To anti-abortion activists who worked diligently to help President Trump win in 2024 and deliver a Republican trifecta, the Food and Drug Administration's (FDA) decision last week to approve a generic version of mifepristone — a pill used in medication abortions — was a slap in the face.
The "pro-life" community is well aware that in the aftermath of the Dobbs decision, it's not prudent politics to take a purist stance on issues like a national abortion ban. And they understand issues like in vitro fertilization can divide "pro-life" activists and lawmakers.
This was different.
Abortion pills are at the center of the fight over abortion and the movement's top policy issue on the federal level — and the FDA issued the approval even as Secretary Robert F. Kennedy Jr.'s Department of Health and Human Services (HHS) is "conducting a study of the reported adverse effects of mifepristone to ensure the FDA's risk mitigation program for the drug is sufficient to protect women from unstated risks."
"The most disappointing thing about the approval of the generic abortion drug is that it's a reversal of what Secretary Kennedy has said himself. He said in a congressional committee hearing that the Biden administration twisted the data — his words, twisted the data — around the abortion pill," Noah Brandt, the vice president of communications at Live Action, told me.
Organizations that had been messaging positively about the Trump administration are now getting more critical, with the thinking being that negative public pressure can jolt the Trump administration into delivering on other priorities. Live Action, for instance, led a letter of 25 anti-abortion groups seeking reversal of the decision.
"The FDA made a huge error, huge misstep here. … This is not MAGA, this is not MAHA," Kelsey Pritchard, political communications director at Susan B. Anthony (SBA) Pro-Life America, said, adding that the approval makes it easier to get abortion pills through the mail in defiance of state laws. She hopes "that by pointing this out and calling this a huge misstep, that they will see how serious this is and reverse course."
Students for Life of America President Kristan Hawkins called the FDA's approval a "stain" on the Trump presidency — and Kristi Hamrick, the organization's vice president of media and policy, told me there could be "a deep state problem at the FDA."
"We're going to need to see President Trump be more engaged on this if the FDA is incapable of a real review," Hamrick said, balking at "how inexplicable it is to allow more of a drug on the market that you are actively saying could be problematic."
But it's a delicate balance for the anti-abortion crusaders who have a rare opportunity to secure wins in a Republican trifecta. Others in the space are privately advocating for remaining in close contact with administration's allies and providing them data, while also providing public support for anti-abortion policies and giving the administration cover.
In "abortion pill" pregnancy terminations, mifepristone — which blocks production of the hormone progesterone needed for pregnancy — is typically taken along with misoprostol, which induces uterine cramping. It is also used in some cases to manage early miscarriages.
Last week's approval of the Evita Solutions generic mifepristone marks the second generic version of the drug approved by the FDA.
An HHS spokesperson said that the FDA has "very limited discretion in deciding whether to approve a generic drug" and must do so if it's identical to the brand-name drug. They also noted generic applicants are not required to provide new evidence proving safety and effectiveness, and that the FDA does not endorse any drug.
White House press secretary Karoline Leavitt has echoed those points in recent public statements, as did White House spokesperson Kush Desai when I reached out: "The FDA has limited discretion in drug approvals, and must, by law, approve a generic drug if it is demonstrably similar to a brand-name drug. The FDA's approval should not be seen as the Administration's endorsement of the drug, and HHS continues its study into the reported adverse effects of mifepristone."
That's not helping smooth things over.
"I just do not buy the idea that their hands were tied and they had to do it," one anti-abortion activist told me, granted anonymity to speak candidly.
There's also a sense of frustration with the political position the anti-abortion activists are in. With virtually no support from Democrats, all the opportunity in securing wins for their causes rests with the Republican trifecta and Trump administration.
"Where else are we going to go?" the anti-abortion activist said — before warning that trying to appease people who are in the middle or in favor of abortion rights will not work because those activists will criticize Trump and Republicans "no matter what they say or do."
Pritchard of SBA Pro-Life America warned that it would be a mistake for Republicans to take the anti-abortion base for granted.
"Republicans should remember that they can't win elections without pro-life voters," Pritchard said. "We're such a huge block of voters in this country, and a very important part to how Republicans win every year."
At the top of SBA's priority list is getting HHS to reverse Biden-era regulations that increased access to mail-order abortion pills. "We really think it's an easy lift," Pritchard said.
Others are willing to wait for that mail-order abortion pill rule change until HHS conducts its review of mifepristone, in hopes that a robust review could lay the groundwork for reversing the approval of the drug.
But some of those activists would be incensed if it takes until after the midterm elections to release the mifepristone review, wanting to see more immediate progress on their anti-abortion priorities.
Melanie Israel, a visiting fellow at the Heritage Foundation, said the structure of that HHS review is critical — and not much is known about its structure yet.
"It can't be an exercise where you simply ask the same unnamed, anonymous bureaucrats that got us into this mess in the first place to essentially go back and check their work and rubber-stamp it," Israel said. "We would want to see the FDA looking at real-world data, not selected reporting of whatever the pill manufacturers choose to share."
Jennie Bradley Lichter, president of the March for Life (which just announced a 2026 featured speaker who says she started a medication abortion, then reversed it), also pointed to the importance of HHS delivering a thorough mifepristone review.
"There are some valid questions to be asked about why that approval had to happen now, but even crediting the administration's explanation, it just makes it all the more critical for them to complete the safety study that's been promising," Lichter said.
More from my colleagues: FDA under pressure from right after abortion pill approval ... GOP lawmakers slam abortion pill approval ... White House responds to abortion pill blowback: 'Not an endorsement'
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