Massachusetts has long been at the forefront of providing and protecting access to reproductive health care. Its role in doing so — in a national context — will likely increase once President-elect Donald Trump returns to the White House.

Throughout his campaign, Trump continuously reiterated that abortion access should be left up to the states, but his past and present record demonstrate an effort to chip away at and erode that access. From promising and succeeding to appoint Supreme Court justices to overturn Roe v. Wade to aligning himself with state-level officials working to restrict patients from traveling to access care, experts agree that a second Trump administration will continue to be a key part of the national effort to restrict and prevent abortions.

They also agree that Massachusetts residents will largely remain unaffected. In fact, state legislators have been galvanized to explore further protections and prepare for the various domino effects that may come if and when other states clamp down harder on abortion access.

“We have more work to do,” said Sen. Rebecca Rausch, D-Needham. “We have to build upon the many successes that we have had and the many advancements that we have made.”

Rausch has sponsored multiple bills involving not just abortion care and access, but also support for new parents and young children.

She said her work is underpinned by Gov. Maura Healey’s commitment, most explicitly seen in the executive order signed in 2024, and this support encourages further legislative action.

In addition to updating her abortion access bill, Rausch said she intends to explore a number of related changes, including the ability to issue limited licensure to medical students coming to Massachusetts from states where abortion is banned to pursue training.

That bill speaks to the increasing role the state will likely assume in the coming years. In particular, while pregnant people seeking abortions in states where it is banned often do not need to travel as far as Massachusetts for care, in-state providers of abortion medicine have played a vital role through telehealth and shipping medication.

Massachusetts is one of eight states with shield laws protecting those providers from federal prosecution, but it is here where one of the biggest potential challenges lies, experts say. Texas has already sued one state providing telehealth medical abortion services.

The challenge comes from an 1873 law banning the interstate shipping and receiving of — among other “obscene” materials — anything “designed or intended for the prevention of conception or procuring an abortion.”

Congress followed that up 30 some years later with a similar law adding criminal culpability for the carrier service used to ship those materials. The two laws became known collectively as the Comstock Act.

While federal appeals courts have ruled in various cases over the last century in ways that have severely limited the scope and application of the Comstock Act, it remains largely unchanged in the United States Code. The much-discussed Project 2025 outlines the ability of the Department of Justice to challenge state-level shield laws by enforcing the act as it is written and prosecuting providers of abortion medication.

“We have to take it pretty seriously,” said Carrie Baker, a lawyer and professor at Smith College. “Attorneys general [across the country], including Andrea Campbell, are very determined to challenge anything the Trump administration tries to do to impose a broader abortion ban … but the fact of the matter is those cases would end up before a heavily Trump-packed Supreme Court.”

Self-managed abortions through medication became even more common after the Dobbs decision that upended Roe v. Wade. According to WBUR, abortions increased in 2023 by 37% in Massachusetts, 65% of which occurred through the use of abortion medication.

Most importantly, rates of patients from outside of the state increased seven-fold. Nationally, research conducted by the Society of Family Planning indicates that telehealth abortions now make up 20% of all abortions, with the majority coming from patients in states with some kind of access restriction.

The medications themselves, mifepristone and misoprostol, have come under attack as well. Louisiana has sought to classify them as Class IV controlled substances, and Baker spoke on the potential for the U.S. Food and Drug Administration to reverse its approval of mifepristone.

In-person abortions still make up the majority of procedures.

After Dobbs, patients in states with abortion bans were forced to travel to states that did not have bans to obtain abortions, with the New York Times reporting more than 171,000 such cases in 2023 — more than double compared to 2019.

Since then, there have been attempts in multiple states, including Idaho and Alabama, to ban that travel. However, it is unclear if those bans would pass constitutional muster, according to Nicole Huberfeld, a professor of health law at Boston University.

“Dobbs specifically stated that there’s a constitutional right to travel … but dimensions to that have yet to play out because the right to travel has not been well explored by the Supreme Court,” she said. “It’s setting up a path for cases to make it to the Supreme Court and more completely articulate what the doctrine is for the so-called right to travel.”

Regardless of what further changes actually occur, patients and providers of care in states that have already seen upheaval in abortion regulation are likely to continue to self-regulate and delay procedures, Huberfeld said.

“Health care providers are afraid to provide care, even if it would be technically lawful in their state, because they don’t know if it’s lawful,” she said. “People don’t seek care because they’re afraid they can’t get it.”

While advocates say these challenges are grim and take a serious toll on patients in other states, Massachusetts is in a unique position to not just defend access to reproductive health, but advance it. Activists and legislators in the state are ready to continue the work of providing care no matter what comes their way.

“How is this an opportunity to get people galvanized, to light a fire under people, to get people to think creatively? That is the positive path forward,” Baker said. “What’s our vision for society and what can we do now to get there?”

Austin Chen writes for the Greenfield Recorder from the Boston University Statehouse Program.