This week would have marked the 53rd anniversary of Roe v. Wade, the 1973 Supreme Court decision that legalized abortion nationwide — that is, until 2022, when the court overturned it. Since then, abortion has been banned in 13 states and severely limited in 10 others.

Yet anti-abortion activists remain frustrated, in some cases even more so than before Roe was overturned.

Why? Because despite the new legal restrictions, abortions have not stopped taking place, not even in states with complete bans. In fact, the number of abortions has not dropped at all, according to the latest statistics.

“Indeed, abortions have tragically increased in Louisiana and other pro-life states,” Liz Murrill, Louisiana’s attorney general, said at a Senate Health, Education, Labor, and Pensions Committee hearing this month.

That’s due in large part to the easier availability of medication abortion, which uses a combination of the drugs mifepristone and misoprostol, and particularly to the pills’ availability via mail after a telehealth visit with a licensed health professional.

Allowing telehealth access was a major change originally made on a temporary basis during the covid pandemic, when visits to a doctor’s office were largely unavailable. Before that, unlike most medications, mifepristone could be dispensed only directly, and only by a medical professional individually certified by the Food and Drug Administration.

The Biden administration later permanently eliminated the requirement for an in-person visit — a change the second Trump administration has not undone.

While the percentage of abortions using medication had been growing every year since 2000, when the FDA first approved mifepristone for pregnancy termination, the Biden administration’s decision to drop the in-person dispensing requirement supercharged its use. More than 60% of all abortions were done using medication rather than a procedure in 2023, the most recent year for which statistics are available. More than a quarter of all abortions that year were managed via telehealth.

Separately, President Donald Trump’s FDA in October approved a second generic version of mifepristone, angering abortion opponents. FDA officials said at the time that they had no choice — that as long as the original drug remains approved, federal law requires them to OK copies that are “bioequivalent” to the approved drug.

It’s clear that reining in, if not canceling, the approval of pregnancy-terminating medication is a top priority for abortion opponents. This month, Susan B. Anthony Pro-Life America called abortion drugs “America’s New Public Health Crisis,” referencing their growing use in ending pregnancies as well as claims of safety concerns — such as the risk a woman could be given the drugs unknowingly or suffer serious complications. Decades of research and experience show medication abortion is safe and complications are rare.

Another group, Students for Life, has been trying to make the case that the biological waste from the use of mifepristone is contaminating the nation’s water supply, though environmental scientists refute that claim.

Yet the groups are most frustrated not with supporters of abortion rights but with the Trump administration. The object of most of their ire is the FDA, which they say is dragging its feet on a promised review of the abortion pill and the Biden administration’s loosened requirements around its availability.

President Joe Biden’s covid-era policy allowing abortion drugs to be sent via mail ”should’ve been rescinded on day one of the administration,” SBA Pro-Life America’s president, Marjorie Dannenfelser, said in a recent statement. Instead, almost a year later, she continued, “pro-life states are being completely undermined in their ability to enforce the laws that they passed.”

Lawmakers who oppose abortion access are also pressing the administration. “At an absolute minimum, the previous in-person safeguards must be restored immediately,” Senate HELP Committee Chairman Bill Cassidy said during the hearing with Murrill and other witnesses who want to see abortion pill availability curtailed.

Sen. Jim Banks (R-Ind.) said at the hearing that he hoped “the rumors are false” that “the agency is intentionally slow-walking its study on mifepristone’s health risks.”

The White House and spokespeople at the Department of Health and Human Services have denied the review is being purposely delayed.

“The FDA’s scientific review process is thorough and takes the time necessary to ensure decisions are grounded in gold-standard science,” HHS spokesperson Emily Hilliard said in an emailed response to KFF Health News. “Dr. Makary is upholding that standard as part of the Department’s commitment to rigorous, evidence-based review.” That’s a reference to Marty Makary, the FDA commissioner.

Revoking abortion pill access may not be as easy as advocates hoped when Trump moved back into the White House. While the president delivered on many of the goals of his anti-abortion backers during his first term, especially the confirmation of Supreme Court justices who made overturning Roe possible, he has been far less doctrinaire in his second go-round.

Earlier this month, Trump unnerved some of his supporters by advising House Republicans that lawmakers “have to be a little flexible” on the Hyde Amendment to appeal to voters, referring to a decades-old appropriations rule that bans most federal abortion funding and that some Republicans have been pushing to enforce more broadly.

And while the anniversary of Trump’s inauguration has many analysts noting how much of the Heritage Foundation’s Project 2025 blueprint has been realized, the most headline-grabbing portions on reproductive health have yet to be enacted. The Trump administration has not, for example, revoked the approval of mifepristone for pregnancy termination, nor has it invoked the 1873 Comstock Act, which could effectively ban abortion nationwide by stopping not just the mailing of abortion pills but also anything else used in providing abortions.

Still, abortion opponents have decades of practice at remaining hopeful — and playing a long game.

HealthBent, a regular feature of KFF Health News, offers insight into and analysis of policies and politics from KFF Health News chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Congressional Republicans are reportedly trying to insert anti-abortion language into government funding legislation as the shutdown continues, with the GOP and President Donald Trump digging in against a clean extension of Affordable Care Act tax credits as insurance premiums surge.

Sen. Ron Wyden (D-Ore.), the top Democrat on the Senate Finance Committee, sounded the alarm on Saturday about what he characterized as the latest Republican sneak attack on reproductive rights.

“Republicans said they might vote to lower Americans’ healthcare costs, but only if we agree to include a backdoor national abortion ban,” Wyden said in remarks on the Senate floor.

The senator was referring to a reported GOP demand that any extension of ACA subsidies must include language that bars the tax credits from being used to purchase plans that cover abortion care.

But as the health policy organization KFF has noted, the ACA already has “specific language that applies Hyde Amendment restrictions to the use of premium tax credits, limiting them to using federal funds to pay for abortions only in cases that endanger the life of the woman or that are a result of rape or incest.”

“The ACA also explicitly allows states to bar all plans participating in the state marketplace from covering abortions, which 25 states have done since the ACA was signed into law in 2010,” according to KFF.

Wyden said Saturday—which marked day 39 of the shutdown—that “Republicans are spinning a tale that the government is funding abortion.”

“It’s not,” Wyden continued. “What Republicans are talking about putting on the table amounts to nothing short of a backdoor national abortion ban. Under this plan, Republicans could weaponize federal funding for any organization that does anything related to women’s reproductive healthcare. They could also weaponize the tax code by revoking non-profit status for these organizations.”

“The possibilities are endless, but the results are the same: a complete and total restriction on abortion, courtesy of Republicans,” the senator added. “Trump said he’d leave abortion care up to the states. Well, this latest scheme makes it crystal clear: A de facto nationwide abortion ban has been his plan all along.”

The GOP effort to attach anti-abortion provisions to government funding legislation adds yet another hurdle in negotiations to end the shutdown, which the Trump administration has used to throttle federal nutrition assistance and accelerate its purge of the federal workforce.

Trump is also pushing a proposal that would differently distribute federal funds that would have otherwise gone toward the enhanced ACA tax credits, which are set to expire at the end of the year.

“It sounds like it could be a plan for health accounts that could be used for insurance that doesn’t cover preexisting conditions, which could create a death spiral in ACA plans that do,” said Larry Levitt, executive vice president for health policy at KFF

President Donald Trump and his administration have been hit with an onslaught of lawsuits since his return to the White House, but according Newsweek, on Friday they received some rare legal pushback from a conservative organization.

Per Newsweek's report, Judicial Watch, a conservative nonprofit, filed a lawsuit against the Department of Health and Human Services, alleging that the agency had failed to provide a timely response to its Freedom of Information Act (FOIA) request. The group requested survey information pertaining to abortion-related research at a facility in Pittsburgh.

The request was initially submitted on May 30 of last year, and according to the filing, while it was acknowledged by HHS on the same day, the organization has not heard back about it since then. The nonprofit is looking to obtain "All documents and communications of officials in the Office of Extramural Research concerning the Final Research Performance Progress Report (FRPPR) for the GUDMAP program at the University of Pittsburgh (Project Number U24- DK110791-01)," as part of an investigation for fetal tissue research programs using federal funds.

"As of the date of this Complaint (Jan. 2, 2026), Defendant has failed to: (i) determine whether to comply with the request; (ii) notify Plaintiff of any such determination or the reasons therefor; (iii) advise Plaintiff of the right to appeal any adverse determination; or (iv) produce the requested records or otherwise demonstrate that the requested records are exempt from production," the lawsuit alleged.

Newsweek noted that this lawsuit is among many that the Trump administration has faced for its alleged failures to comply with FOIA requests in a timely manner. Judicial Watch, for example, also sued the Justice Department over allegations that its FOIA request for "records about the alleged transfer of fetal tissue" was not answered sufficiently.

“Americans have a right to know basic information about the taxpayer-funded abortion industrial complex," Tom Fitton, president of Judicial Watch, said in a statement. "As long as the government continues to fund these gruesome projects, Judicial Watch will work to expose them.”

For generations, conservatives and libertarians attacked liberals and progressives for failing to respect states' rights, arguing that it was grossly unfair to make Alabama and Mississippi residents live by Massachusetts standards. The states' rights argument was often used by Republicans to criticize the U.S. Supreme Court's Roe v. Wade ruling of 1973; abortion laws, opponents of the decision argued, needed to be determined on a state-by-state basis instead of having a national standard.

In an article published on February 5, journalist Ross Rosenfeld cites a range of ways in which the second Trump Administration, he says, is showing a total disdain for states' rights.

"Beyond the immediate concern that Trump intends to interfere in upcoming national elections," Rosenfeld explains, "his comments and actions are a stark departure from previous Republican positions on states' rights. Just a decade ago, when Trump first sought the presidency, the Republican Party platform included complaints against the Obama Administration for 'bullying of state and local governments'…. And Trump himself stated, in 2016, that 'many, many things actually should be states' rights.' He said he was willing to leave issues involving transgender Americans and abortion to the states, and promised to 'make states the laboratories of democracy once again.'"

Rosenfeld continues, "Yet the notion of states' rights has gone the way of the wind as Trump has remade the GOP in his authoritarian image and sought to massively expand his executive power. Now, he's deemed states' rights rather inconvenient to his maximalist goals."

Trump, Rosenfeld argues, showed no regard for states' rights when he called for elections to be taken over by the federal government instead of run by individual states — a proposal that, the journalist notes, would be blatantly unconstitutional. And Trump "attacked the rights of cities and states to enact 'sanctuary city' policies," Rosenfeld observes.

"Trump has issued executive orders targeting states' own climate laws, despite the fact that, as attorney David Doniger of the National Resources Defense Council puts it, 'the U.S. Supreme Court has upheld state authority to enact and enforce such laws from the early 19th Century to the present day,'" Rosenfeld explains. "After the murder of nurse Alex Pretti in Minneapolis by a Border Patrol agent and a Customs and Border Protection officer, the president told reporters, 'You can't have guns. You can't walk in with guns'…. Trump and his MAGA underlings have decided, in other words, that the Second Amendment — long an inviolable part of Republican orthodoxy — does not apply to anti-ICE protesters…. Trump, then, only cares about states' rights when it serves his political or policy purposes."

Rosenfeld adds, "But by and large, during his second term, Trump has shown little regard for states’ rights and sovereignty. There's no clearer example of this than his militarization of American cities."

In the past, many Democratic mayors tried to maintain a dialogue with conservative Republican presidential administrations despite strong policy differences. Members of Democratic former Philadelphia Mayor John Street's administration were critical of the George W. Bush Administration, yet when President Bush visited Philly for Fourth of July celebrations in 2001, Street rolled out the red carpet for him.

Similarly, quite a few Democratic mayors worked with the Reagan Administration during the 1980s despite their vehement criticism of Reaganomics.

But in 2026, tensions between Democratic mayors and President Donald Trump are growing "increasingly hostile," according to the Associated Press (AP). And AP reporter Steven Sloan, in an article published on February 6, stresses that mayors and other local officials are actively taking steps to prepare for attacks from the Trump Administration.

"A half-dozen state and local officials from both major political parties, over the past week, described an increasingly hostile relationship with Washington," Sloan reports. "While there's inherent tension between city, state and federal governments over power, politics and money, the current dynamic is unlike anything they've experienced, particularly after federal agents killed two U.S. citizens in Minneapolis last month."

Sloan cites Denver Mayor Mike Johnston as an example of a Democrat who views U.S. cities as under attack.

Johnston told AP, "We used to prepare for natural disasters. Now, we prepare for our own federal government."

But Democrats aren't the only state and local officials who are worried about the Trump Administration.

Republican Fresno, California Mayor Jerry Dyer told AP, "This is unprecedented. I've never seen federal law enforcement come to the cities, whether it's National Guard or ICE, and police cities without a level of cooperation from local police."

Another Republican, Burnsville, Minnesota Mayor Elizabeth Kautz, told AP that because of U.S. Immigration and Customs Enforcement (ICE) raids, she now carries her passport for identification.

Kautz told AP, "With the introduction of ICE, our cities are no longer safe."

"Tensions" between the Trump Administration and non-MAGA mayors and governors, according to Sloan, "have upended longtime Republican arguments that the federal government should leave local governance to the states under the 10th Amendment to the U.S. Constitution."

"Now," Sloan reports, "a Republican president is articulating a muscular federal approach over the protest of Democrats…. The president’s willingness to use federal power is often issue-based, favoring states in areas like abortion or education while embracing a strong federal role on immigration and elections. Trump said, this week, that Republicans should 'nationalize' elections — a power the Constitution expressly gives to states.