Reproductive rights advocates and providers fear the Trump administration is poised to try to ban abortion nationwide following this week’s testimony from acting Attorney General Todd Blanche before the Senate Judiciary Committee.
Five of the panel’s Republican senators — including Chairman Chuck Grassley of Iowa, Katie Britt of Alabama and Ted Cruz of Texas — questioned Blanche during his confirmation hearing on Wednesday about the administration’s regulation of abortion pills by mail, a growing form of access in the years since the Supreme Court’s overruling of Roe v. Wade. His response to Cruz’s question about whether the administration would enforce a dormant 1873 law, the Comstock Act, set off alarm bells when he signaled his willingness to invoke it to drastically curtail abortion access.
“Everybody’s antennae are up in the air,” said Kristin Lyerly, an obstetrician-gynecologist in Wisconsin and the chair of the Committee to Protect Health Care, a physicians’ advocacy organization. “All of the abortion providers that I’m plugged in with are watching this all very closely and trying to prepare for every possible alternative.”
That is because even if Blanche’s nomination to be President Donald Trump’s attorney general on a permanent basis stalls in committee, he can continue serving in his acting capacity in charge of the Department of Justice.
Many Americans may have never heard of the Comstock Act, a Victorian-era law that bans the mailing of “every article or thing designed, adapted, or intended for producing abortion, or for any indecent or immoral use.” The anti-vice law has not been enforced in nearly a century, but it gained new currency among Republicans seeking to reduce telehealth abortions after the Biden administration began allowing abortion pills — mifepristone and misoprostol — to be delivered to patients by mail in 2021. Since then, medication abortions by mail have increased from 5% of all abortions in 2022 to more than a quarter last year, according to data collected by the Society of Family Planning. Medication abortions also account for the majority of abortions nationwide.
Trump’s allies have made clear they intend to reverse this trend. Project 2025, the Heritage Foundation’s playbook for Trump’s second term, repeatedly cited the Comstock Act by its statute numbers — not its name — and said the government should enforce it “against providers and distributors of [abortion] pills.”
On Wednesday, when Cruz asked Blanche if the DOJ would commit to “the faithful enforcement of the Comstock Act and other federal pro-life acts,” the acting attorney general’s answer was unequivocal.
“Yes,” Blanche replied.
Rachel Rebouché, a reproductive law scholar and professor at the University of Texas at Austin, characterized that response as an “about-face” for the Trump administration, given that Trump told CBS News in August 2024 that he would not enforce the Comstock Act to ban the mailing of abortion pills if re-elected.
While Republican senators and administration officials have largely focused on curbing access to abortion pills, Rebouché and other abortion advocates believe the Justice Department could use the Comstock Act to prohibit the mailing of tools used by medical professionals in procedural abortions.
“The law doesn’t single out ‘pills’ only,” Rebouché said. “The Judiciary Committee and Blanche are focused on pills, and that certainly would be covered by Comstock, but there’s no end to what it might cover as it’s related to abortion.”
Angel Foster, co-founder of the Massachusetts Medication Abortion Access Project, said a broad application of the Comstock Act would “wreak havoc on obstetrics and gynecology.”
Spokespeople for the Justice Department did not respond to questions from MS NOW on Thursday about potential plans to invoke the Comstock Act.
In an exchange with Britt, who discussed a case in which a woman was allegedly forced to take abortion pills by an ex-partner, Blanche called the mailing of abortion pills “wrong” and said, “I very much commit our resources to stopping this.”
Some said they view Blanche’s Senate hearing performance more as political posturing than as an imminent threat, given the negative impact that such a seismic policy change could have for Republicans just months before the midterms.
Longtime anti-abortion activist Randall Terry told MS NOW he believes “it would take enormous willpower and extensive political capital” for Blanche to enforce the law.
Foster also doubts that the DOJ could move to enforce Comstock without the backing of the White House.
“If this was a priority for Trump, I think he would’ve moved on it,” she said.
Still, Foster and other abortion providers are preparing for restrictions. In addition to the threat posed by Comstock, the Food and Drug Administration is conducting a so-called safety study of mifepristone, despite the fact that more than 100 scientific studies have confirmed the pills are safe and effective, including in cases when they are prescribed virtually and mailed to patients. Multiple legal cases are also playing out that could lead to a court ruling restricting access.
Tammi Kromenaker, director of the Red River Women’s Clinic in Moorhead, Minnesota, said she has spoken to other providers about stockpiling abortion pills to potentially distribute to patients in person if they cannot be mailed. Providers have also discussed stockpiling “all of the supplies” used in procedural abortions in case the Trump DOJ interprets Comstock as broadly as possible, she said, adding that some have even suggested that private mail carriers or underground distribution networks may not be subject to enforcement.
If the Department of Justice is able to enforce the 19th century law, she said, “I think that we’ll have some clever solutions to this.” But she warned it would cause “even more of a maternal health crisis than we have right now.”
Other providers have discussed preparing to potentially pivot to prescribing misoprostol by itself, given that mifepristone has been the focus of anti-abortion Republicans’ attempts to restrict access to the pills. Research shows the use of misoprostol by itself to induce abortion is slightly less effective than using both pills together. But advocates have said misoprostol-only regimens are likely the most commonly used form of medication abortion globally due to that pill’s availability.
Melissa Grant, co-founder of the healthcare nonprofit Carafem, which mails abortion pills to 21 states, told MS NOW on Thursday that her organization began providing misoprostol-only abortions in May, after the conservative 5th Circuit Court of Appeals in Louisiana temporarily blocked nationwide telehealth provision of abortion pills. (The Supreme Court temporarily paused that decision within days. The legal battle in that case — which Louisiana brought against the FDA — continues to play out, with oral arguments scheduled for September.)
Grant said the 5th Circuit decision was like “a fire drill for what we think could potentially happen in the future.”
But she also knows she may have to come up with a third alternative, depending on her lawyers’ advice and how the administration potentially regulates access to the pills. “Unfortunately, we can’t predict what the next trick is that they may pull out of their hat,” Grant said.
In a statement provided to MS NOW, Danika Severino, vice president of care and access for Planned Parenthood Federation of America, said the organization’s abortion providers “have already been forced to implement contingency plans once this year thanks to political interference,” referring to the 5th Circuit decision in May.
“Planned Parenthood is ready to do it again no matter who is behind the attack,” Severino added.
Amy Merrill, co-founder of Plan C, a website that provides information about access to medication abortion, agreed that “if restrictions are imposed, mailed options and virtual support are likely to continue through a range of alternate pathways.” These could include community networks or providers outside the U.S. who mail pills into the country, she said.
Blanche’s testimony came the day after Justice Department officials met with representatives of the anti-abortion group Americans United for Life, a spokesperson for the organization told MS NOW. The spokesperson insisted that “no promises were made” in the meeting, but that staffers were “happy” with Blanche’s comments about plans to restrict mifepristone.
Leaders of other anti-abortion groups, including SBA Pro-Life America and Students for Life of America, also expressed optimism following Blanche’s testimony.
But not all abortion opponents believe Comstock is the best way for the administration to crack down on the pills.
Terrisa Bukovinac, Terry’s wife and founder of Progressive Anti-Abortion Uprising, a left-wing group that opposes abortion, told MS NOW she is concerned about the potential use of the Comstock Act given its history of censoring LGBTQ expression.
“If [Blanche] does choose this route, I implore him to reassure the American people that the invocation of the Comstock Act will be used exclusively to end the distribution of abortion-inducing drugs,” she said.
To Kromenaker, the abortion provider in Minnesota, the current threats to access remind her of recent history — and she’s preparing accordingly.
“Any threat needs to be taken seriously at this point, because for a long time, many of us truly did believe they were going to overturn Roe, and a lot of people said, ‘Oh, you’re being hysterical,’” Kromenaker said.
“You prepare as much as you can, and within the constraints of your budget and your resources. But we just don’t know what they’re going to throw at us,” she added.
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