Donald Trump spoke at the March for Life rally in January 2019 during his first term as president. (Mark Wilson | Getty Images)

The 2024 election results created complicated new realities for reproductive rights in the U.S., with Americans even in a few red states overwhelmingly voting to protect the right to have an abortion while also overwhelmingly electing anti-abortion representatives in state houses, courts, Congress and the White House.

With a Republican trifecta coming to the nation’s capital in January, anti-abortion activist groups are planning for the first potentially friendly presidential administration since the 2022 Dobbs v. Jackson Women’s Health Organization decision overturned Roe v. Wade and eliminated a 50-year federal right to terminate a pregnancy. They aim to end other federal and state protections while vastly expanding restrictions on reproductive health care.

Though many anti-abortion leaders are skeptical of President-elect Donald Trump’s commitment to their cause, they say they are willing to compromise to maintain influence in his administration. Some groups are strategizing how to end-run Trump’s campaign pledge not to enact any federal abortion bans — by heavily restricting medication abortion or trying to ban a common abortion procedure.

“I don’t think we have a champion here for pro-life causes,” said longtime anti-abortion organizer Rev. Patrick Mahoney. “What we have here is someone who will not work against us and try to crush us. We will not see pro-choice federal judges.”

The director of the Christian Defense Coalition and the chief strategy officer of Stanton Public Policy Center told States Newsroom that he is not a supporter of Trump and disagrees with his rhetoric on immigrants. But Mahoney said he is happy Democratic presidential nominee Kamala Harris lost. The vice president had vowed to try to restore federal abortion rights and throughout her career has advocated for reproductive rights. As California attorney general, she prosecuted anti-abortion activists charged with illegally recording abortion providers about a decade ago.

“We can have an opportunity now to begin the second phase after Roe was overturned,” Mahoney said. “We knew overturning Roe was only a starting line, not a finishing line.”

Live Action president Lila Rose was one of the few prominent anti-abortion leaders who called out Trump before the election, after he criticized Florida’s six-week abortion ban and vowed to veto a federal ban. In late August, Rose told Politico she would write in a presidential candidate and would encourage her millions of followers to do the same if Trump did not change course. On her podcast, the millennial activist recently revealed that she met with Trump and asked him to say he would vote against Florida’s abortion-rights amendment, which he did. Days before the election, Rose endorsed Trump on X.

Live Action did not respond to an interview request.

Nationally, three out of 10 abortion-rights measures failed: Florida’s proposed amendment had the highest threshold to clear, but got 57% out of the required 60% of the vote. It would have reversed the ban that reproductive rights advocates say has decimated abortion access in the Southeast.

Another anti-abortion leader willing to compromise with the incoming president and Congress is Steven Aden, general counsel at Americans United for Life, the policy shop behind many state and federal abortion restrictions. Aden said he was disappointed the Republican Party removed from its platform a previous commitment to a federal ban.

However, he said his group was still able to inject critical language into the current platform that effectively supports states establishing fetal personhood through the U.S. Constitution’s 14th Amendment, which grants equal protection under the law. The platform also says Republicans “will oppose Late Term Abortion,” a political term used to refer to abortions in the second and third trimesters, the rarest but most restricted types of abortions in the U.S.

“We had direct input into the Trump campaign and framing the pro-life language in the party platform,” Aden told States Newsroom. “The platform language was much pared down, but we believe that the pro-life language preserves the essence of the party’s position on the pro-life issue, and we’re proud of that, and look forward to continuing to work with the incoming Trump administration.”

Federal reproductive rights protections in question

Early into his term, Democratic President Joe Biden began reversing blocks on federal funding domestically and globally for reproductive health organizations that also provide or refer for abortions. Leading up to and following the Dobbs decision, the Biden administration loosened restrictions to the medication abortion regimen, a combination of mifepristone and misoprostol, which has become the most common way of terminating pregnancy in the U.S. during the first trimester. The U.S. Food and Drug Administration allowed abortion medication to be obtained via telemedicine and dispensed directly at pharmacies.

Nearly half the country has partially or fully banned abortions. But abortion numbers have risen since before Dobbs, researchers have reported, attributing the increase in part to expanded access to telemedicine abortion and to more people using online abortion clinics that mail abortion drugs from states with so-called shield laws to those with bans.

Anti-abortion groups Susan B. Anthony Pro-Life America and Students for Life of America recently unveiled memos asking the Trump administration to pull regulatory levers that especially target abortion drugs.

Under the U.S. Department of Health and Human Services, regulations could include:

• The FDA reinstating medication abortion restrictions, such as requiring multiple in-person appointments and revoking telemedicine. Or altogether revoking the 2000 approval of mifepristone.

• Reversing guidelines that under the federal Emergency Medical Treatment and Labor Act, emergency departments at hospitals enrolled in Medicare — even in states with abortion bans — must offer pregnant patients the medical treatment necessary to stabilize an “emergency medical condition.” This law is the subject of an ongoing lawsuit deferred by the U.S. Supreme Court earlier this year. In sharp contrast to the mainstream medical community, anti-abortion advocates argue these guidelines are unnecessary and would allow doctors to broadly interpret a health emergency to mean anything.

When asked about stories of alleged denied care, maternal deaths, and doctor confusion related to state abortion bans, Aden chalked up the problem to a misinterpretation of state laws, which he said should be clarified to address these problems, while noting several times, “I’m not a doctor.” Americans United for Life’s recommended health-exception language in part says abortion should be allowed “to preserve the life of a pregnant woman or to address a serious risk of substantial and irreversible impairment of a major bodily function.”

“That’s a health exception with teeth,” Aden said. “It doesn’t allow for a free-ranging, quote unquote, ‘mental health’ exception that would swallow the rule.”

• Funding a study on the potential health effects of abortion pills in the water system from patients miscarrying in their toilets after taking medication abortion drugs. Anti-abortion leaders like Mahoney said they were disappointed with Trump’s pick for HHS secretary, Robert F. Kennedy Jr., who has previously said he supports abortion rights. But Mahoney said he’s hoping to appeal to Kennedy’s skepticism of FDA drug approvals. “How do chemical abortions being flushed down the drain affect our water supply? We’re definitely going to push hard on that,” Mahoney said.

• Revoking a rule requiring health clinics that receive federal family planning Title X grants to offer referrals for abortion clinics, which is also the subject of an ongoing federal lawsuit. It is already prohibited to use federal funds for abortions unless the pregnancy is the result of rape or incest, or has become fatal. Activists also want to defund Planned Parenthood, the largest reproductive health center network, and extend tax credits to anti-abortion pregnancy centers.

Trump’s pick to lead the Centers for Medicare and Medicaid Services, which manages the country’s largest health programs, is Dr. Mehmet Oz, who opposes abortion.

The U.S. Department of Justice could:

• Enforce part of the 19th century Comstock Act to prohibit the mailing of abortion-inducing drugs. Aden said enforcing this law would likely mean cracking down on online abortion clinics like Aid Access.

• Revoke or refuse to enforce the federal Freedom of Access to Clinic Entrances Act,  enacted because of the sometimes-violent anti-abortion protests of the 1980s and 1990s. One of several activists sentenced to prison for staging a clinic blockade in Washington, D.C., Lauren Handy was also involved in obtaining aborted fetuses outside the same clinic. Trump had indicated he would potentially pardon Handy and fellow blockaders. Activists have said they will also ask the DOJ to investigate the doctor at the abortion clinic from where Handy obtained the fetuses, of whom she and other activists have accused, without evidence, of infanticide.

The U.S. Departments of Defense and Veterans Affairs could:

• Revoke policies that expanded abortion access for veterans and members of the Military.

The U.S. Agency for International Development could:

• Reinstate the so-called Mexico City Policy, which barred federally funding international organizations that provide or refer for abortions.

As they brace for the potential impact of Dobbs without a federal safety net, reproductive justice activists are working to expand access and fight anti-abortion laws, while also protecting new state wins. The election results did not change the fact that most people want abortion access, said Fatima Goss Graves, president and CEO of the National Women’s Law Center, during a recent media press briefing organized by the progressive Robert Wood Johnson Foundation.

“Donald Trump won the election, but so did abortion, and people need to hold this incoming administration to its word that it would not restrict abortion,” Graves said. “We have to square the idea that millions of people in the United States voted for reproductive freedom … but they also will be experiencing a situation that will become even more dire, and that people will feel scared and hopeless in this period.”

Arguments for a national abortion ban

Aden said AUL would support a federal “dismemberment” bill, referring to a proposed ban on a common second-trimester abortion procedure known as dilation and evacuation, or D&E. This procedure involves dilating the cervix and removing the contents of the uterus, typically performed beginning around 12 weeks. It would be a way to effectively get a 12- or 15-week ban without calling it that.

Despite its safety and efficacy record, the D&E procedure has been banned in several states, over the objection of the American Medical Association and the American College of Obstetricians and Gynecologists. It’s part of an old anti-abortion playbook, which under Republican President George W. Bush resulted in a federal ban on another later abortion procedure — dilation and extraction, or D&X — by reframing it as “partial-birth” abortion, which the U.S. Supreme Court upheld in 2007’s Gonzales v. Carhart decision.

Abortion foes describe D&Es as a gruesome procedure, or as Aden puts it, “tearing 13-week-old humans apart limb from limb.” Anti-abortion doctors recommend more risky and invasive procedures like C-sections, even when the abortion is medically indicated.

If D&Es are banned, there would be fewer options for later abortions, which are sometimes necessary, said reproductive-health legal expert Rachel Rebouché, dean of Temple University School of Law in Philadelphia. She noted that some of the U.S. Supreme Court justices have indicated support for abortion restrictions for reasons of preserving fetal dignity rather than preserving maternal health.

“That litigation, from the anti-abortion perspective, depends on saying the fetus is a person with rights that attach at a certain point, if not from conception,” Rebouché told States Newsroom. “Dobbs opens the door wide open for those kinds of regulations. … But the question is, is there a role for the federal government to enact a nationwide ban that would curtail the rights of states that have not gone the way of Idaho or Texas or others?”

Aden said that for now AUL will be more focused on the incremental approach to abortion restrictions, as well as calling for expanded child and prenatal tax credits and other social supports. The attorney, who was 11 when Roe was decided in 1973, is expecting another half-century of litigation over abortion with the hopes that one day the U.S. Constitution gives personhood rights to the unborn, regardless of the stage of that pregnancy. Aden said a so-called Human Life Amendment is likely impossible in the near term, needing approval from two-thirds of both houses of Congress. He said U.S. culture is not there yet.

“It would require a cultural sea change in the way that the majority of Americans view human life in the womb,” Aden said. “That’s our second generational goal. Having won our first generational goal of overturning Roe, we’d love to see the day when every life is welcomed and protected in law. And if that’s through a constitutional amendment, then we’re here for that.”

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Beyoncé takes part in a campaign rally focused on reproductive rights with the Democratic presidential candidate, U.S. Vice President Kamala Harris, at Shell Energy Stadium on Oct. 25, 2024 in Houston, Texas. (Photo by Justin Sullivan/Getty Images)

Democratic presidential nominee Kamala Harris appeared alongside superstar performer Beyoncé on Friday night to encourage voter turnout and reinforce the differences between the two parties on reproductive rights, with just days to go before voting ends.

The rally at Shell Energy Stadium in Houston, Texas, followed months of speculation about whether Beyoncé would support Vice President Harris publicly ahead of the Nov. 5 presidential election. The two-hour event featured other celebrities, including Willie Nelson and Jessica Alba, as well as women detailing being denied medical care for pregnancy complications in Texas after its abortion ban went into effect.

Beyoncé, who has won more than 30 Grammy Awards as well as hundreds of others throughout her career, said casting a vote is “one of the most valuable tools” that Americans have to decide the future of the country.

“We are at the precipice of an incredible shift, the brink of history,” Beyoncé said, adding that she wasn’t speaking at the rally as a celebrity or a politician.

“I’m here as a mother,” she said. “A mother who cares deeply about the world my children and all of our children live in. A world where we have the freedom to control our bodies.”

‘Horrific reality’

Harris, who is locked in an extremely close race with Republican presidential candidate Donald Trump, said abortion bans and restrictions implemented during the last two years have been “devastating.”

“We see the horrific reality that women and families face every single day,” Harris said. “The stories are vivid, they are difficult to hear, they are difficult to tell.”

Harris said there are also many stories that women and their families won’t discuss in public about challenges they’ve faced with access to medical care during pregnancy complications.

“An untold number of women and the people who love them, who are silently suffering — women who are being made to feel as though they did something wrong, as though they are criminals, as though they are alone,” Harris said. “And to those women. I say — and I think I speak on behalf of all of us — we see you and we are here with you.”

Harris said if voters give Trump another four years in the Oval Office, he will likely nominate more justices to the Supreme Court, which she argued would have a negative impact on the country.

“If he were reelected, he’d probably get to appoint one, if not two, members to the United States Supreme Court,” Harris said. “At which point Donald Trump will have packed the court with five out of nine justices … who will sit for lifetime appointments; shaping your lives and the lives of generations to come.”

Texas has one of the country’s most restrictive abortion laws, which has led to concerns about its OB-GYN workforce, how the state addresses maternal mortality and testimony before Congress about women having to leave the state to get care for pregnancy complications.

Texas is also where anti-abortion organizations decided to file a federal lawsuit in November 2022 challenging the U.S. Food and Drug Administration’s 2000 approval of medication abortion.

The two-drug regimen, consisting of mifepristone and misoprostol, is currently approved for up to 10 weeks gestation and is used in about 63% of abortions nationwide, according to data from the Guttmacher Institute.

The case made its way to the U.S. Supreme Court, which ruled earlier this year the organizations lacked standing to bring the lawsuit in the first place, but the justices didn’t address the merits of the anti-abortion groups’ arguments.

Speaking at ‘ground zero’

Harris told reporters on Friday before the rally began that Republican lawmakers in Texas have made the state “ground zero in this fundamental fight for the freedom of women to make decisions about their own body.”

Harris contended that access to reproductive rights, including abortion, is “not just a political debate” or “some theoretical concept.”

“Real harm has occurred in this country, real suffering has occurred,” Harris told reporters. “People die, and it is important to highlight this issue because this is among the most critical issues that the American people will address when they vote for who will be the next president of the United States.”

During Trump’s first term in office, he nominated three Supreme Court justices, who later joined with other conservatives to overturn the constitutional right to abortion established in the 1973 Roe v. Wade case.

The Supreme Court’s ruling two years ago sent “the authority to regulate abortion … to the people and their elected representatives.”

That has led to a hodgepodge of laws with 13 states banning abortion, six states restricting access between six and 12 weeks, five states setting a gestational limit between 15 and 22 weeks, 17 states restricting abortion access after viability and nine states not setting a gestational limit, according to KFF.

Polls find support for abortion access

Public support for abortion access has outpaced support for restricting access for decades, according to consistent polling from the Pew Research Center.

The most recent survey from May shows that about 63% of Americans want abortion to be legal in most or all cases, while 36% said they believe it should be illegal in most or all cases.

Additional surveying from Pew shows that 67% of Harris supporters believe abortion access is “very important — nearly double the share of Biden voters who said this four years ago, though somewhat lower than the share of midterm Democratic voters who said this in 2022 (74%).

“And about a third of Trump supporters (35%) now say abortion is very important to their vote — 11 points lower than in 2020.”

In addition to playing some role in the presidential election, voters in 10 states — Arizona, Colorado, Florida, Maryland, Missouri, Montana, Nebraska, Nevada, New York and South Dakota — will weigh in on abortion access directly through ballot questions.

Congress could supersede any protections or restrictions on abortion access established within states, if the House and Senate ever agree on legislation and a future president signs it into law.

Republicans are slightly favored to gain control of the Senate for the next two years following the election, while control of the House is considered a toss-up, as is the presidential race.

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Medication abortion has become the most common method of abortion since the 2022 Dobbs decision ended the federal right to abortion. (Getty Images)

Researchers whose anti-abortion-funded studies were used to argue for restrictions on medication abortion — and then were retracted on methodological grounds — are now taking legal action against academic publisher Sage, which pulled their papers in February.

Represented by conservative law firms Consovoy McCarthy and Alliance Defending Freedom, the latter of which sued the Food and Drug Administration over abortion drugs in 2022, the researchers claim Sage’s retractions were unjustified and politically motivated and have led to “enormous and incalculable harm” to their reputations. They asked the Ventura County Superior Court in California to compel Sage to arbitrate with the researchers.

“Sage punished these highly respected and credentialed scientists simply because they believe in preserving life from conception to natural death. These actions have caused irreparable harm to the authors of these articles, and we are urging Sage to come to the arbitration table — as it is legally bound to do — rescind the retractions and remedy the reputational damage the researchers have suffered at the hands of abortion lobbyists,” said ADF senior counsel Phil Sechler in the recent announcement.

A representative for Sage declined to comment on the pending litigation.

A representative for the anti-abortion think tank Charlotte Lozier Institute, which employs the petitioning researchers, declined to comment. The nonprofit serves as the research arm of the influential Susan B. Anthony Pro-Life America, which works to elect federal and state anti-abortion lawmakers.

The three studies at the center of the dispute were published in the journal “Health Services Research and Managerial Epidemiology,” between 2019 and 2022. Two of them featured prominently in a federal lawsuit aimed at restricting abortion pills, which the U.S. Supreme Court rejected this summer but continues to make its way through the lower courts.

States Newsroom was the first to report last year that Sage had opened an investigation after pharmaceutical sciences professor Chris Adkins contacted the journal with concerns that the researchers had misrepresented their findings. In the 2021 paper, the researchers looked at Medicaid data in 17 states between 1999 and 2015 and tracked patients who had had a procedural or a medication abortion and counted each time they went to an emergency department in the 30 days following those abortions. Their finding that emergency room visits within 30 days following a medication abortion increased 500% from 2002 to 2015 was frequently cited by plaintiffs and judges in the FDA case and used to conclude that the abortion-inducing drug mifepristone is dangerous. But Adkins and other public health experts told States Newsroom that the researchers inflated their findings, and appeared to conflate all emergency department visits with adverse events.

These concerns prompted Sage to re-examine the peer review process and to identify that one of the initial peer reviewers was an associate scholar with the Charlotte Lozier Institute. The publisher then enlisted a statistician and two reproductive health experts to newly peer review all three articles.

“Following Committee on Publication Ethics (COPE) guidelines, we made this decision with the journal’s editor because of undeclared conflicts of interest and after expert reviewers found that the studies demonstrate a lack of scientific rigor that invalidates or renders unreliable the authors’ conclusions,” Sage said announcing the retractions, which notes that the experts found that the papers had “fundamental problems with the study design and methodology,” “unjustified or incorrect factual assumptions,” “material errors in the authors’ analysis of the data,” and “misleading presentations of the data.”

In a petition to compel arbitration filed late last week, the studies’ lead author James Studnicki and nine co-authors argue that Sage has delayed arbitration in violation of California contract law. They say they’ve had difficulty publishing new research since the retractions. As examples, the petition notes that in March a free online archive and distribution server for unpublished, non-peer-reviewed manuscripts refused to post one of the petitioners’ manuscripts and that in April a journal rejected the same manuscript, “citing similar pretextual reasons that HSRME used in its retraction.”

“These rejections are just the tip of the iceberg but reveal the enormous and incalculable harm that Sage’s retraction has inflicted on the Authors’ reputations and their ability to publish research and scholarship,” reads the court petition. “As scientists, the Authors’ credibility is their lifeblood, but Sage has destroyed the Authors’ hard-earned professional reputations.”

Studnicki, Charlotte Lozier’s vice president and director of data analytics, was on the editorial board of “Health Services Research and Managerial Epidemiology” until last fall, but the journal’s editor-in-chief dismissed him after the journal and Sage decided to retract the papers. The blog Retraction Watch reports that the journal is no longer accepting new submissions.

Medication abortion has become the most common method since the 2022 Dobbs decision ended the federal right to abortion.

Despite claims by the Charlotte Lozier Institute that medication abortion is unsafe, when administered at 9 weeks gestation or less, the FDA-approved regimen has a more than 99% completion rate, a 0.4% risk of major complications, and around 30 reported associated deaths over 22 years. Common symptoms include heavy bleeding and cramping, diarrhea, and nausea, and sometimes medical intervention is necessary to avoid infection. ProPublica recently reported on two women in Georgia who suffered rare complications of medication abortion, but whose deaths were ruled preventable and were attributed to the state’s near-total abortion ban.

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