WASHINGTON (AP) — Abortion advocates say there is still work to be done to further restrict access to abortion when republican donald trump returns to the White House next year.

They point to the federal orientation 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 easing prescription restrictions for abortion pills which have allowed women to order the medication online with the click of a button.

“The work now begins to dismantle the pro-abortion policies of the Biden-Harris administration,” the Susan B. Anthony List, the powerful anti-abortion lobby, said in a statement Wednesday. “The pro-life achievements of President Trump’s first term are the foundation for his second term.”

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

Trump has said abortion It is a problem for the states, not the federal government. However, during the campaign, he clearly noted that he appointed Supreme Court justices who were in the majority when they overturned the national right to abortion. And there are things his administration can do, from electing judges to issuing regulations and promoting an anti-abortion agenda.

Trump unlikely to require emergency abortions in hospitals

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

There have been reports of women being sent home or left untreated in hospitals in dangerous situations. It proliferated throughout the United States. since the Supreme Court struck down the national right to abortion in 2022. In some cases, hospitals said state abortion bans had prevented them from terminating pregnancies.

“We are seeing that pregnant people’s lives are in danger,” 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 suffered sepsis and now we are hearing reports of deaths.”

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

Some doctors and hospitals have also said federal guidance offered them protection for performing 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 at risk. But he hasn’t gone so far as to say he supports exemptions when a woman’s health is at stake.

Abortions may be necessary to prevent organ loss, major 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, the fetus may still be alive, but continuing the pregnancy can be harmful. Doctors have argued that the legal gray area has put them in a bind.

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

The Biden administration sued Idaho, arguing that its state law conflicted with federal law requiring hospitals to provide stabilizing treatment, which could include abortions, to patients. The state changed its law to allow abortions in cases of ectopic pregnancies, but other dangerous scenarios are still unknown. The Supreme Court declined to address the issue earlier this year, issuing a limited order that cleared the way for hospitals to provide emergency abortions while the case moved through lower courts.

However, enforcement of the federal law is suspended in Texas, which questioned the Biden administration’s guidelines on emergency abortions.

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

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

Challenges to abortion pill access will continue under Trump

The ease with which women have been able to obtain abortion pills could also be up for reconsideration under Trump.

During the COVID-19 pandemic, the Food and Drug Administration made it easier to obtain abortion pills, including mifepristone, allowing women to access the medications via telehealth. The agency approved the drug’s safety during 10 weeks of pregnancy and said adverse effects occur in 0.32% of patients.

Abortion advocates have disputed this, arguing that the drugs are unsafe and, at the very least, not suitable for easy access without a doctor’s personal supervision.

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

Some women are worried. Telehealth company Wisp saw an immediate spike in abortion pill orders between Election Day and the next day, increasing by 600%. In states like Florida and Texas, where the drug cannot be legally shipped, the company saw a nearly 1,000% increase in orders for so-called morning-after pills, also known as emergency contraception.

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

Currently, women typically follow 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 regimen only in case a restriction on mifepristone 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 moved away from a more rigid stance on abortion, even saying he would not sign a national abortion ban if it reached his desk.

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

“I don’t think we have a clear idea of ​​what it would do,” Ziegler said.

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Associated Press writer Lindsay Whitehurst contributed to this report.