The antiabortion lobby expected to be more triumphant by now: A conservative Supreme Court overturned Roe v. Wade, Republicans control both chambers of Congress, and the self-styled “most pro-life president in history” again occupies the Oval Office.
But abortions are up in the years after the overturning of Roe, and the antiabortion lobby has a new locus for blame. “Trump is the problem. The president is the problem,” Marjorie Dannenfelser , the influential president of Susan B. Anthony Pro-Life America, said in an interview with The Wall Street Journal.
The ubiquity of abortion pills during the second Trump administration has led antiabortion advocates to decry the president’s appointees, including Health and Human Services Secretary Robert F. Kennedy Jr. and Food and Drug Administration Commissioner Marty Makary , and promise cash and political firepower to politicians who oppose the drugs.
Dannenfelser’s assessment for supporters packed into a glitzy neoclassical auditorium in downtown Washington for the group’s spring gala Wednesday was dire: If Republicans don’t abandon Trump’s strategy of letting states decide abortion law , “then the movement as we know it is finished.”
Now, Dannenfelser’s group is preparing to spend $160 million in the coming midterms and the 2028 presidential primary. The hurdle for candidates looking to tap in to that support: They must commit, Dannenfelser said, “to pro-life action at the national level.”
Leaders in the antiabortion movement are quick to credit Trump for nominating the Supreme Court justices who overturned Roe, but their frustration has been building for months.
They hoped that the administration would roll back Biden-era rules allowing the abortion pill, mifepristone, to be prescribed online and shipped through the mail. The regulations have allowed clinicians in states with liberal abortion laws, such as New York, to prescribe and send pills to women in states with strict abortion bans, such as Mississippi. The Food and Drug Administration has instead left those rules intact. Under Makary’s leadership, the agency approved a new generic version of the drug last fall, and has yet to produce a promised safety study of the pill.
The Justice Department, meanwhile, has asked courts to pause or completely dismiss lawsuits from Republican state attorneys general over access to mifepristone.
“This is just insulting, right? This is not what we voted for,” said Marc Wheat, general counsel for Advancing American Freedom, an organization founded by former Vice President Mike Pence .
Tony Perkins , president of the conservative Family Research Council, called the situation “unprecedented.”
“You have Republican states that are challenging a Republican administration over this because their laws are being undermined,” Perkins said. “Pro-life voters are going to be wondering what’s going on when they head into the polls in November.”
A federal appeals court on Friday blocked doctors from mailing mifepristone to pregnant women without seeing the patient in person, ruling in favor of Louisiana. The decision marked a significant win for antiabortion groups and sparked outcry from supporters of abortion rights. The Trump administration had asked a federal court earlier this year to block Louisiana’s challenge.
After the ruling, Dannenfelser said: “It’s shameful that the Trump administration’s inaction has forced pro-life states to take their battle to the federal courts.”
Asked about criticism from antiabortion advocates, White House spokeswoman Allison Schuster said, “Since his first term, the President has been a proven leader in the pro-life movement and he will continue to champion these policies to protect the sanctity of life.” Calling Trump “the most pro-life and pro-family president in history,” Schuster said the FDA is conducting a review of mifepristone in response to what she called “widespread concerns” about the drug.
SBA called for Makary to be fired last December following reports that the commissioner was slow-walking the safety review of the abortion pill. Later that same month, Pence called on Trump to take an additional step and fire Kennedy, calling him “a progressive wolf in pro-life sheep’s clothing.”
“It’s very clear that the issue is perceived as the third rail, and you just have to stay away from it,” Dannenfelser said of how she believes the White House handles the topic. “You cannot utter the A-word.”
For months, the administration said the new safety study was coming, and Makary has said publicly that his agency is working on the data acquisition needed to finish the review. But privately, the FDA commissioner has told others in the administration that he can’t produce the study until a new drug-safety data-monitoring system, known as Sentinel 3.0, is up and running, people familiar with the matter said.
Makary has argued current systems are inadequate to the task—a claim some FDA staff dispute. The FDA hasn’t yet finished the lengthy process of finding a contractor to run the new system, which might not be ready to use until late 2026 or even 2027, some of the people said.
Sen. Bill Cassidy (R., La.), an SBA favorite who has been criticized by Trump, said a review is necessary because he worries easy-to-access abortion pills have led to women taking them at later stages of pregnancy, resulting in more dangerous complications such as hemorrhage. He is also worried about women being coerced into taking the pills by boyfriends or others.
The FDA says on its website that the drug, approved more than 20 years ago, is safe when used as indicated.
HHS spokesman Andrew Nixon said the FDA awarded a contract for the mifepristone study and is close to selecting a contractor for the Sentinel 3 system, which is on track to be operational by the end of this fiscal year.
Some in the antiabortion movement, including SBA, have accused the Trump administration of dragging its feet on the review to avoid political controversy before the midterms, an allegation that both the White House and FDA deny. Makary’s delays on Sentinel, according to people familiar with the situation, have frustrated health officials, including Kennedy, who wants the system to review both mifepristone and other drugs, vaccines and chronic health issues.
Makary had already surprised some top administration officials with his decision to approve a generic version of the abortion pill last fall, according to people familiar with the matter.
“The FDA only approved a second generic mifepristone tablet because federal law requires approval when an application proves the generic is identical to the brand-name drug,” HHS’s Nixon said.
Makary told the Journal last year that the administration could have slow-walked the approval. “There are ways we could have subverted, we could have drug our feet,” he said in October, voicing indifference to policy around the abortion pill. “I don’t think about the abortion pill” or its safety restrictions, Makary said.
While Trump campaigned explicitly on an antiabortion message the first time he sought the GOP nomination, he has subsequently held the issue at arm’s length, saying he favors states deciding their own policies.
Dannenfelser called Trump immediately after he announced during the 2024 campaign that he would leave the issue to the states. The message from the then-former president, she recalled, was that a hard line on abortion, specifically federal restrictions, would cost Republicans with voters. “It’s killing us,” she recalled him saying.
Dannenfelser tried calling Trump earlier this year, after he called for “flexibility” on the Hyde Amendment banning federal funds for abortion.
She said she was sent to voicemail.
Write to Philip Wegmann at philip.wegmann@wsj.com , Liz Essley Whyte at liz.whyte@wsj.com and Jennifer Calfas at jennifer.calfas@wsj.com
