WASHINGTON (AP) — Anti-abortion advocates say there is still work to do to further limit it access to abortion when republican Donald Trump he returns to the White House next year.

They point to the federal guidance that the Democratic administration President Joe Biden released around emergency abortionsrequiring hospitals to provide them to women whose health or life is at risk and relaxing prescription restrictions for abortion pills which allowed women to order their medication online with the click of a button.

“Now begins the work of dismantling the pro-abortion policies of the Biden-Harris administration,” Susan B. Anthony List, the powerful anti-abortion lobby, said in a statement Wednesday. “President Trump’s First Term Pro-Life Accomplishments Are Baseline for Second Term.”

The group declined to reveal details of what specifically they will seek to overturn. But abortion rights advocates are bracing for new restrictions on abortion once Trump takes office. And some women are, too, with online orders for abortion pills surging in the days after Election Day.

Trump said abortion it’s a problem for the states, not the federal government. However, during the campaign, he made it clear that he appointed Supreme Court justices who were majorities in overturning the nation’s right to abortion. And there are things his administration can do, from electing judges to issuing regulations to pushing an anti-abortion agenda.

Trump is unlikely to require emergency abortions from hospitals

The Trump administration is expected to roll back Biden’s controversial directive requiring emergency rooms to provide abortions when necessary to stabilize a woman’s health or life. The Biden administration has argued that the decades-old federal law that requires hospitals to provide stabilizing treatment to patients in exchange for Medicare funding also applies in cases where an abortion might be needed.

Reports of women being sent home or left untreated by hospitals in dangerous scenarios have proliferated in the United States since the Supreme Court struck down the nation’s right to abortion in 2022. In some cases, hospitals said state abortion bans prevented them from terminating a pregnancy.

“We see pregnant women’s lives being put at risk,” Fatima Goss Graves, president and CEO of the National Women’s Law Center, said Wednesday. “We are seeing women who have become infertile, who have succumbed to sepsis and now we are hearing reports of death.”

Even if a Trump administration abandons guidance on the law, Goss Graves said advocacy groups like hers will continue a legal battle over the Biden administration’s interpretation of the law.

Some doctors and hospitals also said the federal guidelines give them protection to perform emergency abortions in states like Idaho and Texas, where the threat of prosecution for performing an abortion hangs over their decision-making.

Trump has said he supports exceptions for cases of rape and incest, as well as when a woman’s life is in danger. But he didn’t go so far as to say he supports exemptions when a woman’s health is at risk.

Abortions may be necessary to prevent organ loss, significant bleeding, or dangerous infections for pregnant women in rare but serious scenarios. In cases such as ectopic pregnancy, premature rupture of membranes, and placental abruption, a fetus may still be alive, but continued pregnancy may be harmful. Doctors claimed that the legal gray area put them in crisis.

In Idaho, for example, one hospital resorted to airlifting women out of the state after a strict abortion ban was enacted, allowing abortions only to prevent a woman’s death.

The Biden administration sued Idaho, arguing that its state law conflicts with federal law that requires hospitals to provide patients with stabilizing treatment, which could include abortions. The state has amended its law to allow abortions for ectopic pregnancies, but other dangerous scenarios still remain unaddressed. The Supreme Court declined to address the issue earlier this year, issuing a limited injunction that cleared the way for hospitals to offer emergency abortions while the case worked its way through lower courts.

However, enforcement of the federal law is suspended in Texas, which has challenged the Biden administration’s emergency abortion guidelines.

A patchwork of state laws governing abortion will remain in place under the Trump administration. Voters in Florida, Nebraska and South Dakota defeated constitutional amendments on Tuesday, leaving the bans in place.

In MissouriHowever, voters on Tuesday approved a ballot measure to overturn one of the nation’s strictest bans. Abortion rights amendments have also passed in Arizona, Colorado, Maryland and Montana. Nevada voters also approved an amendment, but will have to pass it again in 2026 for it to take effect.

Challenges over access to abortion pills will continue under Trump

The ease with which women have been able to obtain abortion pills may also be up for re-examination under Trump.

During the COVID-19 pandemic, the Food and Drug Administration has made it easier to get abortion pills, including mifepristone, by allowing women to access medications through telehealth. The agency approved the drug’s safety up to 10 weeks of pregnancy, saying adverse effects occur in 0.32 percent of patients.

Anti-abortion advocates have contested this, arguing that the drugs are not safe and, at the very least, not suitable for easy access without personal supervision by a doctor.

Although the Supreme Court preserved access to the drug earlier this year, anti-abortion advocates and conservative states have they renewed their challenge in the lower courts.

Some women are worried. Telehealth company Wisp saw an immediate spike in abortion pill orders between Election Day and the day after, with a 600 percent increase. In states like Florida and Texas, where the drugs cannot be legally delivered, the company has seen a nearly 1,000 percent increase in orders for the so-called “morning-after” pills, also known as emergency contraception .

The company fills about tens of thousands of orders a month for reproductive products, including birth control pills and abortion pills, CEO Monica Cepak told The Associated Press.

Currently, women usually take a two-step regimen of mifepristone and misoprostol to complete a medical abortion. Cepak said the company will closely monitor mifepristone under the Trump administration and is prepared to switch to a misoprostol-only regimen if the mifepristone restriction is implemented.

But Trump could be a wild card on the issue, said Mary Ziegler, a law professor at the University of California, Davis who is an expert on reproductive health issues. In the final months of the campaign, he backed away from a harder stance on abortion — even saying he wouldn’t sign a national abortion ban if it met his office.

Although he has enjoyed staunch support from anti-abortion groups, he is willing to break with allies when he wants to.

“I don’t think we have a clear idea from him about what he would do,” Ziegler said.

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