abortion advocates have disputed this, arguing that the drugs are not safe and, at the very least, are not suitable for easy access without personal supervision from a doctor.

Although the Supreme Court upheld access to the drug earlier this year, anti-abortion advocates and conservative states have renewed their challenge in lower courts.

Some women are concerned. Telehealth company Wisp saw an immediate spike in abortion pill orders between Election Day and the next day, with a 600% increase. In states like Florida and Texas, where the drug cannot be legally shipped, the company saw a nearly 1,000% increase in orders for so-called “morning after” pills, also known as emergency contraception.

The company fills about tens of thousands of orders every month for reproductive products, including birth control pills and abortion pills, CEO Monica Cepak told the Associated Press.

Currently, women typically follow a two-step regimen of mifepristone and misoprostol to complete a medication abortion. Cepak said the company will closely monitor mifepristone under the Trump administration and is prepared to switch to a misoprostol-only regimen if the restriction on mifepristone is implemented.

But Trump could be a wild card on the issue, says Mary Ziegler, a law professor at the University of California, Davis, an expert on reproductive health issues. In the final months of the campaign, he backed away from a more rigid position on abortion — even saying he wouldn’t sign a national abortion ban if it came across his desk.

Although he has strong support from anti-abortion groups, he is willing to break with allies when he wants to.

“I don’t think we have a clear idea from him about what he would do,” Ziegler said.

___

Associated Press writer Lindsay Whitehurst contributed to this report.