Sweden and Belgium want to discuss an EU limit on the number of children conceived from a single sperm donor — to prevent future generations from unwitting incest and psychological harms. Donor-conceived births are rising across Europe as fertility rates decline and assisted reproduction becomes more widely accessible — including for same-sex couples and single women. But with many countries struggling to recruit enough local donors, commercial cryobanks are increasingly shipping reproductive cells known as gametes — sperm or egg — across borders, sometimes from the same donor to multiple countries. Most EU countries have national limits on how many children can be conceived from one donor — ranging from one in Cyprus to 10 in France, Greece, Italy and Poland. However, there is no limit for cross-border donations, increasing the risk of potential health problems linked to a single donor, as well as a psychological impact on children who discover they have dozens or even hundreds of half-siblings.  Sweden, backed by Belgium, is raising the topic with EU ministers on Friday, with hopes of preventing future generations from dating half-siblings and reducing risk of heritable diseases. “This issue has been left unresolved for too long,” an official from Belgium ,granted anonymity to speak freely, told POLITICO, adding that an “international limit is a first step in the right direction.” A limit would prevent high numbers of children conceived from the same donor, reducing risks of hereditary diseases and half-siblings unknowingly getting together. “We don’t want genetic half siblings to … start families,” Carolina Östgren, research officer at the Swedish National Council on Medical Ethics, told POLITICO.  Sweden’s ethics council started looking into the issue in 2023, following an article published in newspaper Dagens Nyheter, which reported that Swedish clinics are selling donated sperm abroad resulting in one donor potentially fathering more than 50 children. In Sweden, each donor can only provide donations to six couples. However, there are no restrictions on how many children a donor may father across different countries. And the clinics are using this to go beyond the national limits.  BOOMING BUSINESS, GROWING RISKS Some cryobanks — sperm and egg banks — set their own voluntary limit for the maximum families or children per donor. The fertility clinic in the Dagens Nyheter article had a voluntary cap of 25 families worldwide per donor; however, while the donors were informed about the exports, many recipient parents didn’t know their children could have up to 50 half-siblings. Most EU countries have national limits on how many children can be conceived from one donor. | Andreas Arnold/Picture Alliance via Getty Images A recent case —  a donor with a rare cancer-causing gene whose sperm was used to conceive at least 67 children, 10 of whom have since been diagnosed with cancer — “is another example of why we have to regulate this on an international level,” Östgren said.  A spokesperson for the European Sperm Bank, one of the bloc’s largest cryobanks providing sperm and egg donations to 80 countries, told POLITICO that donors go through extensive health checks and family history reviews. From a medical perspective, choosing a donor is generally safer than conceiving naturally, the spokesperson argued. However, those screenings would not have detected the cancer-causing TP53 gene mutation that was carried by the donor.  “You can never be 100% sure of detecting everything,” Peter Reeslev, head of Denmark-based Fertility Consultancy, which provides international advice to fertility clinics, said in a written response. “Centralised registry can support and limit donor number of offspring, but imagining no illnesses will occur among donor conceived children is naïve.” “We can’t do whole-genome sequencing for all sperm donors — I’m not arguing for that,” Edwige Kasper, a biologist at Rouen University Hospital in France, who presented the cancer-risk donor case at the annual conference of the European Society of Human Genetics in Milan told The Guardian. “But this is the abnormal dissemination of genetic disease. Not every man has 75 children across Europe.” On average a European man has one to two children. But through donations, the number can rise as high as 550 children, as in the case of a Dutch sperm donor who has been banned from further donations. MIND THE CAP! Cryobanks warn that overly strict limits could reduce supply, which is already running short. The European Sperm Bank argued that only 3-5 percent of men who begin the selection process are approved, warning that if family limits are set too low this would drive up screening costs and wait times, potentially pricing out would-be parents. Cryobanks use one donor for conceiving as many children as possible, because the unit cost is lower, Östgren said. The European Sperm Bank caps the number of would-be parents that can use one donor at 75, allowing one donor to potentially father hundreds of children. Its price for a single-use sperm vial varies from around €700 to €1,100. But this bank also offers prospective parents the chance to opt for an exclusive donor — meaning no other families will ever receive their sperm. But it comes at a cost. Screening fees would be distributed across fewer families which would increase the price, the European Sperm Bank said in written response, without giving a value.  But that logic doesn’t fly with ethicists. “You cannot say that it’s cheaper, and that’s why we should do it,” Östgren said. “We must think of other factors than the business logic here.” The concerns also go beyond hereditary health risks and possible incest. Thanks to the rise of consumer DNA testing and social media, donor-conceived individuals are now discovering dozens — sometimes hundreds — of genetic half-siblings worldwide.  “The psychological impact of discovering that you have dozens of half-brothers and sisters in Europe or even the wider world carries a huge impact,” the Belgian official said. “The world is getting smaller and smaller. People look for each other, find each other faster.” Fertility consultant Reeslev agreed that “due to changes in communicational platforms and transparency e.g. DNA testing, the time has come for a sperm donor limit on a European level.” In some countries, the donor’s identity is kept secret unless the child experiences severe health conditions. Other countries allow donor-conceived children to know who the donor is from a certain age, ranging from 15 to 18 years. Some, such as Denmark, allow the donor to choose whether to be anonymous or open.  Belgium wants to erase the anonymity option. “We also advocate (for) a European central donor register and support the removal of anonymity,” the official said. “This is about the right of the child to know their parentage.” THE CASE FOR EU ACTION To raise attention of the issues in March this year Sweden, together with ethics councils from Norway, Finland and Denmark, published a joint report, calling for the EU discuss issues around international donations.  Donor-conceived births are rising across Europe as fertility rates decline and assisted reproduction becomes more widely accessible. | Lee Sanders/EPA Their call has been heard.  “We’re really happy that they are taking this seriously and discussing it on the broader level, on the European level,” Östgren said.  The European Sperm Bank is also hoping the ministerial discussion will lead to a harmonized cap on the number of families per donor and the establishment of a central EU donor registry to ensure long-term traceability and secure access to vital donor information.  That’s because the EU’s new regulation on substances of human origin, which will apply from 2027, while a step toward harmonizing currently widely varying rules and standards, doesn’t introduce a bloc-wide family limit and central donor registry. In the meantime Östgren believes an EU decision would be a first step toward worldwide guidance. “Sperm is exported … in the whole world,” Östgren said.

Lawmakers and activists are warning that nationalist candidate Karol Nawrocki’s win in the Polish presidential election represents a “defeat” for women’s rights and further threatens abortion access in Poland. Nawrocki, a self-described football hooligan backed by the right-wing nationalist Law and Justice (PiS) party — and by U.S. President Donald Trump’s administration — won Poland’s presidential election last weekend, narrowly beating centrist Rafał Trzaskowski. His victory deals a significant loss to the current government, led by centrist Donald Tusk, and represents “a devastating blow to anyone fighting for reproductive freedom,” said Nika Kovač, coordinator for the My Voice, My Choice campaign, which is working to improve access to abortion across the EU. “As a staunch conservative with strong nationalist backing, Nawrocki is expected not only to uphold but potentially tighten Poland’s already draconian abortion laws,” Kovač said in a written statement. “His win slams the door on hope for political reform in the near future — and locks in a future where women’s lives remain expendable.” Poland has some of the strictest abortion rules in Europe. The PiS party tightened the country’s abortion laws to a near-total ban in 2020, making the procedure allowed only in cases of rape or incest, or if the life of the woman is endangered. Nawrocki has said he would not sign any bills expanding the right to abortion. Tusk’s 2023 campaign, which pushed out PiS from government after eight years of rule, heavily relied on his commitment to liberalize abortion laws. But activists said they have become embittered with his promises, after attempts to ease the strict regulations hit a political wall as the opposition and incumbent President Andrzej Duda blocked several of his efforts. A bill to decriminalize abortion up to the 12th week of pregnancy narrowly failed to pass in the parliament and a parliamentary vote to stop prosecuting people who assist with abortions failed because of conservatives within his ruling coalition.  “We are quite disillusioned and disappointed,” said Kinga Jelinska, an activist from women’s rights and abortion group Abortion Dream Team and co-founder of Women Help Women. “I am not surprised that many people did not go to vote in this election … These are the votes that were missing in comparison to 2023, because people are disillusioned and they don’t want to go and vote and then have nothing delivered.” Now, Nawrocki’s win means that “there is no chance to change the abortion laws in Poland,” said Polish Member of the European Parliament Joanna Scheuring-Wielgus, from the Socialists and Democrats group.  Tusk’s efforts have been “effectively paralyzed,” added Kovač. “Even a supportive parliament cannot bypass a president who holds veto power — and Nawrocki has made it clear where he stands (on abortion).” This does not mean that Polish women will stop fighting for these rights, Scheuring-Wielgus said. “Sooner or later the discussion in Poland on this topic will erupt again. I am convinced of this.” HOSTILE ENVIRONMENT It’s not just the failed legislative efforts that anger activists; Jelinska said the current government has repeatedly failed to protect women seeking abortion and doctors performing the procedure from harassment, including at the newly opened Abotak center. Activists from Abortion Dream Team opened the center in March, right opposite the Polish parliament — the first place in Poland where women can go to access and take abortion pills. But the center has been the target of ongoing attacks and steady harassment since its opening, Jelinska said, and Tusk and Trzaskowski (Warsaw’s mayor) have done nothing about it, she claimed. “We have not seen any support for our center, even though this is a situation where we actually risk our health to be there,” she said. “It is fake promises, and people are not stupid.” Doctors and organizations assisting with abortion face constant harassment in Poland. The U.N. Committee on the Elimination of Discrimination against Women concluded last year that women in Poland are facing severe human rights violations due to restrictive abortion laws, with many forced to carry unwanted pregnancies to term, seek unsafe clandestine procedures or travel abroad for legal abortions. The case of Justyna Wydrzyńska, an activist who was sentenced to eight months of community service for facilitating an abortion in 2023, made international headlines. And in April, Polish MEP Grzegorz Braun stormed a hospital in Poland and threatened a doctor with a citizen’s arrest for performing a legal late-term abortion. “We also can expect that in the future, there will be more prosecution and more attacks, because this kind of voice gets legitimized in the presidential seat,” Jelinska said. Amid ongoing challenges, the EU should step up and show solidarity to women in Poland, Left MEP Manon Aubry said. Last month, Aubry was one of the MEPs that traveled to Poland to deliver abortion pills to the Abotak center. She said she is planning to do it again soon. “It’s part of the role of the European Union,” she said. “When fundamental values of the European Union are under threat — like it is the case in Poland when it comes to women’s rights or to rule of law in general — then it’s our responsibility to stand up and act in solidarity.” The My Voice, My Choice campaign wants the European Commission to establish a fund to help women who can’t access abortion care in their own country to travel to another with more liberal abortion laws. It successfully gathered the 1 million signatures needed to be considered by the Commission earlier this year.  The Polish election shows why the campaign is “more essential than ever,” Kovač said. “When the political system fails us, it is movements like ours that must lead the fight.”

PARIS — France took a major step toward legalizing assisted dying on Tuesday as a majority of members of parliament voted in favor of landmark legislation. In the French lower house — the National Assembly — 305 MPs voted to pass a bill granting “a right to assistance in dying for adult patients afflicted with a serious illness who have requested it,” while 199 voted against. France joins a growing list of Western European countries that are moving toward enabling people to end their lives under strict conditions. Those who oppose assisted dying warn such laws can endanger vulnerable people, especially young people and those with mental health conditions. The French bill includes several safeguards to prevent such outcomes. To be eligible, patients must be over 18 and either French nationals or permanent residents. They must also have a “serious and incurable” illness that is both life-threatening and has reached an “advanced” or “terminal” stage. Meanwhile, their suffering — whether physical or psychological — must be considered “unbearable” or “resistant to treatment.” Patients must be capable of giving informed consent, and must self-administer the lethal medication, unless unable to do so. The final call is to be made by each patient’s doctor. The legislation requires that doctors consult with at least one other medical professional who specializes in the patient’s pathology, as well as with a health care worker who was involved in the person’s care. Assisted dying is already legal in various forms in Austria, Belgium, Luxembourg, the Netherlands, Spain and Switzerland. In the U.K., British MPs voted in favor of legalization in November, and the legislation is currently nearing its final phase. The French bill will now be debated in the Senate, which is controlled by a conservative majority that could seek to amend or remove several provisions. If the parliamentary process fails to produce an agreement between the two chambers, President Emmanuel Macron — who promised the legislation during his 2022 campaign — has suggested the issue could be put to the public via a referendum, although constitutional experts have questioned the legality of such a move. French lawmakers also unanimously green-lit a separate bill to improve palliative care in France.

Croatia’s incumbent President Zoran Milanović, a critic of NATO and the EU whose populism has earned comparisons to Donald Trump, won the first round of the country’s presidential ballot on Sunday with 49.1 percent support. Runner-up Dragan Primorac, the candidate of the Croatian Democratic Union (HDZ) of Prime Minister Andrej Plenković, won 19.4 percent, according to the State Election Commission with 99.9 percent of precincts reporting. With neither candidate winning an outright majority, Croatia will hold a runoff on Jan. 12.   The results continue the split in the country’s top leadership. While the presidency is a largely ceremonial position, the reelection of Milanović — the most popular politician in the country — would be a thorn in the side of his archrival Plenković. In a victory speech in Zagreb, Milanović vowed to promote “a Croatia with an attitude, a Croatia that takes care of its interests and is aware that only we care about what is happening in our country.” Prime Minister Plenković, speaking after the results were declared, welcomed his party’s candidate making into into the second round. “From tomorrow is a new game, two new weeks,” he said. “Milanović has no program,” he continued. “We do not want to be dragged toward Russia, we want Croatia to go in the right direction.” During his campaign, President Milanović sought to capitalize on a series of scandals that have resulted in more than 30 ministers from the prime minister’s party resigning or being fired over corruption during Plenković’s mandate. He also faulted Plenković for his pro-European stance, calling him the “errand boy” of European Commission President Ursula von der Leyen, and cast immigration as Croatia’s top challenge. Plenković, for his part, sought to portray the vote as a plebiscite on Croatia’s future in the EU. “Milanović is a cancer of Croatian politics,” he said earlier this month, repeating that the president sought to draw Croatia toward Moscow. But Ivan Grdešić, a professor of political science at Libertas International University in Zagreb, said geopolitics alone could not make up for Primorac’s liabilities — among them that he is “not charismatic enough” to “have a larger appeal to people.” “I think he is just a little bit too sophisticated in some of his debates,” said Grdešić, who has served as Croatia’s ambassador to the U.K. and to the U.S. Primorac was also burdened by yet another scandal, this one involving Health Minister Vili Beroš, who was arrested and fired after the European Public Prosecutor’s Office opened a corruption investigation in November. “I hear many doubts from patients who are concerned by the fact that he is a candidate from the same political party as the fired minister,” said Jasna Karacic Zanetti, an ombudsman for patient rights in Croatia. Milanović’s office declined POLITICO’s request for an interview, while Primorac did not reply. Sunday’s presidential election was Croatia’s third vote this year, following a snap parliamentary election in April and the European Parliament election in June. Ketrin Jochecová, Sebastian Starcevic and Hanne Cokelaere contributed to this report.

The United Kingdom’s recent vote to move toward the legalization of assisted dying represented a historic moment for the country — but it also mirrors a wider trend in Europe. Countries are on a path to liberalize their laws to expand end-of-life options to include euthanasia and assisted suicide. To some experts, the latest position in the U.K. reflects what is a growing and inevitable trend among Western European countries. Various forms of assisted dying are already legal in Austria, Belgium, Luxembourg, the Netherlands, Spain and Switzerland. “It will not happen in all countries at once, but especially in Western Europe and Northern Europe, if there are no laws available yet, there will be an urge to have such laws,” said Martin Buijsen, professor of health law at the Erasmus University Rotterdam. “I think that’s inevitable.” But to others, there are concerns that existing laws are already being pushed beyond their intended purpose, and fears that this slow trudge toward assisted dying being the norm could lead to harm — especially to vulnerable people. In Switzerland, for example, the recent use of a suicide pod stirred controversy and led to several arrests, while in the Netherlands, young people with mental health conditions are also legally taking their own lives with help from the state. “I have seen no jurisdiction in which the practice has not expanded, not one single jurisdiction,” said Theo Boer, professor of health care ethics at Protestant Theological University. “By imposing really strict criteria we can slow down the expansion … but they will not prevent the expansion.” For the U.K. this was the country’s second attempt to pursue such a law. This time it heeded lessons from its first failed attempt (making the conditions more restrictive) — and perhaps from stories from across the Channel. LEARNING THE LESSONS Assisted dying can refer to both euthanasia and assisted suicide. In euthanasia, a physician or provider administers a patient a fatal drug to deliberately end their life; while for assisted suicide the patient is legally prescribed lethal drugs they must take themselves to end their own life. In several of the countries that have legalized assisted dying, the number of people using it to end their lives is increasing. In 2023, 9,068 people died from assisted dying in the Netherlands — 5.4 percent of deaths that year. This is up 4 percent compared with 2022 and up 87 percent from 2013. Similarly, in Belgium there were 3,423 cases of euthanasia in 2023, up 15 percent compared with the previous year and comprising 3.1 percent of total deaths in the country. The Netherlands and Belgium were the first European countries to legalize euthanasia in 2002. Some have raised the alarm at the increasing number of people choosing to end their lives, warning governments debating similar laws to be aware of this phenomenon. “What I saw was not only the increase in the numbers — which for me was a sign that it was no longer the last exception, the last resort — but it became more and more a default way to die,” said Boer. “In addition to the numbers, we saw an expansion of the pathologies underlying euthanasia requests.” Boer had initially supported the Dutch euthanasia law and was a member of the Dutch euthanasia review committee. But he has since become an outspoken critic of this law and has warned other governments debating similar bills of the possible “side effects.” The rising number of patients — especially young people — with mental health disorders dying by euthanasia has also spurred fierce debate in the Netherlands, Buijsen said. The number of euthanasias for patients with psychiatric disorders doubled over the last five years, from 68 to 138. Similar debates arise around cases of minors and patients with dementia, he said. But it’s not a one-size-fit-all. According to researchers at the University of Bologna, the proportion of euthanasia and assisted suicide on overall deaths “continues to vary widely” in countries where the practice has been legalized for years, “mainly due to the circumstances under which [they] were adopted into law and the different practices approved.” Switzerland, for example, is one of the most popular destinations for foreigners looking to access assisted dying, and has been offering legal assisted suicide since 1942. POLITICAL AND SOCIAL BARRIERS It has taken some countries several years to push their assisted dying laws over the finish line, amid opposition from conservative parties, religious institutions and highly emotive debates. The Portuguese parliament approved an euthanasia bill four times over three years, but conservative President Marcelo Rebelo de Sousa vetoed all drafts. Eventually, the parliament overturned his veto in 2023 and forced him to sign the bill. But even today, the legislation has not been published in the country’s official journal, meaning it’s not in effect. While in countries such as Italy and Ireland, the powerful presence of the Catholic Church has historically steered the conversation away from legalization for years. It’s only recently, however, that things are changing. In Italy, the country’s Constitutional Court ruled in 2019 that assisted suicide was permissible when patients are able to make decisions and are in overwhelming pain. This led to Italy’s first case of assisted suicide in 2022 — despite there being no law to allow it. While in Ireland, progress on the debate shows the Church’s influence on policy may be weakening. Irish MPs earlier this year endorsed a parliamentary report calling for assisted dying and presented a “Voluntary Assisted Dying Bill 2024” to the lower house in June. But Ireland is also among a group of countries impacted by political upheaval. The Irish bill lapsed with a snap election and the dissolution of the Dáil. Similarly, France was debating an assisted dying bill earlier this year, but the process was interrupted by the dissolution of the government and subsequent snap election. And in Iceland, MPs presented a bill on euthanasia in March 2024, but the government fell in October, leading to a parliamentary election in November. TIMING IS EVERYTHING Timing and a country’s political landscape play a crucial role in determining the success of such proposals. And while the issue does not fall neatly along party lines — some Labour MPs in the U.K. were very vocal in criticizing the change of law — a left-leaning government or parliament are much more likely to pass similar bills. At the same time, conservative figures such as Boris Johnson and Marine Le Pen have spoken against euthanasia. In Spain, far-right party Vox challenged the country’s euthanasia law in 2023, but failed. Spain passed its law to legalize assisted dying in 2021. “If the [U.K.] vote had been taken before general elections, the outcome might have been somewhat different,” said Buijsen. “You will need, in some way, a kind of a progressive majority in parliament in order to have these laws passed.” The requirements of accessing assisted dying also vary greatly. While some countries, like the British bill, require the patient to have a terminal illness, others such as Belgium and the Netherlands only require that the patient is experiencing constant and unbearable suffering with no cure or prospect of improvement, including psychological suffering. Other Western European countries to have approved assisted dying include Luxembourg in 2009 and Austria from 2022. Countries including Scotland, Jersey and the Isle of Man have started the debate and made attempts to introduce legislation in recent years. In Germany, assisted dying falls into a gray area. The practice is illegal but the Federal Constitutional Court decriminalized it in 2020. A GEOGRAPHICAL DIVIDE While Western European countries are increasingly entertaining the assisted dying debate, Eastern and Central Europe are moving at a much slower pace. No countries in Eastern Europe have legalized assisted dying or are currently entertaining legislative proposals. But that doesn’t mean the topic is not entering public discussions. Veljko M. Turanjanin, law professor at the University of Kragujevac, in Serbia, said the country has seen several discussions to legalize euthanasia, as the public opinion and many medical professionals seem to be in favor. But the strong influence of the Orthodox Church has slowed progress, he said. “I think in the state where the government and the Church are linked close, it will not be an easy task for the government to pass such kind of legislations,” Turanjanin said. But when countries in the region do eventually move toward legalization, surrounding countries are likely to follow suit, he said. “I think when [Serbia and Croatia] legalize euthanasia or assisted suicide, the other countries will do the same.”

Olivér Várhelyi, the Hungarian commissioner-designate for health and animal welfare, failed to win an immediate stamp of approval from members of the European Parliament on Wednesday evening. Coordinators for the responsible committees decided instead to ask him a second round of written questions following a three-and-a-half hour grilling, during which Várhelyi fended off questions on women’s rights, competitiveness, animal welfare and his links to Hungarian Prime Minister Viktor Orbán. “We note that the answers given by Mr. Várhelyi did not meet Renew Europe’s expectations and so we conclude that we cannot support his nomination at this stage,” Renew said in a press release following the meeting. The coordinator in the Environment, Public Health and Food Safety Committee (ENVI), Greens MEP Sara Matthieu, added in a release: “Commissioner-designate Olivér Várhelyi did not convince us.” Of the 16 commissioners-designate to have undergone hearings so far this week, Várhelyi is the only one not to have passed. Only far-right groups and the European Conservatives and Reformists (ECR) voted in favor of the Hungarian nominee, two parliamentary officials said. The Greens, Renew and Socialists & Democrats (S&D) wanted Várhelyi to go through a second hearing, while the European People’s Party (EPP) pushed for a second round of written questions — the option the groups eventually settled on, three parliamentary officials told POLITICO. Várhelyi, who served as the enlargement chief in Ursula von der Leyen’s first College of Commissioners, has until Monday to respond to the MEPs’ questions. After that, coordinators will hold a second evaluation meeting, after which they will need to reach a two-thirds majority. If they fail to either reject or approve him, the vote will go to the entire committees where Várhelyi will need a simple majority for the green light. IT WAS NEVER GOING TO BE EASY Várhelyi was in trouble from the get-go, with multiple MEPs saying he had little chance of winning the two-thirds majority to pass. The Hungarian faced heat over his loyalty to Hungary’s Orbán and multiple confrontations with MEPs — he famously called them “idiots” in an incident last year. Lawmakers also cited his lack of experience in health policy. During his hearing Wednesday, Várhelyi faced multiple critical questions about his stance on women’s rights and abortion. He repeatedly said he is an “ally” of women, but that abortion lays outside of EU competencies. “I am deeply worried to hear a potential health commissioner say that abortion is not a medical question,” Greens MEP Matthieu said. “He appears unaware or unbothered that countless women are dying for being denied access to reproductive and sexual health services.” Just before the hearing, Commission President von der Leyen met with the chair of the Socialists and Democrats, Iratxe García, the chief of center-right European People’s Party (EPP) Manfred Weber, and Renew Europe’s boss Valérie Hayer, an EU official confirmed. The official said it was to take stock “of the hearings in progress.” Also prior to the hearing, Renew floated the idea of stripping back Várhelyi’s powers as health commissioner. “Várhelyi going just through with competences over vaccines or reproductive rights won’t be supported by Renew,” a senior Renew official said. This idea was not discussed during the meeting, according to an MEP and a parliamentary assistant present in the room. MEPs would need to demand a change of powers in the evaluation letter they send to von der Leyen after assessing Várhelyi’s answers to the additional questions and making a final decision on his candidacy. Additional reporting by Barbara Moens.

Abortion has haunted Republicans since the fall of Roe v. Wade. But the issue failed to stop former President Donald Trump, who on Tuesday overcame a large gender gap — and Democrats’ relentless focus on women’s reproductive health — to win back the White House. With message discipline that often eluded other parts of his campaign, Trump and his allies positioned themselves as moderates on abortion, arguing the issue should be left to states, pledged to veto a national abortion ban should it reach his desk, pitched government support for in-vitro fertilization and other reproductive health services, and promised to be a champion for women. These attempts to neutralize an issue that has dogged Republicans since Roe’s fall in 2022 helped Trump notch a clear victory against Vice President Kamala Harris with an electorate angry over the economy, inflation and immigration bent on punishing the party in power. Vice President-elect JD Vance, who himself backpedaled after years of supporting federal abortion restrictions, also worked to tamp down widespread outrage from the fall of Roe by promising to preserve federal access to abortion pills and fund more generous social programs for new parents. Trump allies even invoked the late Justice Ruth Bader Ginsberg in a nearly $20 million ad blitz just before Election Day arguing Republicans aligned with her views on abortion. But more than anything, Republicans mostly avoided the issue and pivoted to more politically favorable territory, including the economy, crime, immigration and transgender rights. “Donald Trump has been very, very clear in saying this is a states’ rights issue and we’re not going to get involved at the federal level,” Pete Hoekstra, the chair of the Michigan GOP told POLITICO in September. “The bottom line is that if we’re debating the abortion issue, we’re debating the issue that the Democrats want to talk about, and if we’re debating on the economy, if we’re debating on the border, jobs, and those types of things, we believe we’re debating on the issues that are most important to voters today.” Democrats had bet on abortion remaining as strong a motivator as it has been in races around the country since Dobbs. But other issues, including the economy, proved more salient to many voters. CNN’s national exit poll found that abortion was the top issue for only 14 percent of voters, behind democracy at 34 percent and the economy at 31 percent. That exit poll also underscored the political pragmatism of the GOP’s attempts to appear moderate on abortion: 28 percent of people who believe abortion should be legal voted for Trump. “The post-Dobbs Dem overperformance was non-existent. Or at least was swamped by other factors favoring Trump,” said Tom Bonier, a senior adviser to the Democratic data firm TargetSmart, on X. “Clearly Trump was not viewed as a threat to abortion rights by enough voters, which is mind-boggling.” With control of Congress hanging in the balance, a national abortion ban isn’t out of the question — though Trump campaigned on promises to veto such a bill. But there are myriad ways his administration and the judges he appoints can curtail access to the procedure without passing legislation. Conservative allies of the president-elect at the Heritage Foundation’s Project 2025 and other groups have urged him to direct the FDA to reimpose pre-pandemic restrictions on online prescription of mail delivery of abortion pills or revoke their FDA authorization — outcomes judges could also bring about as several lawsuits over the pills make their way through federal courts. These steps would block access nationwide to drugs that account for more than two-thirds of U.S. abortions, including in states with laws protecting the procedure. Abortion opponents have also called for his administration to enforce the Comstock Act, an 1873 law banning the shipping of “lewd” items including drugs or instruments used for abortions. Trump, in August, said he had no plans to enforce the Comstock Act. Trump is, however, expected to reimpose many of the anti-abortion policies of his first administration, including restrictions on the Title X family planning program and global HIV programs. “Now the work begins to dismantle the pro-abortion policies of the Biden-Harris administration,” Marjorie Dannenfelser, president of SBA Pro-Life America said Wednesday. “President Trump’s first-term pro-life accomplishments are the baseline for his second term.” Most anti-abortion groups stood by Trump throughout the campaign even as he repeatedly broke with them on federal abortion restrictions, exceptions for rape and incest and other policies, bucked them on the party platform, and welcomed into his inner circle people with a mixed-to-liberal record on abortion. SBA Pro-Life America poured tens of millions of dollars into boosting Trump and down-ballot Republicans despite previously saying his rejection of a national ban could be disqualifying. But some in the movement fear that Trump’s success will convince other Republicans to run as abortion moderates. “They’ll certainly be opportunistic GOP consultants who will try to seize on that and say, ‘See, we need to drop the abortion talk,’” said Kristan Hawkins, the president of Students for Life of America. “The party needs to see this is not the way of the future.” Yet Hawkins and her allies argue his victory would be worth these setbacks if he appoints hardline anti-abortion officials to key positions at HHS, FDA and the Justice Department who they can depend on to implement their agenda. Throughout her campaign, Harris spotlighted women who suffered severe health complications — and some who died — after being denied abortions, and she repeatedly reminded voters that the chaos resulted from “Trump abortion bans,” her nickname for the state laws that kicked in after the fall of Roe. In the election’s final weeks — as polls showed a virtual tie — Harris held abortion-focused rallies in Atlanta and Houston, dispatched former first lady Michelle Obama to Michigan and went on the popular “Call Her Daddy” podcast to highlight the fallout from GOP policies and warn of national restrictions should Trump win power. It wasn’t enough. Michigan Democrats warned in the final stretch of the campaign that they were struggling to persuade voters that abortion remained under threat after the state passed a ballot initiative protecting access to the procedure in 2022. And even in other battleground states like Georgia, North Carolina and Arizona where abortion restrictions remain in effect Democrats’ message was overpowered. While Arizona has yet to be called, Democratic strategists in the state are attributing their expected loss, in part, to the Republican-controlled legislature. It moved earlier this year to repeal a Civil War-era near-total abortion ban and leave in place a law prohibiting the procedure after 15 weeks, which Democrats said made it harder to convince voters that abortion access was under threat. “I’m more concerned with economic problems than stuff that’s already in the state rights,” said Yusuf Isaak, a 19-year-old community college student in Mesa, standing outside a polling place Tuesday afternoon. “I feel like economic problems are more pressing because they actually affect everyone’s day-to-day life.” Edna Meza Aguirre, a board member of Planned Parenthood of Arizona based in Tucson, said in the run-up to the election that despite her and other volunteers’ efforts to focus voters’ attention on abortion rights, many in her community were backing Republicans because of immigration concerns. “They’re listening to what conservatives are saying about individuals crossing the border, taking our jobs, and raping our women, and also complaining that they’re a burden upon society,” she said. “It’s a really effective way they’ve determined to have hate be an issue.” Too many other voters, she added, planned to sit out the election. “We hear people say that they’re too discouraged to vote, or we hear them say that voting doesn’t matter when it does.” Democrats’ abortion-rights playbook also failed in New Hampshire, which the party had viewed as its best chance to flip a governor’s seat this year. Democratic nominee Joyce Craig, the former mayor of Manchester, had made expanding abortion access the focal point of her campaign — and her main line of attack against her Republican rival, former Sen. Kelly Ayotte. But Ayotte parried in ads vowing to uphold New Hampshire’s law allowing abortions up to 24 weeks of pregnancy and in limited cases afterward, and to protect access to in-vitro fertilization. And though Democrats had insisted that abortion ballot initiatives in Arizona and other swing states would help drive progressive turnout and give their candidates an edge, the measures had a limited impact even when they passed overwhelmingly — and may have even helped Republicans by giving voters a “release valve” for their feelings on the issue. In a swath of states, including Arizona, Florida, Missouri, and Montana, a majority of voters backed both abortion-rights ballot measures and GOP candidates with records of opposing abortion, including Trump. Lisa Kashinsky contributed to this report.