Trump's election could impact abortion rights in the US.

• This election, one of the main concerns that motivated voters was the issue of abortion.
• The comeback of President-elect Donald Trump may make abortion rights in the U.S. more vulnerable and uncertain, according to health policy experts, despite ballot measures protecting access in seven of the 10 states that had them.
• Trump and his appointed officials have the potential to limit access to abortion on a federal level without requiring Congress to pass new legislation.

This week, seven out of 10 states passed ballot measures to protect abortion rights, a contentious topic that motivated voters to cast their ballots.

The reproductive well-being of many women could be at risk if President-elect Donald Trump's victory leads to changes in access to the procedure, health policy experts warned.

Trump has wavered significantly on his stance regarding abortion, most recently stating that he would not endorse a federal ban and would prefer to leave the matter to the states. However, Trump and his appointed officials to federal agencies could potentially limit abortion on a federal level through strategies that do not necessitate Congress to enact new legislation.

As restrictions on abortion increase over the next four years, health outcomes will deteriorate, resulting in unnecessary suffering and death, according to Katie O'Connor, senior director of federal abortion policy at the National Women's Law Center.

Since the Supreme Court overturned Roe v. Wade in 2022, the U.S. has seen a significant shift in abortion access, with more than 25 million women living in states with stricter abortion restrictions. Trump has claimed credit for this change, as he reshaped the court.

A potential increase in abortion restrictions by the Trump administration could endanger the well-being of numerous patients, particularly those from disadvantaged backgrounds or minority groups.

If the government is not fully committed to providing abortion access to all who seek it, there will be chaos and confusion on the ground regarding what is legal and available, which will contribute to the ongoing health-care access crisis we're seeing with abortion.

According to a poll conducted in June by The Associated Press-NORC Center for Public Affairs Research, at least 70% of Americans oppose a federal ban on abortion or a ban on the procedure at six weeks. It is uncertain what actions Trump may take regarding this issue.

Experts predict that if Trump decides to restrict access, it may involve limiting the use of medication abortion, especially when it is provided through telehealth or by mail.

In the U.S., medication is the most common method for ending a pregnancy, accounting for 63% of all abortions last year, according to a March study by the Guttmacher Institute, which advocates for abortion access.

Trump's campaign did not immediately respond to a request for comment.

The decades-old Comstock Act

The Abortion Coalition for Telemedicine's co-founder and executive director, Julie Kay, stated that a Trump administration could potentially restrict or ban medication abortion by interpreting the Comstock Act, which has been inactive for many years.

Since its passage in 1873, it has been a federal crime to send or receive materials intended for abortions through the mail. Despite this, the law has not been strictly enforced for many years.

The Trump administration could utilize the act to hinder the transportation and distribution of abortion pills and any medical devices used in abortion procedures, thereby impeding physicians from performing abortions at hospitals, as stated by Kelly Dittmar, director of research at the Rutgers Center for American Women and Politics.

If Trump wants to enforce it, he must appoint an anti-abortion U.S. attorney general, who needs Senate confirmation.

The Comstock Act's provisions are outdated, according to the Biden administration. Trump stated in August that he had no plans to enforce the Comstock Act.

Anti-abortion advocates and people close to Trump, including his running mate, JD Vance, have urged against the use of the Comstock Act to restrict abortion pills. Some of Trump's former advisors, in the conservative policy blueprint Project 2025, also support this restriction. Additionally, every major anti-abortion organization in the country endorses this approach.

O'Connor pointed out that there would likely be legal opposition to any attempt to enforce it.

The Comstock Act could potentially be used to ban abortion, and it has been suggested by Supreme Court justices, including Samuel Alito and Clarence Thomas, who have invoked it during oral arguments in a medication abortion case.

Appointing anti-abortion actors to key agency roles

Trump has the power to appoint anti-abortion leaders to control key federal agencies, which could limit or ban the procedure in the U.S. This includes the Department of Health and Human Services, the Food and Drug Administration, and the Department of Justice.

According to Kelly Baden, vice president for policy at the Guttmacher Institute, the agencies have played a crucial role in making clear or safeguarding as much as possible in the post-Dobbs world regarding abortion rights, following the Supreme Court's decision in Dobbs v. Jackson Women's Health Organization, which overturned Roe v. Wade.

The FDA could face restrictions or elimination of access to mifepristone, one of the drugs used in a common medication abortion regimen, if Trump and his political appointees were to direct the agency.

In 2023, anti-abortion physicians clashed with the FDA in a legal battle over the agency's longstanding approval of mifepristone. However, in June, the Supreme Court rejected their challenge and upheld the Biden administration's decision, allowing the medication to remain widely available.

Trump's FDA appointees may attempt to reverse certain changes made from 2016 to 2021 that broadened access to mifepristone. This could involve reinstating regulations that would necessitate mifepristone to be dispensed in person, which would effectively eliminate telehealth access to the pill.

Nearly 1 in 5 abortion bills were accessed through telehealth in the last months of 2023, according to a May research project by the Society of Family Planning.

The restriction of telehealth as an option would have a "chilling effect" on abortion access, according to Alina Salganicoff, senior vice president and director of Women's Health Policy at KFF, a health policy research organization.

Abortion being banned in certain states may result in more people traveling for care, longer delays, and a higher likelihood of being denied the procedure due to difficulties in obtaining it in person, as stated.

Experts warned that any attempt by new FDA leaders to rescind mifepristone's approval altogether would disregard significant scientific research demonstrating its safe and effective use in the U.S.

In August, Trump hinted at the possibility of directing the FDA to revoke access to mifepristone. However, Vance later tried to clarify that he did not intend to take such action.

Trump's recent comments regarding mifepristone access seem to contradict his statement in June, where he declared during a CNN debate that he would not obstruct access to the drug.

Reviving old rules, gutting Biden's

Trump could potentially reverse some of the policies that made abortions more accessible during his first term and undermine some of the initiatives taken by the Biden administration to increase access.

The Biden administration reversed a domestic gag rule implemented by Trump in 2019, but Trump could potentially reinstate it.

The Title X family program, which has been in existence for many years and offers family planning and preventive health services to patients, particularly those from low-income backgrounds, is prohibited from referring patients for abortion care or providing counseling that includes information about abortion.

Guttmacher's Baden stated that the rule "decimated" Title X's network of family planning clinics, limiting their ability to serve low-income patients. She added that these clinics are "still recovering from that."

Baden stated that he saw no reason to believe that he wouldn't reinstate that rule within the first 100 days.

Biden's efforts to protect and expand access to reproductive health services could be quickly nullified by a Trump administration, according to Baden.