President-elect Donald Trump’s victory in an election in which abortion rights were a particular focus raises major questions about what may be next for abortion access in the US

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

Vice President-elect JD Vance, meanwhile, suggested he would supports 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 said, there is no clear road map for the future of abortion in a the second Trump administration — though they did offer a few theories.

A national abortion ban, if approved by Congress, would override state-level protections, including seven ballot measures that passed Tuesday. But even if Republicans gain control of the HouseThat kind of federal restriction is also unlikely, four experts said. Trump said would not sign such a ban. (He declined to say, however, whether he would veto one if it landed on his desk.)

More likely, experts suggested, are efforts 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.

“Threats to medication abortion are what we will be watching most closely, especially in the first months and year of administration,” said Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute.

Tuesday’s election results signaled continued public support for abortion rights in general. Ballot measures to protect access to abortion passed in seven out of 10 states; in Arizona and Missouri, those victories overturned existing restrictions, while the other five states that passed such initiatives had not previously restricted abortion.

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

Given those results, as well as voters’ past support for abortion rights, many Republican senators may be wary of supporting a federal ban, experts say.

“Republican politicians have been running away from their strong anti-abortion policies for the last two years because of how popular, clearly, access to abortion is,” said Katie O’Connor, senior director of federal abortion policy at National Women’s . Law Center.

But several experts described other paths to abortion restrictions that wouldn’t necessarily involve Congress.

One option is through Trump’s appointees at the Food and Drug Administration. Those leaders could try to get the agency to reverse certain changes made from 2016 to 2021 (in three presidential administrations, including Trump’s) that expanded access to the abortion drug mifepristone. This could include reinstating a requirement that abortion pills be dispensed in person. New FDA leaders may also try to revoke the drug’s license.

Another way is for Trump appointees at the Justice Department to choose not to defend access to the abortion pill when legal challenges arise. Although the Supreme Court dismissed a case in June, which sought to restrict access to mifepristone, the attorneys general of Idaho, Kansas and Missouri filed a similar lawsuit last month.

Both cases were filed in federal court in Amarillo, Texas, where the sole judge, Matthew Kacsmaryk, is appointed by Trump. Kacsmaryk previously ruled suspends FDA approval of mifepristonea rejected superior court decision. But if Kacsmaryk rules the same way again, legal experts said, 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 mailing and receipt of “obscene” material and that designed or intended to cause an abortion.

A broad interpretation of the Comstock Act could allow the Department of Justice to prosecute people for providing surgical abortions and drugs, as it could be argued that the law does not allow the distribution of abortion pills or medical equipment used in abortion procedures . The penalty for violating the act is up to five years in prison.

“All it takes is one DOJ person or a zealous US attorney to threaten a clinic with criminal penalties under the Comstock Act, and that could send an extraordinary chill among abortion providers,” he said Wendy Parmet, principal. of 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 he does not foresee these strategies succeeding.

“Any attempt to abuse this law to ban abortion nationally, whether it’s to ban medication abortion or all abortion nationally, would be met with really fierce opposition, both politically , as well as from a legal point of view,” she said.

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

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