Trump’s War on Abortion Rights Faces a Resilient Movement
As the antiabortion movement pursues harsh restrictions and fetal personhood laws, abortion providers and activists are fighting back. Despite deadly state bans and attacks on medication access, reproductive health care victories offer light in the darkness.
A pro-choice demonstrator holds a sign in front of the US Supreme Court on Wednesday, April 2, 2025. (Tom Williams / CQ-Roll Call, Inc via Getty Images)
We’re in a bleak moment in the fight over abortion access. Those waging the brutal battle in support of reproductive health care are facing conservative assaults on many fronts, and with dwindling resources.
Abortion activists have been holding their breath, waiting to see exactly how Donald Trump will respond to pressure from his socially conservative supporters to further restrict abortion access at the federal level. Some antiabortion leaders are advocating that he make use of the Comstock Act, an anti-obscenity law from 1873, to ban the mailing of medication abortion. That would likely cause a massive public backlash, especially because the arcane law was highlighted in Project 2025 and is a talking point in the furthest right corners of the Christian nationalist movement.
But there are also other, less flashy ways that antiabortion extremists are working to further restrict access to reproductive health care.
A more bureaucratic scenario is playing out with the erosion of access to mifepristone, one of two pills used in medication abortion care, which now accounts for the majority of abortions in the country. In the Senate hearing on Robert F. Kennedy Jr’s nomination to be secretary of health and human services, he suggested that he was open to limiting access to mifepristone, citing safety issues. “President Trump has asked me to study the safety of mifepristone,” Kennedy said at the hearing, despite dozens of studies over decades showing the medication’s safety and effectiveness. “He has not yet taken a stand on how to regulate it.” Kennedy could pressure the Food and Drug Administration (FDA) to reverse its 2021 loosening of restrictions, which allowed for telehealth provision and has profoundly altered the landscape of abortion care in the past few years.
Abortion opponents are targeting medication abortion and telehealth in particular, which accounted for nearly one in five abortions nationwide in the last half of 2023, a figure that is likely higher today. Through telehealth care and state shield laws, which protect providers from civil and criminal consequences for providing abortion care to out-of-state residents, people in states with strict bans have been able to access care. Eighteen states have passed these shield laws, and eight of those states specifically include telehealth care, allowing providers to mail abortion pills to patients in states where they don’t have a license. The telehealth shield laws have been a lifeline for people in states with the strictest bans. Around ten thousand abortion pills are mailed every month by telehealth shield providers, and the vast majority are sent into states where abortion is illegal.
The first legal challenge to the shield laws is playing out now. Texas has ordered Dr Maggie Carpenter, a New York–based doctor, to pay more than $100,000 in penalties for violating the state abortion ban and prescribing abortion pills to a woman in Dallas. Carpenter, founder of the Abortion Coalition for Telemedicine, also faces criminal charges from Louisiana’s Republican governor, Jeff Landry, for prescribing abortion medication to a Louisiana resident via telehealth. Louisiana has a near-total abortion ban that allows physicians convicted of performing abortions to be sentenced up to fifteen years in prison.
This is the first test of New York’s shield law, and Governor Kathy Hochul has vowed not to cooperate with either Louisiana’s extradition orders or Texas’s civil suit. The good news is that the shield laws are working exactly as intended, protecting providers who are following their state laws and offering safe, effective, and legal health care. The standoff between abortion-supportive and abortion-restrictive states will likely play out in the courts for years, but in the meantime, all necessary support should be given to the pioneering telehealth shield providers who are helping thousands of people access care that should be available to them in their home states.
The Supreme Court is likely to hear another challenge to mifepristone soon. Despite the court ruling in June 2024 that antiabortion organization the Alliance for Hippocratic Medicine lacked legal standing to challenge the FDA’s regulation of mifepristone, the most conservative justices indicated that they were open to the plaintiff’s arguments about the supposed dangers of mifepristone.
In October 2024, three Republican attorneys general from Kansas, Missouri, and Idaho requested to pursue the case against mifepristone in the same Amarillo, Texas, federal court as the previous challenge, where the only federal judge is the Trump-appointed abortion foe Matthew Kacsmaryk. While the previous legal challenge attempted to rescind the FDA’s approval of the drug entirely, the newest challenge is an attempt to roll back the easing of restrictions that the FDA made temporarily in response to the challenges of accessing in-person health care during the height of the pandemic and then made permanent in 2021.
If the conservative attorneys general get their way, the Supreme Court will order the FDA to reverse course, prohibiting telehealth provision of mifepristone and restricting its use to the first seven weeks of pregnancy rather than the current limit of ten weeks. These restrictions are not about safety, as studies show that mifepristone is incredibly safe when prescribed through telehealth or taken without any medical supervision. Rather, they are part of the antiabortion movement’s longer-term goal of making abortion as difficult to access as possible, even in states with protections.
The Creeping Danger of Fetal Personhood
The antiabortion movement is making terrifyingly fast progress on another longtime goal: injecting the concept of fetal personhood into legal doctrine. The idea that life begins at conception, and that embryos and fetuses are therefore due legal rights and protections, was once a fringe belief held only by the most extreme religious zealots. Now the framework is being inconspicuously enshrined into law.
When Trump signed an anti-trans executive order on his first day back in office, many abortion advocates pointed out the snuck-in language incorporating elements of fetal personhood. “‘Female’ means a person belonging, at conception, to the sex that produces the large reproductive cell,” reads the executive order. According to journalist Carter Sherman in the Guardian, “advocates of fetal personhood hope to ultimately bring a case to the Supreme Court that will lead the justices to declare that the 14th amendment applies from the moment of conception.” Though the executive order did not actually establish new protections or legal status for embryos and fetuses, every time this language gets embedded, even symbolically, it provides a building block for future extremist laws.
More terrifyingly, in a world where fetal personhood is the law of the land, it could lead the government to treat abortion as murder and people who get abortions as murderers. Five states have now proposed bills that would classify abortion as murder and criminalize those providing or accessing abortion care. None of the bills have passed, and it’s unlikely that they will, but just giving a hearing to such extremist legislation is part of the antiabortion strategy of desensitizing the public to the idea of punishing people for health care decisions.
The abolitionist wing of the antiabortion movement, which advocates abolishing abortion through fetal rights and the criminalization of abortion, is growing in influence. Many mainstream antiabortion organizations oppose the criminalization of women who seek abortions, both because they fear a public backlash and because it contradicts their position that women are unknowing victims of unscrupulous abortion providers. But self-described abortion abolitionists now serve as legislators in some deep red states and are able to advance extremist bills.
In Oklahoma, a proposal was recently struck down by a vote of six to two that would have allowed murder charges against women who get abortions, with potential punishments including the death penalty or life in prison. Republican senator Dusty Deevers, who authored the bill, said that patients accessing abortion medication through the mail was a “massive loophole in Oklahoma’s pro-life laws,” and stated, “We have a protected class of murderer in our state.”
In Missouri, a committee considered a bill that would create a database of pregnant women deemed “at risk” of getting an abortion and connect them with parents looking to adopt. The author of the Save MO Babies Act called it “eHarmony for babies,” designed to match prospective parents with babies from women forced to remain pregnant and give birth. Conservative states are coming up with increasingly cruel ways to track, control, and punish pregnant people.
Health Care Denied, Lives Lost
Though abortion opponents claim their bills are about protecting women’s health and safety, the sharp increase in maternal — and, in some states, fetal — mortality reveals the deadly consequences of criminalizing health care. Now that data and reporting has come out about the impacts of state abortion bans and restrictions post-Roe, the horrific proof exists that people are dying and suffering as a result of the new laws. Patients facing life-threatening pregnancy complications are being turned away from emergency rooms, and doctors are so terrified of criminal prosecution that they are performing unnecessary C-sections rather than emergency abortions.
Idaho successfully challenged the federal requirement to provide emergency abortion care in publicly funded emergency rooms, requiring patients to be airlifted out of the state for care. The Trump administration recently announced that it would be dropping the Justice Department case against Idaho, giving the state free rein to continue denying emergency abortion care.
At least five women have died after they did not receive emergency abortion care, including two women in Georgia and three women in Texas. According to a new study by ProPublica, after Texas banned abortion in 2021, the rate of sepsis shot up more than 50 percent for women hospitalized when they lost their pregnancies in the second trimester. Another study found that infant mortality in Texas spiked by almost 13 percent between 2021 and 2022. Abortion bans and restrictions are leading to dangerous delays in lifesaving care and upending standards of care as doctors try to protect themselves from legal consequences that include loss of their medical licenses and decades in prison.
Despite the public outrage every time another pregnant person dies a preventable death or is arrested for miscarrying, extremist antiabortion lawmakers continue proposing bills to punish providers and patients. These punitive bills are not popular with voters, so the antiabortion movement has been careful to frame the restrictions as necessary to protect women. To keep up the ruse, pseudoscientific research from antiabortion organizations like the Charlotte Lozier Institute purports to show the dangers of procedural and medication abortion.
Some red states have recently proposed laws that require collecting data on abortion complications, which could be defined too broadly to be meaningful, to strengthen their argument that abortion is not safe and needs to be banned or highly regulated. Indiana even proposed a bill, recently struck down, that would require anonymized abortion patient medical records to be made available as public records.
This focus on data collection is part of the broader antiabortion strategy of surveillance and tracking of abortion patients and manipulated to serve their goal of legislating away all rights and access to abortion. And because it does not suit their needs to analyze data on maternal mortality rates, some states are simply choosing not to. Texas’s maternal mortality committee recently announced that it would not review pregnancy and childbirth-related deaths from the first two years after the state banned nearly all abortions.
Building Power and Protection, State by State
Despite years of attacks on abortion access, before and after the Dobbs decision, the number of abortions in the country has increased since Roe was overturned and there were more abortions in 2023 than in any year since 2011.
As Trump presides over a government intent on shredding what remains of legal protections for women, queer, and trans people, and all marginalized groups, it’s helpful to keep in mind the recent reproductive health care victories. Seven states passed amendments protecting abortion rights in the 2024 election, including Arizona and Missouri, which had pre-viability abortion bans. In Missouri, providers sued to strike down the abortion ban after the pro-choice ballot initiative passed. Procedural abortions recently resumed in the state, though the fight continues to overcome the many Republican-imposed obstacles to care, and clinics in the state are still not able to provide medication abortion.
Some abortion-friendly states have gotten rid of restrictions around abortion, added state Medicaid funding to cover abortion care, and have designated state funds to go to clinics and abortion funds to help meet the enormous needs of patients traveling from other states. In California, the California Future of Abortion Council was created to strengthen protections and expand access to care, including for out-of-state patients. In Illinois, the Department of Public Health allocated $2 million in training grants to health departments and nonprofits to expand access to reproductive health care by increasing the number and types of trained providers. In Colorado, 62 percent of voters in the November 2024 election approved an amendment that changed the state constitution to recognize the right to abortion and repealed the prohibition on public funding, making it one of eighteen states to allow the use of state funds for abortion care.
In New York, the 2025 budget invests $36 million to provide support to abortion providers and nonprofit organizations to increase access to care for residents and out-of-state patients, including $25 million for the Abortion Access Program and $10 million for enhancing security and safety operations for abortion providers. New York is also considering a bill to invest $10 million in clinical training and would establish a state-funded program designed to address the growing shortage of abortion providers in New York and across the country. In February, after Louisiana brought the criminal case against Dr Carpenter, New York governor Kathy Hochul signed legislation to enable providers who prescribe abortion medication to request that the dispensing pharmacy print the name of their practice on prescription labels instead of their personal name, adding another layer of protection for providers.
These bare-minimum state protections should have existed years ago, but we need to recognize every expansion of access to care as a victory and use them to build momentum to win even greater victories. It’s easy to feel overwhelmed by the barrage of barbaric attacks on reproductive care, but it’s important not to lose sight of the many people who are still able to get abortions because of the work of providers and activists.
We need to keep funneling money to abortion funds, which desperately need it, while simultaneously working toward the longer-term goal of eradicating all restrictions around reproductive health care and the even longer-term goal of universal health care and health justice. This will be an uphill road, and we’ll need to pursue every avenue and enlist every supporter to use their unique abilities to move us forward.
We can have our eyes on many targets, though we should not be so distracted by election cycle politics that we neglect to support the many people who desperately need care in the here and now. The movement for reproductive justice is strong and dynamic. It may take time, but millions of people are already building that better world.