“Big moves on Day 1,” White House senior policy strategist May Mailman crowed on X the morning of President Donald Trump’s inauguration, linking to a news article about a forthcoming executive order. Even amid the barrage of actions during the first hours of the Trump 2.0 presidency, the order—“Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government”—was a bombshell. It directed federal agencies to eradicate every trace of what it called “gender ideology” and established new government-wide definitions of the sexes. “Woman” meant adult human female. “Female” was “a person belonging, at conception, to the sex that produces the large reproductive cell.” Men made “the small reproductive cell.” “Sex,” it decreed, was an “immutable biological reality.” For at least two years, Trump had been promising to “get transgender out” of schools, women’s sports, and the military. “It will be the official policy of the United States government that there are only two genders: male and female,” he would tell his cheering crowds. > Riley Gaines, the swimmer–turned–anti-trans activist, fangirled, “May Mailman > is my Taylor Swift.” But the order’s sweep and audacity seemed to surprise even Trump’s admirers. “It’s perfection,” Megyn Kelly gushed on her SiriusXM show. “In my wildest dreams, I couldn’t have drafted something this beautiful.” On X, the kudos flowed in from people in the United Kingdom, Australia, and Brazil. Many of the posts singled out Mailman, a Harvard-educated lawyer quickly identified as the order’s chief author. Riley Gaines, the swimmer–turned–anti-trans activist, fangirled, “May Mailman is my Taylor Swift.” Mailman had spent four years working in the first Trump administration, becoming an immigration hawk and close ally and friend of senior adviser Stephen Miller. During the Biden era, she landed at the Independent Women’s Forum, a Washington power player that rose to prominence by pink-washing conservative economic policies—claiming to champion women’s freedom and equality while actually working to undermine them. There, she threw herself into the anti-trans cause, going from state to state to promote model legislation, known as the Women’s Bill of Rights, that enshrined narrow definitions of “male” and “female” into law. May Mailman, director of the Independent Women’s Forum’s law center, speaks at a 2024 press conference about suing a sorority that allowed transgender women to join.David ZalubowskiAP Now, at the start of Trump’s second term, Mailman was stepping into the spotlight as a White House surrogate and speaking to conservative outlets about the need to “protect” cisgender women. “If men can just assert that they are women and take women’s privacy away, take their opportunity away, take their safety away,” she told a St. Louis radio host, “then there is no such thing as women’s rights anymore.” But there were intimations that the crusade against trans people encompassed something broader. Mailman wasn’t just anti-trans; she was profoundly dismissive of feminism. “There’s something about, you know, swiping right and left in your apartment by yourself at 11 p.m. after working a hard day that, like, doesn’t feel like feminism is the answer to all your problems,” she mocked on one podcast. She was worried about how “gender ideology” would affect men, too. “Who’s going to be our firefighters? Who are going to be our policemen?” she fretted on another. At a Federalist Society webinar last March, she urged listeners not to even use the word “transgender,” so as not to give “credence” to the idea of “this being a category of people.” She also raised an essential question: After defining sex in the law and kicking trans women out of sports and sororities, what comes next? The answer, she suggested, had something to do with sorting out social roles for men and women. “Trying to figure out how much do we care about gender roles, how much should gender roles infect the idea of womanhood, will, I think, ultimately affect our thinking about gender roles absent transgenderism,” she mused. Then she stopped, as if realizing she was treading into dangerous territory, and smiled. “That conversation is maybe for another day.” This is the story of an extraordinary effort by the second Trump administration to shape our ideas about who and what men and women are—a campaign that began with the targeting of trans people but has vast implications for the rights of cisgender people as well. At the center is Mailman, who describes herself as “one of the most effective and connected veterans of the Trump West Wing,” the get-it-done woman for Trump’s get-it-done man. “Stephen [Miller]’s the ideas guy,” she told Blaze News in April. “And then I’m trying to be the one who makes it happen.” In her whirlwind tour through the White House last year, Mailman made quite a few things happen very quickly—including a high-profile pressure campaign against her alma mater Harvard University to adopt Trumpian priorities in hiring and admissions or lose federal funding. Then, after six months, she left the administration, returning to IWF—now rebranded as just Independent Women—to direct its law center. There, she co-authored amicus briefs in two of the biggest Supreme Court cases of the year, both involving transgender students trying to overturn laws that forbid them from playing girls’ sports. The day after oral arguments, Mailman was on Fox News complaining that some of the justices had dared to call the students “transgender girls.”   > “The executive order absolutely has implications for heterosexual, cisgender > women. Sometimes, I think that’s their main target.” Her Defending Women executive order—and the other anti-trans federal decrees that followed—had an immediate, sweeping impact on the estimated 2.8 million trans Americans over age 13. On the phone several days after January’s Supreme Court hearing, Mailman tells me the push to enshrine definitions of sex had two goals: to prevent courts and administrators from interpreting existing laws in ways that are inclusive of trans people and to make voters feel alienated from Democrats. She frames the idea that transgender women are women as an “elite” concept. “If the left can’t agree that ‘woman’ means ‘female,’” she says, “there is something very othering about that to most Americans.” Now feminist scholars are also starting to raise alarms about the order’s implications for non-trans women. They warn it could be used to undo 50 years of legal and economic progress in the workplace, health care, education, and much more. “At the moment, the most painful, prejudicial consequences are for trans people,” says Kathryn Abrams, a University of California, Berkeley law professor studying sex discrimination. But “the executive order absolutely has implications for heterosexual, cisgender women,” she says. “Sometimes, I think that’s their main target.” For decades, much of the conservative movement has been fighting to undermine anti-discrimination protections based on sex, explains legal historian Mary Ziegler of the University of California, Davis. These include landmark laws like Title IX, which applies in education, and court decisions like United States v. Virginia, which said the government must have a strong reason, based on more than just stereotypes about physical capabilities, to treat men and women differently. Those protections profoundly reshaped American society, giving women more freedom to pursue the lives of their choosing. But they imposed new requirements on powerful institutions that balked at being regulated, and, Ziegler says, they outraged Christian conservatives who believe that “God has a plan for marriage and sexuality and the family” and “God’s plan should be written into the law.” The right slowed the momentum for women’s equality when it killed the Equal Rights Amendment in the early 1980s and turned abortion into a wedge issue. Decades later, the anti-trans movement’s emphasis on strictly defining sex as “biological” has given conservatives a new weapon to claw back the feminist movement’s earlier gains, Ziegler says. The term “biological sex,” she says, has become “the new takedown strategy for anti-discrimination law.” Related HOW RIGHT-WING SUPERSTAR RILEY GAINES BUILT AN ANTI-TRANS EMPIRE Mailman, not surprisingly, disputes that the sex definitions are part of a wider effort to weaken sex discrimination law. “Simply cementing the case that sex is real doesn’t change anything,” she tells me. “It is the status quo.” Nor does she think enshrining sex definitions based on eggs and sperm will lead to women being treated differently from men in, say, classrooms and workplaces. “There’s nothing about that that forces a woman into a separate calculus class.” But Mailman’s allies in the conservative movement—groups like the Alliance Defending Freedom, the religious right legal organization that has led many of the biggest attacks on abortion and LGBTQ rights—have their own agendas. “What they’re trying to do is to replace sex discrimination law with a Trojan horse sex discrimination law that no longer prohibits sex discrimination,” Ziegler says. Rather than attacking protections head on, she explains, “they’re going to say, ‘American anti-discrimination law means you can treat men and women differently because they have different bodies.’” If courts embrace this logic, Ziegler says, it would be much harder to fight back against potential restrictions on women’s lives—laws that limit job options for pregnant workers, for example, or that ban women from military schools—by arguing they violate the Constitution’s equal protection clause.   > “The administration is telling us what their long game is, which is to treat > women’s bodies as commodities and to create laws to exert control over these > commodities.” Other Trump 2.0 priorities, like its fixation with increasing birth rates, add to this growing sense of feminist dread. “They’re so open about the fact that they want women to leave the workforce and have babies—the earlier, the better—and fulfill the role of motherhood,” says Ting Ting Cheng, director of the Equal Rights Amendment Project at the NYU School of Law. “The administration is telling us what their long game is, which is to treat women’s bodies as commodities and to create laws to exert control over these commodities.” “The foundational piece,” Cheng adds, “is defining people by their biology—to essentially see women as people who have one manifest destiny to fulfill.” Last spring, to mark Trump’s 100th day in office, Mailman spoke with Debbie Kraulidis, vice president of Moms for America and host of its podcast. Inevitably, the conversation turned to trans kids in schools. Mailman recalled her own childhood in the 1990s and early 2000s: “When I was growing up,” she declared, “it was okay to be a feminine guy. It was okay to be a masculine girl.” Nowadays, she lamented, “you can’t be a tomboy anymore, because you’ll get your body parts chopped off.” The first child of a surgeon and his Korean-born wife, Mailman (née Davis) remembers her upbringing in “middle-of-nowhere” Kansas with great fondness: “For kids who are from small towns,” she told another podcaster, “you really get to build up your self-esteem and try a lot of things.” At Clay Center Community High School (class of 2006), she was a student council officer, drill team member, and athlete (lettering in cheerleading, tennis, and track), as well as the star at the top of the “Singing Christmas Tree.” By college, she was also a committed conservative, serving as treasurer for the University of Kansas College Republicans and interning for US Sen. Sam Brownback, a GOP stalwart who later became governor. But she didn’t seem to take herself too seriously, entering Spike TV’s “sexiest co-ed” competition in 2007 and earning a write-up in the college paper. “If somebody was doing it who wasn’t me, I’d probably be judgmental,” she told the reporter. Then again, “Why not, for $5,000?”   Graduating into the Great Recession with a journalism degree, she joined Teach for America, landing at Pathway Academy, a majority-Black charter school in Kansas City, Missouri. The school’s executive director, Jennifer Fleming, recalls her as “extremely intelligent, very self-motivated, goal-oriented,” building relationships with students and their families. Mailman would later describe implementing strict discipline, like “standing silent lunch,” in her classroom. Her sixth-grade class scored so high on state tests that the school got its accreditation back, Fleming says. The experience seemed to reinforce Mailman’s conservative beliefs. “I had always thought that Teach for America would help me equip people to be responsible for themselves,” Mailman later recalled for a profile on IWF’s website. “But my kids didn’t have the home environment necessary to do school…I became much more focused on what we can do to build families.” After two years and a master’s degree in education, Mailman headed to Harvard Law, where she chafed at automatically being made a member of the Women’s Law Association, she told me in an email after we spoke in January. “They gave us ladies a little pep speech, saying that women should support each other in class by applauding other women’s contributions,” she wrote. Men had no equivalent. “I hated this. It felt so infantilizing.” Mailman wanted me to know that as a conservative, she’s in favor of treating women equally; it’s left wingers who seek, through such “race and sex based identity groups,” to treat women as “weak or ill equipped” in her view. (Equal doesn’t mean identical, however: “At the same time, sex exists,” she wrote, citing differences between men’s and women’s LSAT scores.) May Mailman (née Davis, standing on left) poses with the girls’ tennis team in her 2006 high school yearbook.Clay Center Community High School From her 2006 yearbook, Mailman was the star at the top of her high school’s “Singing Christmas Tree.”Clay Center Community High School Mailman’s aversion to groups like the Women’s Law Association would echo, years later, in her Trump 2.0 campaign to eliminate diversity and inclusion measures at Harvard and other higher education institutions. The problem with universities, she told the New York Times last fall, is their “culture of victimhood—a glorification of victimhood—that is ultimately bad for Western civilization and bad for the country.” During her Harvard years, she’d felt very much outside the Obama-era political mainstream. “Conservatism was a lonely place,” especially for women, she told a podcaster last year. But that isolation was also empowering: “You end up being very comfortable with yourself, comfortable with your arguments, comfortable not having a lot of friends.” She became president of the ultra-elite Harvard chapter of the ultra-connected Federalist Society. Post-Harvard, she landed a prestigious clerkship with a federal appellate judge in Denver, then moved on to a private law firm. When a Harvard friend reached out with an offer to work at the “center of the universe”—the first Trump White House—she accepted immediately. Mailman started on day one of Trump 1.0 and stayed until the bitter end. According to emails reported by the New York Times, as deputy White House policy coordinator in 2018, she floated a proposal to send detained migrants to sanctuary cities. She describes herself as part of the “cleanup crew” for the administration’s family separation policy at the border. Later, she was promoted to the powerful White House counsel’s office, where her portfolio included social issues and the administration’s response to the Covid-19 pandemic. Trans issues were also on the White House’s radar, including a military ban. In 2018, the Department of Health and Human Services even considered an order that would have narrowly defined sex as “immutable biological traits identifiable by or before birth.” But the conservative base reacted with crickets to proposed anti-trans policies, Mailman recounted on a podcast. “Nobody seemed to care, except for people who didn’t like it.” Indeed, public support for trans rights was at an all-time high. When North Carolina passed a law in 2016 restricting trans students’ bathroom access in schools, Fortune 500 companies boycotted the state. Then in June 2020, the Supreme Court stunned conservatives by ruling 6–3 that firing someone for being gay or transgender violated the federal law banning sex discrimination in the workplace. “It is impossible to discriminate against a person for being homosexual or transgender without discriminating against that individual based on sex,” Justice Neil Gorsuch, Trump’s first appointee to the high court, reasoned in Bostock v. Clayton County. Mailman hated the decision: “I would argue there’s no logic to Bostock,” she told me. Mailman was still working for Trump when his supporters stormed the Capitol on January 6, 2021. That very day, she accepted a job offer from the Ohio attorney general, anticipating that her colleagues were about to become “unhirable for a very long time,” she later admitted. One month after Trump left office, Mailman also began a fellowship with the Independent Women’s Forum. Like many conservative organizations, IWF was starting to invest in anti-trans politics—putting Mailman at the center of the next big culture war. The organization Mailman joined had its roots in the 1991 Supreme Court nomination that was itself a turning point for the role of women in American politics. President George H.W. Bush’s nomination of Clarence Thomas to replace civil rights icon Thurgood Marshall on the nation’s highest court was greeted with howls of liberal outrage. Even before Anita Hill’s sexual harassment allegations threatened to tank his nomination, Thomas’ close friend Rosalie Silberman organized “Women for Judge Thomas” to vouch for his character. Thomas’ confirmation activated a generation of left-leaning women around the issue of sexual harassment. Silberman and her comrades created the Independent Women’s Forum to counter them. “We listened to the spin of those days—the litany that women are victims and men just don’t get it—and decided that those woebegone women did not speak for us,” Silberman said in 1998. “Nor did we think that they spoke for the vast majority of American women.” IWF’s policy agenda was defined by being anti-regulation and anti–“female victimhood.” At various points over its 35-year history, the organization has opposed the Violence Against Women Act, women’s admission to the Virginia Military Institute, the Affordable Care Act, and paid family and sick leave. It claimed Title IX was being used to defund men’s sports, that sexual violence rates were overblown, and that the gender pay gap was the result of women’s choices. For a time, it was run in tandem with the Koch brothers–affiliated interest group Americans for Prosperity. Supreme Court nominee Clarence Thomas appears at his Senate confirmation hearing in 1991.Lee Corkran/Sygma/Getty Members of the Independent Women’s Forum gather in a Northern Virginia conference room in 1995.Mary Lou Foy/Washington Post/Getty From the beginning, much of IWF’s influence was derived from its messaging, starting with its claim to be “independent”—seeming to stand apart not just from feminists, but from ultra-right groups, in part because it didn’t take a public stance on abortion. “Being branded as neutral, but actually having people who know-know that you’re actually conservative, puts us in a unique position,” IWF Board Chair Heather Higgins, a pharmaceutical heiress, explained at an event for potential 2016 donors. “Our value…is taking a conservative message and packaging it in a way that will be acceptable.” IWF’s first public, tentative forays into anti-trans politics seem to have started around 2017, with news releases ridiculing colleges for putting free tampons in men’s restrooms and for recommending that professors ask students their pronouns. Then in 2019, the conservative anti-trans movement suddenly got serious. That’s when the far-right American Principles Project turned a Kentucky gubernatorial election into a petri dish for anti-trans messaging—and found that a video about a boy in girls’ wrestling struck a nerve. > It didn’t matter that trans athletes were—and continue to be—vanishingly rare, > or that lawmakers in some states were unable to identify a single player who > would be affected by their bans. The Democrat won anyway. But conservatives had identified a compelling narrative: Trans people were victimizing female athletes. Within months, Republicans in 17 states introduced a new type of bill, banning trans girls from playing on girls’ sports teams. It didn’t matter that trans athletes were—and continue to be—vanishingly rare, or that lawmakers in states like Tennessee and South Carolina were unable to identify a single player who would be affected by their bans. The sports issue became the turning point for an anti-trans coalition that included juggernauts of the religious right like the Heritage Foundation and Alliance Defending Freedom. IWF stepped up to provide a female face and voice for the message. Never mind that the “women are victims” narrative contradicted so much of its past work. By 2022, threat of trans athletes had become a central theme of IWF’s messaging. It snapped up aggrieved athletes like college swimmer Riley Gaines, training her to communicate her story of tying for fifth place with transgender swimmer Lia Thomas and eventually hiring her as a spokeswoman. Payton McNabb, a high school volleyball player injured from a spike by a transgender girl, became another “ambassador.”    Mailman embraced the message too, testifying on behalf of IWF against trans athletes in front of a House Judiciary subcommittee. IWF’s media training was a big part of why she joined the group. “I wanted to be on liberal media as a conservative person,” she says, “trying to talk to people,” the way pundits of old used television to shape public opinion when she was a kid. As Mailman sees it, female messengers have been critical to shifting the narrative around trans issues because—stereotype alert!—they are better at conveying empathy than men. For a long time, she tells me, progressive messages of acceptance and affirmation held sway, and “women do want to be kind, and we do want to be empathetic.” So conservatives needed women to challenge “the empathy play,” she went on. For men, it’s “not their natural language.” Differentiating the sexes based on such stereotypes is exactly the type of thing that causes left-leaning women to shudder. But one of the most confounding aspects of the Defending Women executive order is its connection to a group of activists who define themselves as radical feminists. In 2022, IWF announced an ambitious new project that would serve as a prototype for the Defending Women order: a model bill, then known as the Women’s Bill of Rights, that defined male and female in law according to a narrow view of biology. At a press conference, IWF and other social conservatives spoke alongside current and former members of Women’s Liberation Front, a small left-wing group vehemently opposed to the very idea of transgender identity. IWF leaders described their legislation as merely ensuring that policymakers were all on the same page about the meanings of “female” and “male.” But former WoLF board member Kara Dansky, speaking on the call, made it clear that the bill’s goal was to end legal recognition of transgender people. “Everyone is either female or male,” she declared on the call. “Everything else is a lie.” Sometimes known as trans-exclusionary radical feminists, or TERFs, activists like Dansky believe that women’s rights will be lost if the category of “women” includes people assigned male at birth. They’ve pushed for decades to exclude trans women from women’s spaces. (Some who adhere to these views—including, famously, Harry Potter author JK Rowling—consider the TERF acronym a slur and describe themselves as “gender critical”; others embrace it.) Mailman tells me that TERF activists, particularly Dansky, were the intellectual force behind the effort to enshrine sex definitions. “The ones that were really driving the charge and had just a lot more knowledge and background, and had been thinking about these issues, writing about these issues, for such a long time, tended to be people on the left,” she says. (Dansky, in an email, says she did not contribute directly to the model bill’s language or strategy, though she does call Mailman an “extremely intelligent lawyer.” Like Mailman, she doesn’t believe that enshrining sex definitions could turn back the clock on women’s equality under the Constitution. “Radical feminists are gender abolitionists who fully support women who do not conform to sex stereotypes,” she writes.) Former Women’s Liberation Front board member Kara Dansky speaks at a 2020 event at the Seattle Public Library.Lindsey Wasson for the Washington Post/Getty The Women’s Bill of Rights wasn’t the first time radical feminists had teamed up with social conservatives on transgender issues. In 2016, WoLF received a $15,000 grant from the Alliance Defending Freedom to fund a lawsuit over trans students’ access to bathrooms and locker rooms. In 2021, WoLF took another $50,000 from ADF to sue California over a law that allows transgender women to be housed in women’s prisons. “It would be foolish to let performative virtue-signaling prevent us from using available resources,” WoLF legal director Lauren Bone emailed when I asked about the group’s work with the far right. Both sides have benefited from the strange alliance, Joanna Wuest, an assistant professor at Stony Brook University, points out. Right-wing money and connections allow fringe TERF groups to “punch above their weight,” she says. And conservative Christian groups get “a lot of rhetorical leverage out of saying [that even] radical feminist organizations are opposed to this interpretation of sex as gender identity.”  > Conservative Christian groups get “a lot of rhetorical leverage out of saying > [that even] radical feminist organizations are opposed to this interpretation > of sex as gender identity.”  Soon after the Women’s Bill of Rights was unveiled, Sen. Cindy Hyde-Smith (R-Miss.) introduced a version of it in Congress. With the midterms approaching, IWF targeted hundreds of thousands of Facebook users in swing states with ads touting the model bill as part of its supposed crusade for women’s empowerment, boosted by a $100,000 “Innovation Prize” from Heritage. In 2023, versions of the legislation began popping up in statehouses around the country. To promote it, IWF sent Riley Gaines and Mailman—a trip Mailman would later describe as her “first foray into TERFdom.” Mailman, by then married to former professional baseball player David Mailman, leaned on her own experiences as a woman to advocate for the bills. “‘Identification’ replaced the biological reality that we have been living our entire lives—that I am particularly 32 weeks into living right now,” she said on a stage in West Virginia, visibly pregnant with her second child. Her blitz through the state “was terrifying to watch,” says Khadijah Silver, director of gender justice and health equity at Lawyers for Good Government. “She did an incredible job of flooding legal and political environments, partnering with the right groups, to normalize a regressive and anti-scientific and extremely unfeminist analysis of gender—and make it pretty hard to break through that messaging.” The Kansas legislature became the first state to pass the bill in the spring of 2023, and when Democratic Gov. Laura Kelly vetoed it, the Republican supermajority overrode her. (“Victory!” WoLF declared in a press release.) Today, 16 states have similar laws, and two more have issued executive orders likewise defining sex. Logan Casey of the Movement Advancement Project describes the Women’s Bill of Rights as “more existential” than other anti-trans bills. “They’re not targeting just one policy area,” he says. “They’re zooming up and saying across the entire government, here’s how we define the word ‘sex’ so that we can basically apply it everywhere that we want, until somebody stops us.” Mailman drew on the state sex-definition bills as she drafted the Defending Women executive order. But the ink on Trump’s signature was barely dry before scientists began to push back, arguing that for all the order’s claim to “biological truth,” a modern understanding of sex involves far more than eggs and sperm.  Today, many biologists view sex as measured by multiple indicators—hormones, chromosomes, genitalia, brain physiology—that typically but don’t always align. > Scientists began to push back, arguing that for all the order’s claim to > “biological truth,” a modern understanding of sex involves far more than eggs > and sperm. More outcry came from reproductive-rights advocates, because the order defined sex as existing “at conception”—language that nods to anti-abortion religious activists who argue that fetal rights begin at fertilization. House Speaker Mike Johnson, for one, was elated about that phrasing, vaunting it during the 2025 March for Life in Washington. Mailman tells me the “at conception” language was added not for abortion policy purposes, but to make the point that sex is determined by DNA prior to birth. Still, “there’s a nice flavor to respecting fetal personhood,” she says. “That’s an added benefit.” So far, the Trump administration has not used the Defending Women order to pursue anti-abortion policies. Instead, it has zeroed in on attacks on the transgender community. The order had an immediate impact on passports, federal funding for gender-related health research, and transgender prisoners. Soon came more executive orders targeting teachers who supported trans students, schools that let them play girls’ sports, and doctors who provided them gender-affirming health care. Another order stated that being trans “conflicts” with a soldier’s “honorable, truthful, and disciplined lifestyle.” The Departments of Justice and Education formed a special team to investigate schools for promoting “gender ideology”—and some universities, in this new climate, fired instructors and censored Plato. The changes have been so drastic that federal judges have put many of the federal government’s anti-trans policies on temporary hold. But the ultimate decider will be the Supreme Court, which already has signaled its willingness to interpret sex discrimination law in ways that exclude trans people. Last June, conservative justices ruled 6–3 that states can ban puberty blockers and hormone therapy for transgender minors. In November, the Supreme Court allowed the State Department to stop changing trans people’s gender markers on their passports. Mailman appears on Fox News on January 14, 2026, to discuss the transgender sports cases before the Supreme Court.Fox News The court is currently considering a pair of cases that directly ask how much different treatment for the sexes based on “biology” is allowable. The cases involve two states, Idaho and West Virginia, which have both passed laws banning trans girls and women from playing on women’s school sports teams. During oral arguments in January, ultra-conservative Justice Samuel Alito seemed to view the cases as an opportunity to enshrine a constitutional definition of sex: How can a court determine whether there’s discrimination on the basis of sex, he asked, “without knowing what sex means?” But Justice Amy Coney Barrett appeared to understand that there would be greater consequences to a decision that gave states more leeway to treat men and women differently, so long as the state claimed the reason was biological. “Your whole position in this case depends on there being inherent differences, right?” Barrett asked the lawyer for West Virginia. But, she hypothesized, what if a state could produce studies showing that women’s presence in calculus classes held back men’s learning? Could women be excluded from calculus? “Seems to me like there would be some risk on your understanding that that would be okay,” she said. The exchange showed that even the Supreme Court justices are thinking about how an anti-trans ruling could have wider consequences for sex equality, says Kate Shaw, a law professor at the University of Pennsylvania and co-host of the Strict Scrutiny podcast. “They’re opening up the possibility of much broader potential exclusions,” she says. Such a decision could call into question decades of progress fighting sex discrimination. After all, differences between men’s and women’s bodies have been used for much of human history to justify treating women as inferior to men. The Trump administration has been open about its desire to return to those old days—from Defense Secretary Pete Hegseth’s opposition to women in combat to the White House’s reported consideration of proposals for “baby bonuses” to incentivize women to have more children. Even the title of the Defending Women executive order reflects early-1900s logic that the government needs to protect women due to their inherent fragility—an idea the Supreme Court rejected during the sex equality revolution of the 1970s, Shaw argues in a recent law journal article. And at a December press conference announcing a rule targeting trans teenagers’ medical care, Deputy Health Secretary Jim O’Neill described gender roles as divinely ordained. “Men are men. Men can never become women,” he paraphrased Mailman. “Women are women. Women can never become men.” Then he went a step further: “At the root of the evils we face—such as the blurring of lines between sexes and radical social agendas—is a hatred for nature as God designed it and for life as it was meant to be lived.” It’s the focus on transgender people that gives the administration “cover” to pursue this broader regressive agenda, Ziegler argues. For that strategy, she credits Mailman and her allies. The Defending Women order “is about to matter in a big way,” she says. “It created political cover for all of these changes that are going to affect trans people, queer people, along with cis, straight men and women.” Mailman left the White House in early August, pregnant with her third child. But she’s found it hard to step away entirely. In addition to rejoining Independent Women, she has launched her own consulting firm and is representing Netflix as it attempts to acquire Warner Brothers Discovery (reportedly alongside Kellyanne Conway, a Trump 1.0 loyalist who used to be on IWF’s board). She also continued to work for the administration in its negotiations with Harvard. At the time we spoke, she hadn’t turned in her government laptop. On her last official day in the White House, the Wall Street Journal published a story titled, “The Conservative Women Who Are ‘Having It All,’” with Mailman prominently featured. She’d been flying on weekends from DC to Texas, where her husband, who owns a tree-transplanting company, took care of their children with a nanny’s help, the Journal reported. “In theory, I would love to be a trad wife,” Mailman confided. She’d intentionally picked a husband who made more money so she “wouldn’t feel trapped” in the workplace, she said. But she didn’t feel guilty about missing time with her kids: “I don’t have a victimhood mentality.” For all the praise that conservatives heaped on Mailman for her work in the White House, these details about her home life rubbed some the wrong way. A few weeks later, the Institute for Family Studies, a right-wing think tank, started publishing rebuttals to the Journal article—and to the lifestyles of the conservative women it featured. “There is no boss, no industry, no political administration or nation who needs a woman more than her children need her,” one writer, Maria Baer, reprimanded. Baer was calling out Mailman for defying the gender ideals that social conservatives were working so hard to promote. And then Baer stuck in the knife: It was a matter of biology for women to devote themselves to mothering. “We pursue high-powered careers because we want to make an impact, to leave a legacy, to be remembered, or to change the world,” Baer wrote. “There is no surer way to accomplish each of these than by mothering our own children—a job which, by definition, no one else in human history can do.” Mailman probably shouldn’t have been surprised. But the criticism from an organization she respects came as a blindside. “It was frustrating,” she tells me on the phone, her baby fussing in the background. “I felt like I was getting critiqued on something that I literally was actually doing the opposite on.” She’d joined the Trump transition team thinking her tenure would be brief, she says, then accepted a job in the administration to “help my friends,” but only for six months. She’d repeatedly said no to working in the White House “because I wanted to be around my young kids and my husband, not for any cultural pressure reason, but that’s what’s best for me and for what I wanted.” It was yet another reminder that, despite Mailman’s insistence that defining sex narrowly wouldn’t affect women’s equality, right-wing groups can’t be counted on to go along with that rosy thinking. Nor did it seem to strike her as contradictory that being able to pursue “what’s best for me and for what I wanted” depends on the very feminist gains that those groups—now armed with the Defending Women order—are working to undermine. But Mailman was too busy to be upset at her allies-turned-critics. “Everybody is going to have their own opinion about everybody else,” she says. “You just move on.”

After Roe v. Wade was overturned, the Biden administration enforced a rule in 2022 mandating that retail pharmacies receiving any federal funding had to carry and dispense mifepristone, misoprostol, and methotrexate—drugs used in medication abortions and, in the case of methotrexate, the treatment of ectopic pregnancies and autoimmune disorders such as rheumatoid arthritis and lupus—in order not to discriminate on the basis of sex and disability. The Trump administration formally withdrew that rule on Tuesday, allowing pharmacists to refuse to stock or dispense misoprostol and methotrexate, despite their other uses. Even under the Biden-era rule, pharmacists could still refuse to dispense the drug if they suspected or knew a pregnant person was past the date allowed in their state for a medication-induced abortion. Mifepristone was removed from the Biden rule in 2023, after a lawsuit involving anti-abortion litigators at the arch-conservative Alliance Defending Freedom (ADF) in a case that was subsequently dismissed. I asked the two leading pharmacies in the United States—CVS and Walgreens—if they will continue to stock and dispense methotrexate. A spokesperson from CVS told me that “all our pharmacies continue to stock and dispense methotrexate where legally permissible.” Walgreens did not respond by the time of publication. ADF, meanwhile, celebrated the win it couldn’t get in court, writing that “we are grateful to the Trump administration for rescinding Biden-era guidance that forced Americans to dispense abortion-inducing drugs against their conscience.” Days prior to the Biden administration issuing the rule, NBC’s Today Show covered the challenges faced by patients with chronic illnesses in trying to get their lifesaving medication. With the rule rescinded—and coupled with efforts to criminalize abortion drugs in states like South Carolina, raising concerns that even sympathetic doctors will be scared to prescribe mifepristone, misoprostol, and methotrexate—their availability at smaller pharmacies is likely to drop. That’s despite the fact that people who are able to conceive are supposed to take contraceptives while on methotrexate, which can cause fetal abnormalities, according to the American College of Rheumatology, meaning that their risk of getting pregnant—let alone pursuing an abortion—is in fact quite low. Autoimmune disorders primarily affect women, who have also been the main target of abortion restrictions, underlying how treatment for both shows how women’s health is under attack. Research from KFF found that of reproductive-age women who have used methotrexate in the previous year, over 90 percent did so for reasons unrelated to pregnancy. According to the John Hopkins Arthritis Center, around 60 percent of rheumatoid arthritis patients currently are on or have been on methotrexate. It’s unclear how challenging filling methotrexate prescriptions for chronic illnesses remained under the Biden rule, but it will almost certainly become more difficult without it. Without reliable access to treatment, autoimmune disorders can be very dangerous for those who have them. A 2018 brief report funded in part by the Lupus Foundation of America found that systemic lupus erythematous, one form of lupus, is tied for the top ten leading cause of death for women between the ages of 15 and 24. Among Black and Latina women, it’s the fifth leading cause of death for that age group.

Sen. Patty Murray (D-Wash.) decried Republican efforts to discredit medication abortion in an interview Wednesday with Mother Jones, saying that “the only reason they’re going after mifepristone is because it is the way most women get their abortive care.” Mifepristone is one of the pills used in medication abortion, which in 2023 accounted for 63 percent of all terminations in the United States.  On Wednesday morning, the Senate Committee on Health, Education, Labor and Pensions held a hearing on “protecting women” from the “dangers of chemical abortion drugs.” Chaired by Louisiana Republican Sen. Bill Cassidy, the hearing centered on conservative demands for further regulation of abortion medication; two of its three witnesses were medication abortion opponents, including Louisiana Attorney General Liz Murrill, who on Tuesday pushed to extradite a California abortion provider on felony charges, accusing him of sending abortion pills into her state. Democrats taking part, including Sen. Murray, argued that the hearing wasn’t geared toward protecting women but discrediting settled science. In November, Murray led the Senate Democratic Caucus in sending a letter to Health and Human Services Secretary Robert F. Kennedy Jr. and FDA Commissioner Martin Makary expressing concern over the Trump administration’s review of mifepristone. “Republicans are holding this hearing to peddle debunked junk ‘studies’ by anti-abortion organizations which have no credibility and have been forcefully condemned by actual medical organizations,” Murray said in her opening statement. The hearing, she continued, was “really about the fact that Trump and his anti-abortion allies want to ban abortion nationwide.” According to a New York Times review of more than 100 studies spanning 30 years, abortion medication is safe and effective; mifepristone, used both in medication abortion and to treat miscarriage, has had FDA approval for more than 25 years. In October, the FDA approved another generic version of the pill. “You can see that they’re just pulling straws from absolutely everywhere, because they want to obscure the whole goal” to “ban abortion nationwide,” Murray said to me. Republican officials insisted that medication abortion is too easy to get. Yet in 13 states, abortion is banned in nearly all circumstances. Another seven states have enacted time restrictions earlier than what was outlined in Roe v. Wade. At the same time, maternity care deserts are expanding across the nation. According to a 2024 report by infant and maternal health nonprofit March of Dimes, more than a thousand US counties—together home to more than 2.3 million women of reproductive age—lack a single birthing facility or obstetric clinician. Since 2020, 117 rural hospitals have stopped delivering babies, or announced that they would stop before the end of 2025, according to a December report from the Center for Healthcare Quality and Payment Reform. A National Partnership for Women & Families analysis from June warned that 131 rural hospitals with labor and delivery units are at risk of closing altogether due to Republican-led cuts to Medicaid through President Trump’s “One Big Beautiful Bill.” I asked Sen. Murray about requiring consultations for medication abortion—and why pregnant people aren’t going in person to seek out that route.  “It’s pretty stunning to watch these Republicans talk about this with a straight face,” she told me. “The reason many women don’t,” Murray continued, “is the abortion bans that in Republican states don’t give women the option to see a provider.” Murray expressed concern, “especially after we have a hearing like this, where we heard so much misinformation,” that an already confusing landscape for those seeking abortion could be further obscured. And a new study, published Monday in the leading medical journal JAMA, found that the FDA has repeatedly reviewed new evidence about mifepristone and reaffirmed its safety. Abortion medication, Murray pointed out, is less deadly than both penicillin and Viagra. “We didn’t have a hearing today on Viagra,” she told me. “We had a hearing on mifepristone, so their whole thing about safety and all this is just hogwash.”

Abortion will remain legal in Wyoming following a Tuesday decision in the state’s Supreme Court that said its two abortion bans, including a block on abortion pills, were unconstitutional. The court ruled that the bans violate a 2012 amendment to the Wyoming Constitution that protects an adult’s right to make their own healthcare decisions. One law banned abortion with few exceptions, such as in cases of rape or incest, and the other explicitly prohibited abortion pills. Wyoming was the only state in the country to implement an outright ban.  As Bolts, an organization that reports on local elections and policies, noted in 2023, this amendment was part of a conservative push against Barack Obama’s Affordable Care Act. Conservatives argued that the legislation was government interference. Progressives, meanwhile, including reproductive rights advocates in Wyoming, have used the amendment to protect abortion access.  “A woman has a fundamental right to make her own health care decisions, including the decision to have an abortion,” the ruling from Tuesday reads. Wyoming’s only abortion clinic, Wellspring Health Access, was one of the plaintiffs in the case. In a statement, Julie Burkhart, president of the clinic, told Mother Jones that the decision “affirmed what we’ve always known to be true: abortion is essential health care, and the government should not interfere in personal decisions about our health.” “While we celebrate today’s ruling, we know that anti-abortion politicians will continue their push to restrict access to health care in Wyoming with new, harmful proposals in the state legislature,” Burkhart added.  The decision also implies that anti-abortion lawmakers in Wyoming would need to amend the state constitution to ban abortion, rather than a majority vote in the Republican-dominated legislature.  Wyoming Gov. Mark Gordon immediately called for just that on Tuesday, saying in a statement: “It is time for this issue to go before the people for a vote, and I believe it should go before them this fall.” A move to amend the constitution would be decided by voters in the 2026 election.

Even if you have no idea what a crisis pregnancy center is, the donor website for the First Choice Women’s Resource Centers chain in northeastern New Jersey offers plenty of clues: Prominent logos for the anti-abortion groups Heartbeat International and CareNet. A home page banner proclaiming “Sanctity of Human Life Sunday 2026.” An agreement for prospective volunteers that states, “I openly acknowledge my personal faith in Jesus Christ as my Lord and Savior,” and “[I] reject abortion as an acceptable option for any woman.” That’s what appears on the website directed at First Choice’s donors. The chain also has two websites targeted at potential clients—pregnant women who might be seeking an abortion but end up on the crisis pregnancy center website instead, where First Choice is less clear about its religious ties and anti-abortion mission. “Learn more about the abortion pill, abortion procedures, and your options in New Jersey,” one site urges on its home page. “We specialize in pre-termination evaluations,” another site says, with services that include “free and confidential Abortion Information Consultation” and “post-abortion support.” On most pages, it is only at the very bottom that the qualifier, First Choice “do[es] not perform or refer for” abortions, appears. Websites that tell anti-abortion supporters one thing and pregnant women something else are common among the country’s 2,500 crisis pregnancy centers, or CPCs—part of a well-documented history of using misinformation and deception, as well as free ultrasounds and other services, to deter women from having abortions. Some of the best-known strategies include opening “fake” clinics near real abortion clinics, misstating the purported harms of abortion and emergency contraception, and pushing the unproven medical procedure known as “abortion pill reversal.” > Blue states have repeatedly tried to rein in CPCs. But as faith-based > organizations, pregnancy centers have a powerful shield—the First Amendment. Blue-state lawmakers and attorneys general have repeatedly tried to rein in CPCs. But as faith-based organizations, these pregnancy centers have a powerful shield—the First Amendment. When states try to regulate them, CPCs invariably claim that these efforts violate constitutional protections for free speech, religious expression, and freedom of association. In a landmark 2018 decision, the US Supreme Court sided with the CPC industry, blocking a California law that would have required pregnancy centers to inform patients about state-funded family-planning services, including abortion. That decision chilled state and local efforts to curb CPCs’ more controversial practices, creating what one legal scholar has called “a regulatory dead zone.” Meanwhile, since the fall of Roe v. Wade, the number of CPCs has grown—boosted by a surge in state funding and private donations—and reproductive rights supporters have renewed their push for greater oversight, this time focusing on consumer protection. On Tuesday, the Supreme Court will hear arguments in its latest CPC case, this one involving New Jersey’s efforts to investigate whether First Choice may have misled consumers. The question before the court is technical: Can CPCs run directly to federal court to fight an attorney general’s subpoena, as First Choice did, or must they first go to state court? As reporters Garnet Henderson and Susan Rinkunas recently wrote in Mother Jones and Autonomy News, the answer could have sweeping consequences for the $2 billion-a-year CPC industry: > Boring as this procedural quibble may seem, a favorable decision would be a > significant win for CPCs. They have a much better shot at winning any case in > the Trumpified federal courts than they do in state courts that may be more > supportive of abortion rights. What’s more, the ability to use friendly > federal courts as a shield from state regulation would set pregnancy centers > up for success in other lawsuits making their way to the Supreme Court—ones > that could eliminate states’ ability to crack down on [abortion pill reversal] > and other questionable practices entirely. But the case has also raised concerns among groups aligned with progressives that the same type of subpoenas issued by New Jersey against First Choice could be weaponized against humanitarian groups, journalists, and protesters. “The problem is bipartisan,” the ACLU wrote in one amicus brief. While New Jersey focuses on crisis pregnancy centers, “Florida’s attorney general pursues restaurants for hosting drag shows,” and Missouri’s attorney general investigates chatbots “to find out why they express disfavored views about President Trump.” In another brief, lawyers for Annunciation House, a Texas nonprofit that has been targeted for providing shelter and support to immigrants, wrote, “Nonprofit organizations—which rely heavily on volunteers—bear the heaviest burdens when faced with…state investigatory demands.” The stakes, the brief said, “can be existential.” The case dates from November 2023, when New Jersey Attorney General Matthew Platkin—an abortion rights supporter and CPC critic—issued a subpoena against First Choice as part of an investigation into whether the pregnancy chain was “misleading donors and potential clients into believing that it was providing certain reproductive health care services,” Platkin’s office states in a brief. The subpoena was broad, seeking 10 years’ worth of emails, videos, handbooks, the identities of many of its donors, and other information about First Choice’s ads and solicitations, its services and staff, and its claims about medical procedures, including abortion pill reversal. State and federal agencies have been using similar subpoenas to investigate potential violations of the laws they enforce for over 150 years, Platkin’s brief points out. Such subpoenas are not “self-executing,” meaning that Platkin’s office didn’t have the power to enforce them. Instead, in New Jersey and the rest of the country, the long-accepted procedure for enforcing or challenging a state agency’s subpoena is to seek relief in state court. If First Choice disagreed with the ruling from a New Jersey court, it could then plead its case in federal court.  But First Choice’s attorneys—the conservative legal behemoth Alliance Defending Freedom—cried foul, saying the CPC had done nothing wrong and accusing Platkin of “selectively target[ing] the nonprofit based on its religious speech and pro-life views.” Pregnancy centers “have been subject to a shocking level of violence and intimidation,” ADF asserted in one court filing. “First Choice is concerned that if its donors’ identities became public, they may be subjected to similar threats.” > “We haven’t forced those services on anyone. We haven’t charged any women for > the services we provide…. Yet Platkin calls this kind of caring ‘extremist.’” The lawyers also pointed to a 2021 Supreme Court precedent blocking California’s efforts to force charities and nonprofits in the state to report the identities of their major donors. According to ADF, the Platkin subpoena was so concerning that First Choice should be able to seek immediate relief in the federal courts, rather than having to expend time and resources litigating the issue first in state court. The ADF team—including Erin Hawley, wife of Missouri GOP Sen. Josh Hawley—compared Platkin’s investigation to Southern states’ attempts to force the NAACP to produce member lists in the late 1950s and early ’60s.  In an op-ed for NJ.com, First Choice’s executive director, Aimee Huber, noted that in 2022 alone, CPCs throughout the US provided 500,000 free ultrasounds, 200,000 STI tests, 3.5 million packs of diapers, and 43,000 car seats to women and families in need. “Over the last 40 years, First Choice has been privileged to offer crucial resources to more than 36,000 women across our state. We haven’t forced those services on anyone. We haven’t charged any women for the services we provide…Yet Platkin calls this kind of caring ‘extremist.’” But courts have repeatedly ruled that the case wasn’t ready—or “ripe”—to be litigated in federal court. A state judge, meanwhile, ordered Platkin and First Choice to negotiate to narrow the subpoena’s scope. The first time First Choice asked the Supreme Court to weigh in, back in February 2024, the justices declined. But when ADF tried again, this past spring, the court took the case. Most of the amicus briefs siding with First Choice are from a predictable collection of anti-abortion and conservative or libertarian groups, including red-state attorneys general, Republican members of Congress, the Second Amendment Foundation, and the Koch-funded American Legislative Exchange Council, or ALEC. But the CPC chain also received support from some unexpected quarters, including animal rights activists, the Reporters Committee for Freedom of the Press, and the Foundation for Individual Rights and Expression, represented by the ACLU.  In its brief, the humanitarian relief group Annunciation House described being hit with an investigative subpoena by Ken Paxton in 2024 demanding that it immediately turn over thousands of documents about immigrants and refugees it has helped—including sensitive medical and personally identifiable information—or face being shut down. The subpoena touched off a grueling, costly fight in state courts, with the Texas Supreme Court ultimately siding with Paxton. “The chilling effect impacts not only the targeted nonprofit, but also the broader nonprofit community, as organizations may avoid lawful speech or actions out of fear that they will lead to investigatory scrutiny,” the Annunciation House lawyers write. “Left unchecked, the [subpoena] process becomes the punishment.” In an interview with Mother Jones, Grayson Clary, a lawyer at the Reporters Committee, raised similar concerns. “Well beyond the context of this crisis pregnancy center, we have seen more state attorneys general trying to use their consumer protection authorities in new and potentially troubling ways, including to investigate news organizations,” he said, pointing to a Missouri case targeting the left-leaning Media Matters. “Saying, ‘We’re not after the journalism—we’re just protecting the consumers’ is often a fig leaf for efforts to control the content that a news organization is putting out.” “In practical terms,” Clary said, “what’s at stake in this question is how much of a tax does a state attorney general get to place on you for speaking, or for publishing news that they might disagree with, before you get a chance to ask a court to put a halt to it? And that question really can, in practical terms, be life or death, especially for a smaller or nonprofit news outlet,” On the abortion-rights side, what is most surprising about the amicus briefs is that they are nonexistent. But one group paying close attention to the case is Reproductive Health and Freedom Watch, a CPC watchdog. “If the Court finds in favor of this pregnancy center,” executive director Debra Rosen says, “I worry that it’s going to chill further scrutiny into this massive [CPC] industry.” Instead, amicus briefs in support of keeping the First Choice case out of federal court come from agencies that routinely issue investigative subpoenas, including blue-state attorneys general and state medical boards. The consequences of adopting First Choice’s argument would be “far-reaching,” Platkin’s office argues, “turning every quotidian subpoena dispute into a federal case.” The Supreme Court is expected to rule in the case by next summer.

In August 2022, Alabama Attorney General Steve Marshall made a guest appearance on a local conservative talk radio show. It was two months after the US Supreme Court had overturned Roe v. Wade, and abortion was now illegal in Alabama. And Marshall addressed rumors that he planned to prosecute anyone helping people get abortions out of state.   “If someone was promoting themselves out as a funder of abortion out of state,” Marshall explained to the host, “then that is potentially criminally actionable for us.”  Subscribe to Mother Jones podcasts on Apple Podcasts or your favorite podcast app. This particular threat launched an epic legal battle with implications for some of the most basic American rights: the right to travel, the right to free speech, the right to give and receive help.  This week on Reveal, reporter Nina Martin spends time with abortion rights groups in Alabama, following how they’ve adapted to one of the nation’s strictest anti-abortion policies—and evolved their definition of help. This is an update of an episode that originally aired in May 2025.

Abortion may not technically be on the ballot in Tuesday’s off-year state elections, but in the post-Roe v. Wade era, abortion is always on the ballot. Since the US Supreme Court’s 2022 Dobbs ruling that ended the federal right to abortion, statewide elections have become opportunities for reproductive rights supporters and opponents alike to expand or limit access to care by voting on the politicians who create the laws, the judges who enforce them, and, sometimes, on the laws themselves.  When voters have had the opportunity to weigh in directly on ballot measures enshrining abortion protections, those measures have mostly won, even in red states. When the vote is indirect—that is, for people rather than policies—the results are much more mixed. Just consider what happened in 2024, when states that approved abortion-rights measures also went for anti-abortion judges and Donald Trump. This week’s elections are the first time that large numbers of voters can express their feelings about the country’s radical change in direction under Trump 2.0. In five states, the results will also have major statewide and even national implications for access to reproductive care. CALIFORNIA California’s Proposition 50, the blockbuster redistricting measure designed to stop Republicans from rigging next year’s midterm elections, will affect all kinds of democratic rights, including reproductive autonomy. Prop 50 would temporarily suspend California’s current congressional maps, which were drawn by an independent citizens commission, and allow the Democratic-controlled legislature to create new maps that would remain in place through 2030. Governor Gavin Newsom and his allies got the idea after Texas lawmakers, buckling to Trump’s demands, redrew their congressional map to elect more Republicans—potentially enough to keep the US House of Representatives under GOP control in 2026 and beyond. If approved by voters, Prop 50 could sufficiently alter the partisan makeup of California’s House delegation—currently 43 Democrats and nine Republicans—to effectively negate the Texas redistricting effort. Polls show that California voters are very much on board. Republicans currently have a slim six-seat majority in the House; a wider margin could empower them to unleash all manner of new legislative horrors on the country, including, potentially, an extension of this year’s temporary defunding of Planned Parenthood and even a national ban on abortion after 15 or 20 weeks of pregnancy. A Democratic majority, on the other hand, would bring the GOP legislative machine in Congress grinding to a halt. With so much at stake, total spending by both sides is well north of $175 million. During a press call, Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America, described the GOP efforts to further gerrymander red states as “a naked attempt to steal congressional seats” and “an emergency for our democracy.” Prop 50, added John Bisognano, president of the National Democratic Redistricting Committee, is “a defensive shield for our democracy and for reproductive rights.” NEW JERSEY New Jersey voters will pick a new governor and all 80 members of the General Assembly. With Democrats currently holding a 52-to-28 majority there—and a 25-15 margin in the state Senate—most of the attention has been on the tight race between Democratic congresswoman Mikie Sherrill and Republican ex-assemblyman Jack Ciattarelli, to replace termed-out Democratic Gov. Phil Murphy. Recent polls show Sherrill—a former Navy helicopter pilot and onetime federal prosecutor—narrowly ahead. But Ciattarelli, who nearly ousted Murphy in the 2021 race, is hoping he can ride Donald Trump’s 2024 coattails to victory on Tuesday. (Trump didn’t win the state but made huge gains compared to 2020.) New Jersey’s pattern of flip-flopping between Democratic and Republican governors may be another factor in Ciattarelli’s favor: No party has held the office for three consecutive terms since 1961. Months before Roe was overturned, New Jersey lawmakers passed the Freedom of Reproductive Choice Act, enshrining protections for abortion care into state law; Sherrill would go further, adding these protections to the state constitution. Ciattarelli, by contrast, would ban abortion after 20 weeks (currently there are no gestational limits), end coverage under state Medicaid, and require parental consent for minors. A Democratic legislature, however, would thwart any efforts to put those policies in place. But Ciattarelli would be able to stop new reproductive protections from becoming law—for example, potential legislative efforts to strengthen the state’s shield laws that protect abortion providers who care for out-of-state patients. Reproductive rights advocates point to what happened during the tenure of Gov. Chris Christie, a Republican who was in office from 2010 to 2018, during which he repeatedly vetoed funding for family planning. “We’ve been here before, and we know what we could expect under a Ciattarelli governorship,” Kaitlyn Wojtowicz of the Planned Parenthood Action Fund of New Jersey told the New Jersey Monitor. “It would be devastating for public health.”  PENNSYLVANIA For decades after Roe v. Wade became the law of the land, Pennsylvania activists and politicians led the fight to narrow its reach—if not overturn it altogether. These days, despite Roe’s reversal, Pennsylvania continues to allow abortion through 23 weeks of pregnancy, albeit with significant restrictions, including a 24-hour waiting period, bans on Medicaid coverage, and a parental consent requirement for minors. The Pennsylvania Supreme Court demonstrated last year just how much the state has shifted, ruling that the 42-year-old Medicaid ban is a form of sex-based discrimination under the state’s Equal Rights Amendment. The decision suggested that courts might be open to throwing out other abortion restrictions that lawmakers—with Republicans controlling the Senate and Democrats holding a single-seat majority in the House—seem unlikely to repeal anytime soon. On November 4, the Democratic justices responsible for that ruling—Kevin Dougherty, Christine Donohue, and David Wecht—will come before voters in a retention election with enormous consequences not just for abortion, but for next year’s midterm elections and the 2028 presidential election in a crucial swing state. This is the same court, after all, that struck down Pennsylvania’s congressional map in 2018 as an unconstitutional gerrymander and rejected complaints about election monitoring by Trump’s 2020 campaign. The three justices were first elected in 2015, in a sweep that flipped the court to Democrats. If they win on Tuesday—and in the state’s history, only one justice has ever lost a retention vote—they will serve for up to another 10 years. If they lose, only two Democrats and two Republicans will remain, and the next judicial election will not take place until 2027. Political infighting in the meantime would hamper efforts by Democratic governor Josh Shapiro to appoint temporary replacements—a situation that Justice Donohue told the Associated Press could lead to “chaos.” Spending in the races is expected to exceed $15 million—far surpassing previous retention elections—as Democrats try to blunt Republican efforts to retake the court.  TEXAS Texas parents have long had the right to oversee their children’s education and health care and direct their upbringing. Those protections got a lot stronger this year, with the passage of Senate Bill 12—the “Texas Parents Bill of Rights”—which, among other things, requires schools to obtain parental consent before students can receive health services, including counseling, or participate in school clubs and organizations. But that bill—and a slew of other new laws that make it easier for parents to challenge the policies and curricula in schools that they don’t like—still weren’t enough for Texas’s parental-rights extremists. Lawmakers also approved Proposition 15, a constitutional amendment on Tuesday’s ballot that would enshrine a parent’s rights “to exercise care, custody, and control of the parent’s child, including the right to make decisions concerning the child’s upbringing. ” It would also enshrine a parent’s responsibility “to nurture and protect [their] child.”  Supporters claim the constitutional amendment is needed to ensure that parents’ rights can’t someday be repealed. Opponents say the amendment would make it even harder for minors to access contraception and sex education, and for LGBTQ kids to navigate an ever-more-hostile political environment. Prop 15’s vagueness and allusions to parental “responsibility” are also concerning. The measure would “open the door for another parent’s personal beliefs to strip rights from other people’s children and their families,” the reproductive justice group Avow Texas warns, and could lead to “delays in young people getting care, censorship in schools, and increased family policing.” Opponents’ other big fear is that Prop 15 will inspire conservative lawmakers in other red states to pass copycat bills. Denise Rodriguez of the Texas Equal Access Fund says the ballot measure is “about perpetuating the culture wars” and conservatives’ desire to crush dissent: “They want to do everything that they can to control the way that people live.” VIRGINIA Virginians will choose a new governor to replace Republican Glenn Youngkin, who is barred from running for a second consecutive term, as well as a new lieutenant governor, attorney general, and members of the 100-seat House of Delegates. According to recent polls, Abigail Spanberger, a former CIA officer and three-term congresswoman, is leading her Republican opponent, current Lieutenant Gov. Winsome Earle-Sears, in the race to become the state’s first female governor. That comes as a relief to abortion rights supporters, given Earle-Sears’s past statements equating abortion to “genocide” and supporting a six-week ban. Virginia is the only Southern state that hasn’t restricted abortion in the post-Dobbs era; the procedure remains legal through 21 weeks of pregnancy, which has made it a destination for patients from around the South who can no longer obtain care where they live.  The real battle over the fate of abortion in Virginia is taking place in legislative races. Democrats now control both chambers of the General Assembly—the House of Delegates by a 51-48 margin and the state Senate by 21-19. That narrow majority allowed Democrats to pass a proposed ballot amendment this past winter that could let voters decide whether to enshrine abortion protections in the state constitution. But under Virginia law, legislators must pass the amendment again during the 2026 session; then voters will get the final say next November. Republicans are targeting a few key races in Tuesday’s election in hopes of flipping control of the House and derailing the constitutional amendment. (The next elections for the state Senate take place in 2027.)   The House of Delegates races also could affect two other proposed constitutional amendments passed by lawmakers this year. One would restore voting rights for people with past felony convictions. The other would remove a ban on same-sex marriage from the state constitution—a now-defunct “zombie” law that could potentially be revived if the Supreme Court were to overturn its 2015 ruling that gave gay couples the right to marry. It’s a lesson Democrats learned after the Dobbs ruling: Counting on the Supreme Court’s conservative supermajority to protect existing rights is dangerous. Especially when some of the same conservatives who worked so hard to overturn Roe are now gunning for gay marriage.

Anti-abortion advocates haven’t just played key roles in rolling back abortion rights in recent years. They also helped tank President Donald Trump’s campaign-trail promise to make in vitro fertilization free. That’s according to a new report published Saturday in Politico, which reveals that anti-abortion activists—some of whom are opposed to IVF because it involves discarding unused embryos—spent more than a year lobbying the Trump campaign, and then his administration, to ensure that officials did not subsidize or mandate coverage of the procedure. They got their wish earlier this month, when the president announced a far more limited initiative: a cost-cutting agreement with a leading fertility medication manufacturer to slash prices on a drug involved in the IVF process. Trump also announced the creation of a new fertility insurance benefit that employers could voluntarily offer to employees. “There were letters and meetings and calls—a lot of activity,” Kristi Hamrick, vice president for media and policy at the anti-abortion group Students for Life of America, told Politico. “We told [the administration] that it would be an absolute violation of people’s conscience rights to force taxpayers to subsidize IVF, which has the business model that destroys more life than is ever born.” Anti-abortion advocates had long been vocal about their opposition to Trump’s promises to promote IVF. After his February executive order—which claimed to expand access to the procedure but merely required an official to gather ideas on how to do so, as I reported at the time—several leading abortion opponents decried the move. But the Politico story indicates that anti-abortion advocates’ involvement in scaling back the administration’s moves on IVF was greater than previously known. “A lot of people met with different people within the administration over the last eight months to say, ‘This is not pro-life. This is not going to raise birth rates. This pumps money into an industry that a lot of pro-lifers have great concerns over, because of the potential for eugenics. So let’s tap the brakes on this,'” Patrick Brown, a fellow at the conservative Ethics and Public Policy Center, told Politico. Beyond the Ethics and Public Policy Center and Students for Life of America, other anti-abortion groups that were reportedly involved in pressuring the administration include Susan B. Anthony Pro-Life America and Americans United for Life. Those groups did not immediately respond to requests for comment from Mother Jones on Sunday. According to Politico, White House officials also gave the advocates a heads-up before Trump’s announcement of his IVF policies: > In a sign of how seriously they took the groups’ arguments, administration > officials held a briefing call for a select group of activists ahead of last > week’s announcement to address their fears of a coverage mandate. According to > two anti-abortion advocates on the call, granted anonymity to discuss the > private event, the White House did not take questions. > > A White House official, granted anonymity to speak candidly about > behind-the-scenes conversations, confirmed both the call and the key role > anti-abortion groups played in developing the policy. Their influence ensured > that no employer is obligated to cover IVF, that no federal funding supports > it, and that new coverage options can include alternative fertility treatments > promoted by groups who oppose abortion. > > > > “It’s providing flexibility, not just in an ideological sense, but just in a > medical sense,” the official said. “It would be bad policy just to push > everyone onto IVF.” Spokespeople for the White House did not immediately respond to Mother Jones. Politico reports that anti-abortion advocates also pushed the White House Domestic Policy Council—which was tasked with coming up with suggestions to deliver to the president—to back “restorative reproductive medicine” (RRM), a loose group of approaches that allegedly tackles the root causes of infertility, as my colleague Kiera Butler wrote last year. Leading medical organizations have said that RRM is not evidence-based and that it is not a distinct concept, but instead a repackaging of work that fertility doctors already do to support patients. During Trump’s Oval Office announcement, officials did not explicitly reference RRM, but they—including Health and Human Services Secretary Robert F. Kennedy, Jr.—did repeatedly say that they plan to address “the root causes” of infertility. An expert on IVF access who did not want to be named for fear of retribution previously told me they were concerned by these mentions: “On the one hand, we were happy because they didn’t say ‘restorative reproductive medicine.’ And on the other hand, we were concerned because they said ‘root causes’ several times.” But for all the administration’s attempts to pander to every conceivable interest group, it could not manage to make everyone happy. Some on the left said that there was more Trump could do to expand access to IVF and that the announcement amounted to a failure to deliver on his campaign pledge. On the anti-abortion side, the US Conference of Catholic Bishops called Trump’s announcement a “harmful government action” that could “push people of faith to be complicit in its evils.” Lila Rose, head of the anti-abortion group Live Action, said on X that Trump’s announcement is “not a solution to fertility struggles.” And Kristan Hawkins, president of Students for Life, called the announcement a “disappointment.”

In the Oval Office on Thursday, several Cabinet members and advocates for in vitro fertilization (IVF) gathered to claim that President Donald Trump was delivering on his campaign trail pledge to radically expand access to the popular but expensive process for getting pregnant. In reality, Thursday’s announcement falls far short of Trump’s prior promise to make IVF free. Trump announced two steps that the government will take to try to bring down the costs of the treatment, which can reach up to $20,000 per cycle. The first is entering a cost-cutting agreement with EMD Serono, a leading fertility medication manufacturer, to slash prices on Gonal-f, an injectable drug involved in the IVF process. The second is creating a new fertility insurance benefit that employers could voluntarily adopt to offer to employees, just like they do with dental or vision insurance. Officials in the Oval Office cast the news as a historic precursor to the baby boom that Republicans so desperately want. Sen. Katie Britt (R-Ala.), who Trump credits with teaching him what IVF actually is, called the president’s actions the “most pro-IVF thing a president has ever done.” Mehmet Oz, the ex-TV doctor and current administrator of the Centers for Medicare and Medicaid Services (CMS) at the Department of Health and Human Services, chillingly predicted: “I know what you’re all thinking, and you’re probably right: There are going to be a lot of Trump babies. I think that’s probably a good thing.” > Dr Oz: "Now I know what you're all thinking, and you're probably right — > there's going to be a lot of Trump babies. And I think that's a good thing." > pic.twitter.com/A9XYUlbf1h > > — Aaron Rupar (@atrupar) October 16, 2025 These moves could, indeed, have some benefits to Americans seeking to get pregnant using IVF. Oz’s CMS estimates the drug agreement will save users of the fertility medications, which can cost several thousand dollars, up to $2,200 per cycle, the White House says. The drugs will be available directly to consumers on the (subtly-named) trumprx.gov, with additional discounts available to low-income women. Only a quarter of companies with 200 or more employees currently offer IVF coverage, according to KFF, and more than 40 percent of American adults say they or someone they know have used fertility treatments, according to Pew Research. The Labor, Treasury, and HHS departments issued guidance on Thursday for how employers can offer the benefits, and will propose additional pathways in the future, officials said. > It’s unclear how many employers will actually provide the fertility > benefit—especially since the government will not subsidize it. But all in all, the Thursday White House announcement is no substitute for Trump’s campaign trail promise that he would force the government or private insurance companies to fund IVF—a move that would reportedly have cost an estimated $8 billion, or about 40 percent of the price tag on Trump’s recent bailout of Argentina. While campaigning last year, in the midst of concerns about whether mounting abortion restrictions would imperil IVF access, which often involves discarding embryos, Trump told NBC News: “We are going to be, under the Trump administration, we are going to be paying for that treatment,” he said, adding, “We’re going to be mandating that the insurance company pay.” Thursday’s announcement does not do any of this. > Former President Trump tells NBC News that if he’s re-elected, his > administration would not only protect access to IVF, but would have either the > government or insurance companies cover the cost of it. > > More: https://t.co/AzV45GBhFd pic.twitter.com/rZZdejDGXX > > — NBC News (@NBCNews) August 29, 2024 Back in August, anonymous officials told the Washington Post that they had dropped hopes for those plans because it would require an act of Congress to make IVF an essential benefit that insurance companies must cover—a surprising rationale from a White House that seems to be otherwise unconcerned with securing congressional approval. (A bill last year, the HOPE with Fertility Services Act, introduced by then-Rep. and current Labor Secretary Lori Chavez-DeRemer, would have done just that. The bill has not yet been re-introduced in this session of Congress.) And as the New York Times pointed out earlier Thursday, when it first reported news of the IVF announcement, it is unclear how many employers will actually provide the fertility benefit—especially since the government will not subsidize it. Sean Tipton, chief advocacy and policy officer at the American Society for Reproductive Medicine, a research and advocacy organization, told me that “there’s still a lot of details to grapple with before we can really say how beneficial” the new actions will be. But he added: “I do think it’s important that a Republican White House got all the relevant Cabinet secretaries together to say a lot of positive things about IVF.” Sen. Britt, Tipton said, “was not exaggerating” when she praised Trump’s efforts as historic—”but that also shows what a low bar it is,” he added. Sen. Katie Britt (R-Ala.) praised Trump’s efforts to expand access to IVF as historic.Alex Brandon/AP Tipton also reiterated a couple of other ways that, as he previously told me, Trump could have dramatically expanded IVF access: Requiring fertility coverage for federal workers through the Federal Employees Health Benefits Program and mandating IVF coverage by TRICARE, the military health insurance program used by more than 9 million active service members, retirees, and their families. “As the CEO of a big employer, the president should make sure all his employees have access to care,” Tipton said. Spokespeople for the White House did not immediately respond to questions from Mother Jones on Thursday. Trump has a lengthy history of unfulfilled promises on IVF. Back in February, Trump signed an executive order that the White House claimed was “expanding access” to fertility treatments—but all that it actually did was deputize a government official to deliver to Trump, within 90 days “a list of policy recommendations on protecting IVF access and aggressively reducing out-of-pocket and health plan costs for IVF treatment,” as I wrote at the time. And even after that 90-day deadline, which fell in May, came and went, the White House failed to release that report publicly. In the middle of that period, in April, mass firings at HHS led to the elimination of a six-person team working on expanding access to assisted reproductive technology, including IVF, at the Division of Reproductive Health at the Centers for Disease Control and Prevention, as I reported. Mini Timmaraju, president and CEO of the advocacy organization Reproductive Freedom for all, called Trump’s announcement an effort “to gaslight the American public into believing he’ll deliver on empty campaign promises.” Danielle Melfi, CEO of RESOLVE: The National Infertility Association, struck a different tone, calling Trump’s announcement “an important step forward on the road to ensuring all Americans can access the care they need to build the families of their dreams.” But as Tipton put it: “There is a lot of work for the President to do to make good on his campaign promise to make sure that every American who needs help building their families can get that help.”

This article is a collaboration with Autonomy News, a worker-owned publication covering reproductive rights and justice. Sign up for a free or paid subscription, and follow them on Instagram, TikTok, and Bluesky. Crisis pregnancy centers have played a central role in the anti-abortion movement since the 1960s, often misleading and confusing people seeking abortions while purporting to help them. They mimic the appearance of abortion clinics, with similar-sounding names and even lookalike logos. Their volunteers sometimes pose as clinic staff to divert abortion patients from getting care. Their websites are teeming with disinformation, including claims that abortion is unsafe or linked to future mental illness, breast cancer, and fertility issues. “A killer, who in this case is the girl who wants to kill her baby, has no right to information that will help her kill her baby,” Robert Pearson, founder of the very first CPC in the US, once declared. Abortion rights advocates have long called on lawmakers to rein in CPCs and their misleading practices. But a 2018 Supreme Court decision struck down a California consumer-disclosure law’s attempt to do just that, making it virtually impossible for states to enact regulations that single out CPCs.  Soon after, pro–abortion rights legal scholars suggested a new approach: to go after pregnancy centers for false advertising. This regulatory strategy seemed like it would be a slam dunk, particularly thanks to a CPC practice that has rapidly become crucial to the anti-abortion movement’s strategy: abortion pill “reversal,” an unproven medical protocol that CPCs claim can halt a medication abortion about two-thirds of the time. The medical consensus on APR is clear: It’s not possible to “reverse” the effects of the abortion drug mifepristone, and attempting to do so may even be dangerous. To blue-state legislators and attorneys general, the legal issue was also straightforward: Making false promises—especially when those claims could hurt people—is illegal under a host of state and federal laws that ban misleading and deceptive advertising practices. But three years after the reversal of Roe v. Wade, efforts to regulate CPCs for false advertising appear poised to backfire spectacularly. In fact, by pursuing pregnancy centers based on their promotion of APR, well-intentioned Democrats may have unwittingly set the stage for the anti-abortion movement’s next great Supreme Court victory. In its term beginning this month, the high court will hear a case stemming from New Jersey’s attempt to subpoena information—including scientific evidence to back up claims about APR—from First Choice Women’s Resource Centers, a CPC chain with five locations throughout the state. In a brief, First Choice compares the subpoena to Southern states’ attempts to force the NAACP to produce member lists in the late 1950s and early ’60s. Technically, the case has nothing to do with APR or other questionable CPC practices. It’s about a specific legal fine point: Can CPCs run straight to federal court to fight an attorney general’s subpoena, as First Choice did, or must they first sue in state court?  > The fear is that, if far-right legal activists succeed, states could > ultimately be barred from intervening in any way when CPCs advertise unproven > medical treatments like APR. Boring as this procedural quibble may seem, a favorable decision would be a significant win for CPCs. They have a much better shot at winning any case in the Trumpified federal courts than they do in state courts that may be more supportive of abortion rights. What’s more, the ability to use friendly federal courts as a shield from state regulation would set pregnancy centers up for success in other lawsuits making their way to the Supreme Court—ones that could eliminate states’ ability to crack down on APR and other questionable practices entirely. Three cases are waiting in the wings. This summer, a Trump-appointed federal judge permanently blocked Colorado from enforcing a 2023 ban on APR against two plaintiffs who sued to block it: a CPC and a nurse practitioner. The first-of-its-kind statute labeled APR a deceptive trade practice. Meanwhile, in New York and California, federal court battles are raging between state attorneys general and CPCs, this time over state claims that merely advertising abortion pill “reversal” is fraudulent and misleading. The fear is that, if far-right legal activists succeed, states could ultimately be barred from intervening in any way when CPCs advertise unproven medical treatments like APR. That could grant CPCs an unfettered right to spread medical disinformation—no matter how much it may harm vulnerable people navigating an already deadly post-Dobbs landscape.  In all of these cases, CPCs are represented by the far-right legal juggernaut Alliance Defending Freedom, which wrote the Mississippi abortion ban the court used to overturn Roe and has played a leading role in major anti-abortion and anti-LGBTQ litigation in recent years. This includes NIFLA v. Becerra, the 2018 case in which the Supreme Court struck down a California law that required unlicensed CPCs to disclose their lack of licensure, and licensed pregnancy centers to provide information about family planning services.  Recordings from a March CPC industry conference—made by an attendee and shared exclusively with Autonomy News—confirm that ADF and allied law firms view abortion pill “reversal” as a linchpin in their strategy to expand legal and religious protections for the centers. The conference was hosted by the National Institute of Family and Life Advocates, an advocacy organization that provides legal counsel, education, and training for more than 1,800 member CPCs across the US; it was also the lead plaintiff in NIFLA v. Becerra. ADF senior counsel Kevin Theriot joked that NIFLA “seems to be our primary client these days,” and suggested that another legal victory is imminent.  Peter Breen, head of litigation at the Thomas More Society—another right-wing law firm that works closely with the anti-abortion movement—told the audience that the goal is to win court decisions that “protect you a little more vigorously, maybe, than you’re being protected right now.”  In all of these cases, ADF asserts that by attempting to regulate CPCs, blue states are “chilling” their First Amendment rights.  But conference recordings also reveal that, behind closed doors, many anti-abortion doctors are reluctant to embrace APR, despite its ubiquity in their movement. The recordings feature rare admissions about the challenges and risks associated with the experimental treatment, including mention of side effects not included in official case reports. These comments raise questions about how, exactly, CPCs plan to capitalize on any newly won freedoms, and whether anti-abortion leaders will plow ahead with APR when even their own medical experts are hesitant. The FDA–approved protocol for medication abortion involves two drugs: mifepristone, which blocks progesterone, a hormone essential for pregnancy; and misoprostol, which causes the uterus to contract and expel the pregnancy tissue. In abortion pill “reversal,” patients who have taken mifepristone but haven’t yet taken misoprostol are prescribed progesterone under the theory that the hormone will reverse the effects of mifepristone and “save” the pregnancy.  This theory was inspired by the longstanding use of progesterone to prevent miscarriage in early stages of pregnancy—even though randomized controlled trials have found that progesterone therapy has little benefit for most miscarrying patients. The man behind the hypothesis is Dr. George Delgado, a family medicine doctor and prominent conservative activist based in the San Diego area. > As is often the case in disinformation campaigns, there is a kernel of truth > to the anti-abortion movement’s claim that pregnancy can continue after taking > mifepristone. But APR has nothing to do with it. Delgado founded the Steno Institute, an anti-abortion research organization that counts San Francisco archbishop Salvatore Cordileone among its advisers. He sits on the board of the American Association of Pro-Life OBGYNs and is the medical director for a CPC called Culture of Life Family Services. Most recently, he was a plaintiff in Alliance for Hippocratic Medicine v. FDA, in which anti-abortion medical groups unsuccessfully challenged the FDA’s 25-year-old approval of mifepristone, plus more recent regulatory changes that have vastly expanded access to the drug. ADF represented Delgado and the other doctors in the case. Delgado published the first report on APR in 2012—a case study with just six patients, finding that four of them carried their pregnancies to term. (Case reports are considered among the weakest forms of scientific evidence, per a widely used ranking system.) In 2018, Delgado published a larger case report in the journal Issues in Law & Medicine, which has direct ties to AAPLOG. Of 754 patients initially given progesterone, 547 remained in the study and 257 later gave birth, Delgado claimed. As is often the case in disinformation campaigns, there is a kernel of truth to the anti-abortion movement’s claim that pregnancy can continue after taking mifepristone. But APR has nothing to do with it. “We know that mifepristone, by itself, is not a very effective abortion-inducing medication,” says Daniel Grossman, a professor of obstetrics and gynecology at the University of California, San Francisco who is the director of Advancing New Standards in Reproductive Health and the lead author on a 2015 systematic review of the evidence on APR. In one early French trial of mifepristone, for example, 23 percent of participants who took the now-standard dose of mifepristone alone remained pregnant. Supposed APR “success stories” may simply reflect the fact that mifepristone doesn’t work well on its own—this is precisely why it’s used in combination with misoprostol. In Grossman’s view, the anti-abortion movement’s promotion of APR is akin to an “unmonitored research project.” In the US, he adds, there is a “very ugly history of experimenting on people from marginalized groups”—and people who have abortions disproportionately belong to such communities.  > In Grossman’s view, the anti-abortion movement’s promotion of APR is akin to > an “unmonitored research project.” Still, after Delgado’s purported discovery, anti-abortion legislators moved quickly, eventually passing laws in more than a dozen states that required abortion providers to inform their patients of the possibility of “reversing” their medication abortions. (Many of those states now ban abortion entirely.) Delgado went on to found the Abortion Pill Rescue Network, a progesterone-prescription hotline that’s now run by the CPC organization Heartbeat International. In public, anti-abortion groups boast about hordes of women who they claim have changed their minds and successfully “reversed” their medication abortions. In June, Heartbeat International announced that the Abortion Pill Rescue Network has saved “more than 7,000 lives”—up from the “6,000 lives and counting” it claimed in November 2024. It’s impossible to know whether or not these statistics are true. CPCs have a history of inflating the number of clients they serve and the value of services they provide. Creating a perception that demand for “reversal” is exploding reinforces the longstanding myth that many people are unsure of their decision to have an abortion. It’s also a conservative answer to the increasing popularity of medication abortion, which accounted for nearly two-thirds of all abortions in the US in 2023—double the rate from 2014. But at the NIFLA conference, several prominent anti-abortion physicians seemed ambivalent about APR, even as CPC leaders projected bravado about the legal cases and dismissed potential safety concerns. Based on back-and-forth during two sessions—a medical roundtable and a legal Q&A—it appears that many CPCs aren’t even providing APR on site and are instead referring patients to the Heartbeat hotline. This is ironic considering the anti-abortion movement’s strident opposition to telehealth for abortion pills. But it tracks with the results of a recent study, which found that only 3.8 percent of CPCs were advertising on-site progesterone prescriptions in 2024.  During the medical roundtable, Virginia-based family physician and Heartbeat hotline provider Karen Poehailos claimed that demand for APR “has been going through the roof.” A decade ago, she’d get five requests per year, she said; in the three months before the conference, she said she’d written “13 or 14” prescriptions. (Given that there were roughly 643,000 medication abortions in the US in 2023, three to five attempted reversals per month is hardly a huge number.) Poehailos acknowledged that growth in abortion pill use may help explain the rise in APR requests. ”Women can get these as easily as clicking online,” she said. “They did not have to think about as much before they started the abortion.”  In addition to serving as NIFLA’s assistant medical director, Poehailos is also a telehealth provider for FEMM, a fertility tracking app whose development was funded by an anti-abortion billionaire. She estimated that in the past decade, only about three of her APR patients were local, meaning she was able to see them in person. “The rest of them have been through telemedicine,” she said, which requires her to be extra careful. “When these women are so far from me…I document like crazy, and I pray that God protects me,” she said. It also helps to have “friends at ADF,” Poehailos said, apparently referring to Alliance Defending Freedom. > “The majority of the women I have worked with, even if [APR] is successful, > will have some bleeding…“If you see a subchorionic [hemorrhage], that’s kind > of expected. You pray it’s not a huge one.” One of the challenges of APR, Poehailos said, is dealing with a common side effect, bleeding. “The majority of the women I have worked with, even if [APR] is successful, will have some bleeding,” she noted—specifically subchorionic hematoma or hemorrhage, a relatively common condition in which blood collects between the uterine wall and the outside of the gestational sac. Usually the bleeding is mild and resolves on its own. But this outcome isn’t reported in the papers that anti-abortion physicians have published on APR, Grossman points out. “If you see a subchorionic, that’s kind of expected. You pray it’s not a huge one,” Poehailos added.  During their discussion, Poehailos and two other doctors also lamented the quality of some of the medical testing at CPCs they’ve worked with, including ultrasounds and even basic urine pregnancy tests. “We want to serve these women well, we want to serve them in the heart of Jesus,” Poehailos said, “but we are providing medical services under someone’s license, so please … I’m sorry, but I’m not sorry. You need to be serving these women better than this.” Neither NIFLA nor Poehailos responded to requests for comment. Part of the problem may be that CPCs appear to be having trouble attracting specialized professionals. At one point, Sandy Christiansen, medical director for Care Net, another CPC umbrella organization, reassured the crowd that they needn’t find an OB-GYN to be their medical director. Any type of doctor, even a pathologist or orthopedic surgeon, could do the job, she said. “All doctors get trained in women’s medicine to some extent…they can read a scan,” she said. Christiansen didn’t respond to a request for comment. But ultrasound training has only recently become common in US medical schools, and obstetric ultrasound is even more specialized. Indeed, one audience member, who identified herself as a registered diagnostic medical sonographer, said her center’s medical director was a psychiatrist. As a result, “she puts a lot of trust into us.” Poehailos acknowledged that some physicians refuse to provide APR themselves. “Some centers, their doctors are not comfortable prescribing, and they just want to be able to provide ultrasounds for doctors who do,” she said.  During the legal Q&A, some audience members expressed concern about potential repercussions associated with advertising or offering APR. But lawyers on the panel didn’t seem worried.  “I think everyone should go get a [t-]shirt that says ‘It’s just progesterone,’” said NIFLA attorney Angie Thomas, to laughter from the audience. Based on the discussion, the claim that state laws are “chilling” CPCs’ speech appears grounded more in legal strategy than in reality. In California, for example, Attorney General Rob Bonta sued Heartbeat International and a CPC chain called RealOptions Obria over their claims about APR. In a related case, ADF is representing NIFLA and another CPC—neither of which Bonta sued—arguing that the attorney general’s actions chill these organizations’ First Amendment rights. As a result, NIFLA’s “official recommendation” to pregnancy centers in California is not to offer APR, said Anne O’Connor, the organization’s vice president of legal affairs—not because CPCs’ rights really are being “chilled,” but because claiming so strengthens their ongoing case against Bonta. “ADF recommended, you know, it’s better to go conservative in that, to allege that our First Amendment rights have been chilled by what the AG is doing,” O’Connor said. “So you would suggest not telling clients about [APR]?” asked an audience member who said she was affiliated with a CPC in California.  “I told you that’s the official,” said O’Connor. The audience laughed, seeming to pick up on a hint. Other lawyers also seemed to admit that CPCs are free to make APR referrals at the same time they claim they’re being censored. ADF’s Theriot said CPCs could keep giving out information about abortion pill “reversal” and making referrals. “There’s a difference between advertising it,” he said, “and giving people information about the possible availability.” “I think most of the centers in California are still doing it,” added Breen of Thomas More Society, which is representing Heartbeat against Bonta, suggesting that Bonta’s suit has not actually changed CPCs’ behavior. Breen did not respond to a request for comment. In an emailed statement, Theriot said ADF “will fearlessly stand alongside pregnancy centers in their ministry to support pregnant women and their unborn babies” and in their legal fights against “ideologically and politically driven attorneys general.” “We remain confident that our clients’ First Amendment rights will be protected—even if that means taking these cases all the way to the US Supreme Court.” While CPCs have been part of the anti-abortion movement for decades, their numbers have skyrocketed in the past 15 years as Republicans have consolidated their power and waged all-out war on reproductive rights. By June 2022, when Roe v. Wade fell, CPCs outnumbered abortion clinics by as many as 15 to 1 in some states. And since Dobbs, CPCs have received cash injections from state governments and private philanthropists alike, now raking in nearly $1.5 billion a year. But as the industry has grown, criticism has intensified. Abortion rights advocates have worked hard to inform the public about CPCs’ deceptive practices, branding them as “fake clinics”—a label that’s stuck. Encouraged by organizations like NIFLA and Heartbeat, CPCs have responded by trying to become more “medicalized”—bringing in more licensed staff and offering more medical services, such as testing, and less commonly, treatment for sexually transmitted infections. In addition to conferring an aura of legitimacy, medicalization has the potential to open up new funding streams. For example, RealOptions Obria Medical Clinics—one of the chains Bonta sued—operates licensed facilities that accept the state’s version of Medicaid.  > Abortion rights advocates have worked hard to inform the public about CPCs’ > deceptive practices, branding them as “fake clinics”—a label that’s stuck. > CPCs have responded by trying to become more “medicalized.” Reproductive health experts generally see abortion pill “reversal” as part of this medicalization trend. APR also gives the anti-abortion movement another way—besides lawsuits and legislation—to fight back against the soaring popularity of abortion pills in the post-Roe era. While growing numbers of patients have turned to telehealth providers for abortion care, some three-quarters of abortions—including many via pills—still involve at least one in-person visit to a clinic. And many of those patients are encountering CPC volunteers who try to convince them to “reverse” their abortions by taking progesterone instead of misoprostol. At least one abortion provider in the South says she has begun to hear from patients who’ve been drawn in by APR after appointments at her clinics. Calla Hales is the executive director of A Preferred Women’s Health Center, which operates four clinics across North Carolina and Georgia. While APR is more than a decade old, in Hales’ experience, the phenomenon of patients getting ensnared by it is relatively new. “I would have never been able to point to a single anecdote prior to Dobbs,” she says. But this year alone, patients have called her clinics at least six or seven times in as many months after someone affiliated with a CPC convinced them not to take their misoprostol. Some  patients then called Hales’ clinic back wanting to “reverse” their “reversal,” a situation in which there is no medical protocol, so health-care providers are flying blind.  In one case, Hales says, a patient traveled to one of her clinics from a state with a total abortion ban. After they returned home, family members took them to a CPC, which tried to convince them to “reverse” the medication abortion they had already started. In the other instances, patients were approached by CPC volunteers standing outside one of Hales’ clinics. A patient who is duped by the “reversal” sham, Hales adds, is likely to have to travel out of their home state again to complete their abortion—or be forced to seek follow-up care at an emergency department, where doctors may be hostile, lack adequate abortion training or both. “It’s really heartbreaking,” she says, “because there’s so much misinformation as it stands, and it’s really hard for patients to navigate getting abortion care in the first place.”