What could abortion access look like under Trump?

Despite celebrating the passing of abortion-related ballot initiatives in seven states, abortion rights advocates warn that a second Donald Trump presidency puts nationwide access to abortion care in danger.

“An already harmful abortion access crisis will likely get worse,” Kelly Baden, the vice president of policy at the Guttmacher Institute, told ABC News.

“The 13 states that currently ban abortion — there are real consequences to that including death. Women are dying from these abortion bans,” Baden said.

Trump may have persuaded voters that there won’t be a federal abortion ban, but experts warn nationwide access could be at risk.

“I don’t think that people know that a federal abortion ban would preempt state constitutional protection. There could also be this sense that, ‘I’m voting yes on this amendment, and that means my state is fine,'” Elisabeth Smith, the director of state policy at the Center for Reproductive Rights, told ABC News.

“A federal abortion ban — if the U.S. Supreme Court allowed it to take effect — would preempt the policy of a state where abortion is legal and accessible,” Smith said. “We don’t yet know which party controls the House [of Representatives], but that is a possibility.”

The regulation of federal agencies could also impact access to abortion care. Medication abortion could come under fire if the Food and Drug Administration — under a Trump presidency — limits access to mifepristone, one of the pills used in the regimen to terminate pregnancy, or rolls back its approval, as anti-abortion groups have tried to do.

The Trump administration could also attempt to misuse the Comstock Act to try to prevent access to medication abortion, Smith warned.

The 150-year-old law is an anti-obscenity law “makes it a crime to mail anything that’s ‘indecent, filthy, or vile’ or ‘intended for producing abortion,'” according to the ACLU.

Ballot initiatives

Missouri became the first state with a near-total abortion ban in effect to approve a pro-abortion rights initiative since the U.S. Supreme Court overturned Roe v. Wade, ending federal protections for abortion rights.

If the ban is repealed as expected, Missouri could facilitate closer access to abortion care for women in the South. The state borders four states that have ceased nearly all abortion services — Kentucky, Tennessee, Arkansas and Oklahoma.

But, there is not currently a single brick-and-mortar abortion clinic in Missouri which means that even when the law is repealed, it would still take time for access to care to resume, according to Baden.

“So, we’ll continue to see people having to leave the state for clinician-provided abortion care or to find another way to get care in the meantime,” Baden said.

The legal proceeding to overturn the state’s ban under the new constitutional amendment could also take months to years, according to Baden.

The battlegrounds of Arizona and Nevada were also among 10 states with abortion on the ballot Tuesday. Some strategists hypothesized that this would boost turnout among the majority of voters who support legal abortion, aiding Democratic candidates in the process.

But, exit polling showed that some supporters of abortion still elected Trump in battleground states.

Advocates warn that while ballot initiatives have proved effective, they are not a universal solution.

“They are just one tool in the toolbox. They are clearly not our silver bullet, both, because structurally they can’t be. Not every state even allows for ballot measures like that, they’re expensive and they also are not an immediate solution … a series of litigation has to happen,”

Advocates for abortion-care-related protections said they will continue to work to restore and protect access to abortion care under the incoming administration.

“It is our task to hold this incoming administration to its word that it will not work to further restrict or ban abortion and we will hold them to their insistence that they will invest in caregiving,” Fatima Goss Graves, president of the National Women’s Law Center Action Fund, told reporters during a press conference Wednesday.