On the campaign trail, Donald Trump relished the chance to assure voters that the 2022 overturn of Roe v. Wade meant people did not need to worry about more federal abortion restrictions, since it was all effectively moot and now up to the states. As Election Day grew closer, Trump insisted hed be great for women and their reproductive rights and even that he would not support a federal abortion ban, under any circumstances. His flip-flopping worked: Most voters believed that Trump would not be a threat to abortion rights and that he would not prioritize the issue if elected.Since winning, Trump and his transition team have aimed to keep abortion out of the news and maintain the appearance of moderation to avoid losing broader support. While Trump did tap two anti-abortion doctors to oversee the Centers for Medicare and Medicaid Services and the Food and Drug Administration (Dr. Mehmet Oz and Marty Makary, respectively), his Health and Human Services secretary pick is Robert F. Kennedy Jr., who is on record supporting abortion rights. Trumps team also rejected naming Roger Severino to a top HHS post, primarily because his team thought his anti-abortion views would be too controversial. (Anti-abortion leaders lobbied heavily for Severino.) On his first day back in office Trump sought to downplay reproductive rights: None of his first dozens of executive orders directly pertained to abortion, though his anti-transgender decree did invoke the idea that human personhood begins at conception, a key tenet of the fetal personhood wing of the anti-abortion movement. Trump will also be in California on Friday, skipping the chance to speak at the March for Life rally in Washington, DC, which he addressed as president in 2020.But this more evasive period will soon run headlong into the reality of Congress, litigation, and executive governing.His administration will have to weigh in on pending abortion rights lawsuits, legislation dealing with new abortion restrictions, and hell have to appoint more judges. (In his first term, Trump appointed one of the most anti-abortion judges in the country Matthew Kacsmaryk.) In the months ahead, as Congress sends bills to his desk and courts issue more fetal personhood rulings, Trumps carefully crafted moderate image on abortion will face mounting pressure. While he likely does not want to wade back into the messy world of abortion politics an issue he has never held strong convictions about hell soon have to.The anti-abortion strategyEmerging statements from anti-abortion advocates suggest that most are prepared to be lenient with the new president, accepting compromises so Trump can continue to claim that he signed no new federal abortion ban. Activists see it in their interest to accommodate the president so as to stay within his good graces, and influence policy and judicial nominees where possible. Letting Trump keep his promise of no federal abortion ban isnt such a big sacrifice, because there was never much likelihood that Congress would be able to pass such a ban without lawmakers overturning the filibuster. The anti-abortion movement, for its part, had not been counting on the GOP to push bills with a simple majority. Quite frankly, unless something really unusual happens in this election, neither side is going to have the votes in Congress to pass a national law, Carol Tobias, president of the National Right to Life Committee, told the Associated Press in early October. Expect more euphemistic language games. Steven Aden, the general counsel at Americans United for Life, told States Newsroom in November that his national anti-abortion group would support a federal dismemberment bill, meaning a proposed ban on the most common second-trimester abortion procedure, known as dilation and evacuation. This would still technically leave physicians able to use methods like C-sections to terminate later pregnancies allowing Trump to claim he didnt ban abortion writ large but those alternatives are less safe. Several states have banned D&E since 2017.Anti-abortion advocates will also press for enforcement of the Comstock Act, an 1873 federal law that could prohibit anything associated with abortion from being sent in the mail. The Comstock Act was rendered moot by Roe in the 1970s but never formally repealed, and now, with Roe gone, many conservatives see it as an ideal vehicle for restricting abortion nationwide, precisely because it wouldnt require passing a new law. The Trump administration could enforce it, and Trump could continue to insist he kept his campaign pledge to sign no new federal ban. In August, after months of dodging the question, Trump told CBS he generally speaking would not use the Comstock Act to restrict access to abortion medication. However, many people in his orbit, including his vice president, are on record urging the opposite, and its not clear if Trumps Department of Justice will keep the Biden-era interpretation that mailing abortion pills is not in violation of the act. Trumps DOJ pick, Pam Bondi, has not clarified what shed do, but said in her confirmation hearing that she would not let her personal opposition to abortion influence her actions as US attorney general. Other items high on the anti-abortion wish list that could allow Trump to maintain the relative pretense of moderation include renewed efforts to defund Planned Parenthood, the largest reproductive health network in the country. While Planned Parenthood is popular, Trump could say federal funding is at odds with the vision of states deciding abortion policy. On the campaign trail, JD Vance said Trump would support defunding Planned Parenthood, and in his first term, Trump implemented a domestic gag rule on US-based family planning programs, eliminating funding for any program that provided abortion services or even abortion information. It led to 400 Planned Parenthood clinics nationwide losing federal money. Legislation to defund the organization was recently reintroduced in Congress.Activists also want to bring back older restrictions on medication abortion like bans on telehealth which will make the drugs much harder for people to access but enable the president to claim he isnt actually banning them. Anti-abortion groups plan to press the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) to study potential environmental harm from flushing abortion pills down the toilet, a move they hope could lead to new restrictions on how the drugs can be legally administered and disposed of. Activists also hope RFK Jr.s general skepticism of FDA drug approvals helps them win support for a federal study, since they argue the agency erred in its approval of mifepristone 25 years ago.Thorny decisions awaitOne less polarizing course for the Trump administration would be to merely undo Biden administration policies, reverting back to more typical GOP restrictions like the global gag rule, which blocks foreign organizations receiving US aid from providing abortion information or referrals. Every Republican president since Ronald Reagan has implemented this policy, including Trump in 2017. Other things Trump could revoke include Bidens expanded abortion access for military veterans, and a Biden-era Medicaid waiver that supports patients traveling out of state for care. They dont have to advance a pro-life federal law, Eric Kniffin, a fellow at the conservative Ethics and Public Policy Center, told The Hill recently. They just have to stop the overreaches that [the Biden] administration has been taking.But even if Trump wanted to duck more high-octane political fights over abortion, he likely wont be able to avoid the brewing battles over IVF, which now accounts for about 2 percent of births in the US. Personhood advocates argue that discarding unused embryos during IVF is tantamount to abortion, and pushing for new restrictions could significantly affect millions of Americans struggling with infertility. While Louisiana remains the only state to outright prohibit the destruction of embryos, activists are pressing more states to follow its lead. Federal courts may also need to address whether embryos possess constitutional rights a legal battle that could reshape reproductive law.In a post-election memo, SBA Pro-Life America, a major anti-abortion advocacy group, insisted that the Republican Party must focus on the unalienable right to life for the unborn child that exists under the 14th Amendment. This indicates the GOP may be pressured to adopt the far-right goal of fetal personhood more aggressively potentially influencing its stance on issues like IVF too.Several pending lawsuits will force Trump to take clearer positions on abortion access than he might otherwise like.One concerns the federal Emergency Medical Treatment and Active Labor Act (EMTALA) requiring hospitals to provide emergency abortion care. Though Trump campaigned on supporting abortion in emergency situations, he has not yet clarified his position on the law. Project 2025, the controversial GOP blueprint that Trump has distanced himself from, called for rescinding Bidens EMTALA guidance and ending federal investigations into cases of alleged refusals to perform abortion. Trumps administration might also dismiss ongoing EMTALA cases in Texas and Idaho where the federal government has been arguing to preserve abortion rights. Another lawsuit is a newer case taking aim at mifepristone filed by three Republican state attorneys general. This suit notably argues that the FDA violated the Comstock Act by permitting abortion pills to be sent by mail. Last week, Kacsmaryk said this lawsuit could move forward. In the previous federal attempts to challenge the legality of mifepristone, the Biden administration defended access to the medication. Its not clear what Trumps DOJ will decide to do.Beyond these legal challenges, Congress may force Trumps hand as well. While House Speaker Mike Johnson limited certain anti-abortion measures in previous must-pass spending bills, it will be easier this year for Republicans to push restrictions forward. He and GOP Senate Majority Leader John Thune are planning to speak at the March for Life rally later this week, and Thune has already pledged to hold a vote on legislation that would introduce new criminal penalties for doctors based on myths about later abortions a move abortion rights advocates see as part of a larger plan to criminalize the procedure.For now, abortion rights groups are not planning to seek compromiseWhile some Republican lawmakers in addition to Trump have signaled openness to compromise on issues like abortion exceptions, contraception, and IVF, thus far theres little indication that abortion rights groups would seek such opportunities. We have no interest in shrinking our vision, Kimberly Inez McGuire, executive director of Unite for Reproductive & Gender Equity, told me late last year. Working with Republicans on even limited protections could also undercut the narrative of GOP extremism a message advocacy groups see as crucial for Democrats winning in 2026 and 2028.In general, polls show voters have grown even more supportive of abortion rights than they were before the Supreme Court overturned Roe. About 80 percent of voters say protecting contraception access is deeply important to them, and 72 percent of Republican voters had a favorable view of birth control. IVF is even more popular: 86 percent of Americans think it should be legal, including 78 percent of self-identified pro-life advocates and 83 percent of evangelical Christians.These overwhelming public approval numbers show why Trumps strategy of distancing himself from abortion restrictions resonated during the campaign. But governing requires actual decisions and unlike campaign rhetoric, those cant be as easily walked back.Youve read 1 article in the last monthHere at Vox, we're unwavering in our commitment to covering the issues that matter most to you threats to democracy, immigration, reproductive rights, the environment, and the rising polarization across this country.Our mission is to provide clear, accessible journalism that empowers you to stay informed and engaged in shaping our world. By becoming a Vox Member, you directly strengthen our ability to deliver in-depth, independent reporting that drives meaningful change.We rely on readers like you join us.Swati SharmaVox Editor-in-ChiefSee More: