How the Biden Administration Protected Abortion Pill Access—and What Trump Could Do Next

President Joe Biden has taken a number of steps to protect access to abortion pills, particularly in the wake of the U.S. Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization two years ago. But now that Donald Trump has retaken the White House, he'll have the power to roll back some of those moves.

Since the Supreme Court overturned Roe v. Wade in 2022 and more than a dozen states have banned or restricted abortion, the usage of abortion pills has been on the rise. In 2023, medication abortions accounted for about 63% of all abortions in the American healthcare system, meaning that any policy on the two drugs—mifepristone and misoprostol—could have a significant impact on abortion access nationwide. 

President-elect Trump has flip-flopped on his stance on abortion, including abortion pills—while he’s recently said that he wouldn’t block abortion pills, he has in the past suggested that he would be open to revoking access to mifepristone. The uncertainty of what the incoming Trump Administration could do to abortion pill access leaves many reproductive-rights advocates and medical providers concerned.

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Brittany Fonteno, president and chief executive officer of the National Abortion Federation, says the Biden Administration “has been very supportive of abortion access,” but adds that there are limits to the executive power that the President has to protect access in the aftermath of the Dobbs decision. Many of the actions the Trump Administration could take on abortion pills don’t require approval from Congress the way a national abortion ban would. And curtailing access to abortion pills would effectively block people across the country from accessing abortion care—especially in states that have already restricted abortion.

The White House declined to comment on the record for this story, and the Trump transition team did not respond to multiple requests for comment.

Here’s a look at how the Biden Administration worked to protect access to medication abortion—and what authority the incoming Trump Administration would have to undo some of those policies.

Biden Administration

According to Dr. Sejal Hathi, an internal medicine physician who runs the Oregon Health Authority and previously the White House’s Senior Policy Advisor for Public Health in the Biden Administration, one of the most important actions in the past four years was to stand by the U.S. Food and Drug Administration’s (FDA) approval of mifepristone while the drug was challenged in court.

The Supreme Court agreed to hear the case after a lower court judge sided with a group of anti-abortion doctors and organizations, who pushed for the FDA’s decades-old approval of mifepristone to be revoked, despite years of research proving the drug’s safety. The Supreme Court unanimously rejected the challenge in June. As the case was making its way through court, the FDA and the Department of Justice (DOJ) defended access to mifepristone, and the White House released statements of support.

Under the Biden Administration, the FDA facilitated access to abortion pills during the COVID-19 pandemic, including by ending the previous requirement that mifepristone be dispensed in person, allowing healthcare providers to use telehealth to prescribe the drug and patients to receive it by mail. In January 2023, after a comprehensive assessment of the risks and benefits, the FDA made those changes permanent. The FDA also allowed pharmacies to choose to become certified to dispense mifepristone.

“The Biden Administration made it easier for women across the country to access medication abortion, to receive it in the mail, including in states where there are otherwise onerous restrictions,” Hathi says. “They also made it easier for pharmacies of all types, including major retail pharmacies, to dispense the medication simply [by] becoming certified, allowing women to just easily pick it up from their nearest pharmacy.”

After receiving reports that some state officials had announced plans to restrict access to mifepristone, Biden signed a Presidential Memorandum in January 2023, directing Cabinet officials—including the Secretary of the Department of Health and Human Services (HHS)—to consider issuing guidance to help protect the safety and security of patients, providers, and pharmacies who are legally accessing, prescribing, or providing mifepristone.

In 2022, the DOJ’s Office of Legal Counsel released a letter reaffirming that the Comstock Act doesn’t prohibit the mailing, delivery, or receipt of legal medication abortion. The letter came after anti-abortion activists indicated an interest in misusing the 19th century anti-obscenity law to ban the mailing of abortion pills. But Fonteno says the 2022 letter made clear to the public the federal government’s stance that the law wouldn’t be used to restrict abortion pill access, and only applies to people who are mailing abortion pills for a criminal purpose.

Trump Administration

That letter is one of the actions taken during the Biden Administration that experts say could be rolled back by Trump. “Looking to a Trump-Vance Administration, there could be an opportunity for them to rescind that letter,” says Fonteno. That could embolden anti-abortion activists to try and misuse the Comstock Act to ban the mailing of abortion pills, making it harder for people to get medication abortions.

It’s not clear yet what exactly Trump will do when it comes to abortion once he takes office for the second time in January. While the President-elect has applauded himself for his role in nominating three of the Supreme Court Justices who helped bring about the Dobbs decision, he tried to moderate his stance on abortion during the campaign, insisting that he wouldn’t push for a national abortion ban if elected.

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Much of what a Trump Administration would do on abortion pills depends on who the incoming President will appoint to certain positions. New officials at the FDA could decide to revoke the decades-old approval of mifepristone, which is what Project 2025—a presidential transition plan drafted by Trump allies that the President-elect tried to distance himself from during his campaign—calls for. Or Trump-appointed officials could roll back measures passed under the Biden Administration that were meant to facilitate access to abortion pills.

“The people that he appoints to really key positions within his administration is something that we’re definitely keeping our eyes on,” Fonteno says. “Who is going to be the secretary of HHS? What is the Department of Justice going to look like, and will they be weaponizing their power to try to attack abortion access, rather than focus on other ways to keep the American people safe?”

The President-elect has already started announcing his picks for Cabinet positions. Trump named Robert F. Kennedy Jr., who has promoted anti-vaccine misinformation and health-related conspiracy theories, as his pick to head HHS. Kennedy, like Trump, has taken a shifting stance on abortion. Trump also announced Matt Gaetz, who has stood against abortion rights, as his nominee for Attorney General. Both would have to be confirmed by the Senate.

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Trump’s federal judge appointments could also further restrict access to abortion pills. Since the Dobbs decision, many abortion restrictions have been battled out in the courts, including the case over the FDA’s approval of mifepristone. The lower court judge who initially ruled to revoke the FDA’s approval of the drug, U.S. District Judge Matthew Kacsmaryk, was appointed by Trump. By the end of Trump’s first presidential term in 2021, he had appointed nearly 30% of all active federal judges. In his second term, he could continue stacking the courts with conservative judges who could rule against preserving access to medication abortion.

“Medication abortion has just made such a difference in helping many people who would have faced these seemingly insurmountable barriers to accessing care,” Fonteno says. “Curbing access to medication abortion would just really be detrimental to many people’s health care.”