Trump promised to protect access to abortion pills. Things have changed.

(Photo illustration by Anna Moneymaker/Getty Images)

In an interview with TIME Magazine published last December, then-President-elect Trump was asked whether he would preserve access to abortion pills. Trump said that he staked out his position in a "long and hard campaign" and was "strongly against" restricting access. Trump emphasized that he would stand by his "commitment":

TIME: I think what the women of America want to know is, Are you committed to making sure that the FDA does not strip their ability to access abortion pills?

TRUMP: That would be my commitment. Yeah, it's always been my commitment.

During a presidential debate on June 27, 2024, Trump was asked whether, as president, he would restrict access to abortion pills. Trump said unequivocally that he would not.

CNN'S DANA BASH: [T]he federal government still plays a role in whether or not women have access to abortion pills. They're used in about two-thirds of all abortions. As president, would you block abortion medication?

TRUMP: First of all, the Supreme Court just approved the abortion pill, and I agree with their decision to have done that, and I will not block it.

Trump was correct that the Supreme Court unanimously rejected a lawsuit seeking to ban mifepristone, a drug used to induce abortions. But, the ruling was narrow and did not weigh in on whether banning or restricting mifepristone was permissible.

The Supreme Court's decision was based on a finding that the plaintiffs in the case, the Alliance for Hippocratic Medicine, lacked standing to bring the case. The Alliance for Hippocratic Medicine is a coalition of right-wing doctors. (The group was incorporated in Amarillo, Texas, because it guaranteed the case would be assigned to Judge Matthew Kacsmaryk, an anti-abortion activist that Trump appointed to the federal bench.) The Supreme Court found that since doctors can refuse to prescribe mifepristone, no members of the Alliance for Hippocratic Medicine had been harmed.

As a result, the Alliance for Hippocratic Medicine's case against the federal government — along with two other similar cases challenging the legality of mifepristone — continue. The lawsuits argue that the sale of mifepristone violates the Comstock Act, an 1873 law that has been ignored or limited by federal courts for decades. (Among other things, the Comstock Act made it "made it illegal to send 'obscene, lewd or lascivious,' 'immoral,' or 'indecent' publications through the mail.")

Under the Biden administration, the federal government moved to dismiss these pending lawsuits. The Trump administration is taking a different approach. NOTUS reports that "the Trump administration has now asked judges in Hawaii, Virginia and Texas for a 60-day extension to decide how it’ll keep handling those cases, saying it needs the time 'to familiarize itself with the issues.'"

The unusual request for delays, which have been granted by judges in Hawaii and Texas, signal that the Trump administration could be preparing to reverse its position on abortion pills — and abandon Trump's campaign pledge.

“President Trump has asked me to study the safety of mifepristone"

Despite Trump’s campaign promise to not block access to abortion medication, several of his cabinet picks have pledged to take another look at the safety of mifepristone, keeping the door open for future regulations. There have already been numerous studies proving the safety of mifepristone. According to the Food and Drug Administration (FDA), which approved the medication over two decades ago, mifepristone, which is used in conjunction with misoprostol, is “safe and effective.”

During his confirmation hearing, Robert F. Kennedy Jr., the Secretary of Health and Human Services, said Trump wanted him to study mifepristone for “safety issues.” “President Trump has asked me to study the safety of mifepristone,” Kennedy said. “He has not yet taken a stand on how to regulate it. Whatever he does, I will implement those policies.” Kennedy said he would ask the National Institutes of Health (NIH) and the FDA to review the medication.

Trump’s nominee for FDA commissioner, Dr. Marty Makary, also said in his confirmation hearing that he wanted to study the safety of mifepristone. “I have no preconceived plans on mifepristone policy except to take a solid, hard look at the data and to meet with the professional career scientists who have reviewed the data at the FDA, and to build an expert coalition to review the ongoing data, which is required to be collected as a part of the REMS program, the Risk Evaluation and Mitigation Strategy,” Makary said. Makary, who has not yet been confirmed by the full Senate, pledged to “do a review of the data” before making any decisions.

The Trump administration’s requests for delays could allow for more time for these cabinet picks to implement changes regarding the medication. The FDA could decide to impose new regulations and restrictions on mifepristone.

States restrict access

As the Trump administration delays taking a position on mifepristone, several Republican-controlled states have pushed ahead to restrict access to medication abortions.

Bills are moving through state legislatures in Missouri, Texas, and Idaho that would reclassify mifepristone as a controlled substance — following the passage of a similar bill in Louisiana last year.

In Louisiana, mifepristone is now treated like highly addictive drugs such as oxycodone and fentanyl, which were designated as controlled substances in an attempt to curb the opioid crisis. Similar to addictive opioids, mifepristone is now subject to a prescription monitoring program in Louisiana, which tracks which doctors prescribe the medication to which patients and makes other sensitive health information available to an array of state officials.

Being classified as a controlled substance also means that mifepristone must be kept under lock and key in Louisiana hospitals. Doctors in Louisiana are practicing getting mifepristone from the cabinet and back to patients’ rooms as quickly as possible, according to Business Insider. Mifepristone is often needed within minutes to help with birth complications.

Treating mifepristone as a controlled substance creates an environment in which doctors may hesitate to prescribe it, even when it may be necessary to save someone’s life.

Bills reclassifying mifepristone appear to have stalled in the legislative process in Indiana, Wyoming, Oklahoma, North Dakota, and Mississippi.

Missouri Attorney General Andrew Bailey has warned Planned Parenthood clinics in the state that it is illegal for them to provide medication abortions since they do not have a state-approved plan to address any complications that might arise when a patient takes mifepristone. (The clinics have said that they are not currently providing medication abortions since the state health department has not approved the plan they submitted, nor given a timeline for approval.)

In Tennessee, where mifepristone has been treated as a controlled substance since the 2022 Dobbs decision, lawmakers are considering a bill that would allow any “manufacturer, distributor, seller, or reseller of an abortion-inducing drug” who provides mifepristone to Tennessee patients to be sued for up to $5 million in damages.

Another bill in Texas would require a prescription and in-person physical examination from a doctor in Texas before an out-of-state provider can mail mifepristone to a Texas patient, making it even more difficult to obtain a medication abortion in the state.