In 2020, medication abortion — abortion via pills rather than surgery — accounted for the majority of all United States abortions for the first time in the pills’ 20-year history.

Reinforcing access to these medication abortions was one of the Biden administration’s first responses to the fall of Roe. President Joe Biden “directed the Secretary of Health and Human Services to identify all ways to ensure that mifepristone [one of the two drugs used in pill-based abortions] is as widely accessible as possible” in the very same statement in which he asserted a right to engage in interstate abortion trafficking.

These are the emergent twin frontiers of the pro-life legal battle: abortion pills and abortion trafficking. 

These abortions aren’t as “safe and effective” as they’re made out to be, either. Abortion pills are four times more likely to land vulnerable mothers in the emergency room than first-trimester surgical abortions. Surgical abortions pursued out-of-state can be risky, too, as the side effects can be severe for mothers. Women undergoing out-of-state abortions risk being stranded away from family or friends while they suffer potentially extreme pain, bleeding, grief or anxiety.

However, these two abortion strategies have become the preferred ways for the federal government and regulatory agencies to advance abortion after the Dobbs ruling — thereby hampering pro-life legislators at the state level.

The text of the Dobbs decision was clear: the court sought ultimately to allow “each State to address abortion as it pleases.” It specifically rendered judgment that no “right to abortion” is derived from the U.S. Constitution. 

In other words, while it was a tremendous pro-life victory that allows elected officials to make laws protecting children in the womb, Dobbs emphatically did not end abortion in the United States. Much of the fight to protect vulnerable little ones remains with us.

Remembering why we advocate for abortion’s end

That’s why it is essential that legislators, activists and Christians remember why we “address” abortion at all: to end the ongoing massacre of innocent, human life in the womb. 

As early as six weeks, a heartbeat of about 110 BPM is detectable in the womb — no matter how hard pro-abortion activists may fight to revise long standing, uncontroversial medical consensus. By 12 weeks, all of the little human’s major body systems are present and reflexes begin to develop. At 18 weeks, children can hear their mothers’ heartbeat. In the last trimester, they can taste — and smile or grimace at — the flavors of the food their mother eats.

This is not simply a political or campaign issue. This is not just the states’ legal responsibility. This is the gravest human rights abuse in our society. These are children. They always have been and always will be. Children were at the heart of the pro-life movement from its inception — as individuals sought to protect these vulnerable neighbors from the abortion provider’s hand — and they remain there to this day.

A legislation rundown

Yet there is legislation on the books in aggressively pro-abortion states to expand the legal killing of these children. Seven states have no gestational limit on abortion whatsoever, and another 26 states only limit abortions at or around the point of “fetal viability,” generally between 22 and 24 weeks.

Given the fact that 91% of U.S. abortions occur in the first 13 weeks of pregnancy, viability protections translate into unrestricted abortion access for the vast majority of women who desire an abortion. In other words, many of the children who may have been killed under Roe may also be killed under Dobbs.

The state-level response to Dobbs is varied, and a range of pro-life strategies are before the courts at this very moment. Thus far, six states responded by introducing “personhood amendments,” amendments to their state constitution that would permanently enshrine the human child in the womb as a legal person. The Dobbs decision explicitly sidestepped the question of fetal personhood, so these amendments — and the litigation battles they spawn — are breaking new legal ground.

Other states, like Missouri, are exploring protecting children from abortion trafficking. Following a model like Texas’ novel S.B. 8 law, Republican Missouri Rep. Mary Coleman introduced legislation that would allow private citizens to sue anyone they knew had pursued an out-of-state abortion. 

Additionally, 19 states required abortion pill providers to be present for the administration of the first dose, making out-of-state “telemedicine” in these cases effectively illegal. Part of this provider requirement is often a guarantee of emergency care for women undergoing “self-managed” abortions — a surprising stipulation if they are in fact as safe as proponents make them out to be.

However, international providers are untouchable by current federal regulations. One such provider, Aid Access, is based in Europe and provides medical abortions to Americans in states where life is protected. It’s run by a pro-abortion activist and was actively pursued by the Trump administration’s FDA for providing “unapproved” forms of the drugs used in medical abortion, but continues providing abortions by mail to this day. Aid Access claimed it received more than 10,000 requests for the abortion pill regimen in the week after the Dobbs decision.

International pills pose deep and dangerous risks for women who may not have consulted their own doctor who knows their medical history. An incorrect dose could lead to a hemorrhage, for example, or if a woman is Rh negative and doesn’t receive Rhogam at the time of her abortion, she could be putting herself at serious risk in future pregnancies. 

The work before us 

The future of the pro-life movement is growing much more complex. We are not merely fighting to protect women and children from a badly-reasoned 1973 Supreme Court precedent. We are fighting to defend them against international activists, other states, domestic activists and even the current administration. Addressing the use or expansion of abortion pills and abortion trafficking, in all their forms, will become essential as we seek to protect human life in the womb in America. 

But there is another side to this picture. Legally protecting children in the womb alone fails to address the very real and pressing needs of vulnerable mothers all over the nation who are in desperate need of material, emotional and social support. So — as voters, as members of the pro-life movement, and as Christians — we must rally around women, as well. 

We need to find a way to restore motherhood to its rightful status as a role to be celebrated, cherished and protected. 

It will take charity, humility and tireless work from all parts of the pro-life movement in order to do so: part legislative, part community-based, part spiritual ministry and part prayer. 

But it is possible. And it is imperative that we work to realize it. Millions of children in the womb and their mothers depend upon us, now more than ever. The legacy of the pro-life movement hangs in the balance, and we cannot afford to lose momentum or clarity.

So work and pray. Pray in gratitude for each life rescued by existing abortion restrictions, many enacted by the Dobbs decision. And work fervently to rescue children in the many states where their lives are not yet protected or valued. The very fabric of our society depends upon it.

(EDITOR’S NOTE – Chelsea Youman is the Texas State director and national legislative advisor for Human Coalition.)