President-elect Donald Trump’s victory in an election in which the right to abortion was a priority raises major questions about what could happen next when it comes to abortion access in the United States

During the latter stages of his campaign, Trump said he believed states should determine their own abortion policies. But his position on the issue has varied considerably — in an interview in March, he reported support for a nationwide ban on abortions after 15 weeks of gestation, and as president he supported a House bill this would have banned abortion nationwide after 20 weeks. During his 2016 campaign, Trump pledged to nominate justices to the Supreme Court who could help overturn Roe v. Wade. As president, he achieved this goal and sometimes bragged about it.

Meanwhile, Vice President-elect JD Vance suggested he support a national law restricting abortion. More recently, he has adopted Trump’s position of letting the states decide.

The Trump campaign did not respond to a request for comment.

Because of these inconsistencies, policy experts say, there is no clear roadmap for the future of abortion in a context second Trump administration – although they have proposed a few theories.

A national ban on abortion, if approved by Congress, would roll back state-level protections, including seven ballot measures passed Tuesday. But even if the Republicans take control of the HouseAdditionally, this type of federal restriction is unlikely, four experts said. Trump said he would not sign such a ban. (He declined to say, however, whether he would veto a bill if it landed on his desk.)

Experts say efforts are more likely to be made to restrict access to abortion pills, especially when they are administered via telehealth or delivered by mail. Medication abortions accounted for 63% of all abortions in the country last year, according to a March study by the Guttmacher Institutea research organization that supports access to abortion.

“The threats to medication abortion are what we’re going to be watching most closely, especially in the first months and years of his administration,” said Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute.

Tuesday’s election results showed continued public support for abortion rights overall. Election measures to protect access to abortion pass in seven out of 10 states; in Arizona and Missouri, these victories overturned existing restrictions, while the other five states that passed such initiatives did not previously restrict abortion.

In Florida, a measure supporting abortion rights received 57 percent of the vote, but failed because state law required at least 60 percent of the vote. South Dakota and Nebraska, meanwhile, were the first two states since the Supreme Court’s Dobbs decision in 2022 where majorities of voters rejected proposed constitutional amendments to protect access to abortion . (A oppose ballot initiative in Nebraskawhich passed, may have confused some voters, Friedrich-Karnik said.)

Given these findings, as well as voters’ past support for abortion rights, many Republican senators may be hesitant to support a federal ban, experts say.

“Republican politicians have shied away from their anti-abortion policies over the past two years because of the popularity, clearly, of abortion access,” said Katie O’Connor, senior director of federal policy. on abortion to the National Association of Women. Law Center.

But several experts have described other paths to abortion restrictions that would not necessarily involve Congress.

One option is to appoint Trump appointees to the Food and Drug Administration. These leaders could try to get the agency to reverse some changes made between 2016 and 2021 (in three presidential administrations, including Trump’s) that expanded access to the abortion drug mifepristone. This could include reinstating the requirement that abortion pills be dispensed in person. New FDA leaders could also try to deregister the drug.

Another path would be for Trump appointees to the Justice Department to choose not to defend access to the abortion pill when legal challenges arise. Even if the Supreme Court dismissed a case in June, seeking to restrict access to mifepristone, the attorneys general of Idaho, Kansas and Missouri filed a similar suit last month.

Both cases were filed in federal court in Amarillo, Texas, where the only judge, Matthew Kacsmaryk, is appointed by Trump. Kacsmaryk had previously decided to suspend FDA approval for mifepristonea decision overturned by the higher courts. But if Kacsmaryk decides the same way again, legal experts say, Trump’s Justice Department could choose not to appeal, allowing the decision to take effect.

Another option for Trump’s Justice Department: threaten to enforce the Comstock Act, an 1873 law that prohibits the sending and receiving of “obscene” materials and those designed or intended to induce an abortion.

A broad interpretation of the Comstock Act could allow the Justice Department to hold people who performed surgical and medication abortions criminally liable, because it could be argued that the law does not authorize the distribution of abortion pills or used medical equipment in abortion procedures. The penalty for violating this law is up to five years in prison.

“It only takes one person from the Department of Justice or an overzealous U.S. attorney to threaten a clinic with criminal sanctions under the Comstock Act, and that could potentially cause considerable chilling among health care providers who practice abortion,” said Wendy Parmet, director. from the Center for Health Policy and Law at Northeastern University in Boston.

The Justice Department could also use the Comstock Act to threaten legal action against abortion pill makers.

However, O’Connor said she doesn’t anticipate these strategies will be successful.

“Any attempt to misuse this law to ban abortion nationally, whether it is to ban medication abortion or all abortions nationally, would be met with very strong opposition. fierce, both politically and legally,” she said.

Friedrich-Karnik said that at the very least, Trump could restore some of the policies implemented under his previous administration that made abortion harder to obtain, such as a rule prohibiting providers who receive certain federal grants from referring patients to abortion care.

“A lot of policies that were in place under the first Trump administration and then were dismantled by the Biden administration — we would expect all of those policies to come back,” she said.

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