Over almost two hours, President Donald Trump covered issues as varied as tariffs, men’s hockey, immigration and health care. He even touted a drug-purchasing platform offering discounted prices the government has bargained for some fertility drugs. 

But not once did he mention abortion — underscoring, just months before the midterm elections, a growing rift between the White House and a coalition that helped fuel Trump’s two presidential victories. 

Some activists argue that ignoring the issue could ultimately hurt the president with a core constituency. 

“What we have said to the president and people behind the scenes is, don’t discourage your voter. The most loyal voter is the pro-life voter,” said Kristi Hamrick, the head of policy for Students for Life, a national anti-abortion group.

Though Trump spoke about abortion in his 2019 and 2020 State of the Union speeches, calling for a ban on what abortion opponents call “late-term abortions,” he ignored the issue in his address before Congress last year. His Tuesday night speech emphasized the economy — including unpopular tariffs that were struck down last week by the U.S. Supreme Court — and an immigration enforcement approach that has resulted in the killing of two U.S. citizens, sparking national outcry on what was once one of his best-polling issues.

Though Trump did not mention abortion, he highlighted other health care concerns, calling for lawmakers to scrap the Affordable Care Act’s subsidies and touting discounts for the fertility drugs used in in vitro fertilization — which is actually opposed by many anti-abortion activists.

Abortion opponents have been more vocal in their frustrations with the Trump administration, which many see as having done little to capitalize on the fall of Roe vs. Wade. The White House helped pass legislation to cut funding for Planned Parenthood, has pardoned anti-abortion activists convicted of forcing their way into clinics, and, following the lead of Republican administrations since Ronald Reagan, has interpreted foreign aid policy to prohibit funding organizations that tell people about abortion as an option. 

But the administration has not acted on a key anti-abortion priority: restricting access to mifepristone, the medication used in most abortions that can be mailed to states with bans. Now, about a quarter of abortions are performed through telehealth, and the number of abortions done in the country has actually increased, despite Roe’s fall. Medication abortion is very safe and effective, including when done by telehealth.

“The current GOP strategy of leaving this issue to the states clearly does not work,” Marjorie Dannenfelser, head of the anti-abortion group SBA Pro-Life America, said in remarks ahead of Tuesday’s speech.

Though conservative led states have pushed new laws and legal challenges meant to curb access to the drug, the Trump administration has not offered its support to those efforts. The Food and Drug Administration has said it is reviewing mifepristone’s approval — a process abortion opponents hope could be used to block prescribing the pills via telemedicine — but the federal agency has not given a timeline for the process. 

“The White House hasn’t done very much, and I’m not surprised they haven’t. This is a relationship that’s much more strategic than prior Republican administrations,” said Patrick Brown, a fellow at the Ethics and Public Policy Center, a conservative think tank that opposes abortion. “I think it’s fair to say the pro-life movement’s leverage with Donald J. Trump is pretty minimal,” he added.

Trump’s speech fell the same day as a hearing in a key case filed by Louisiana Attorney General Liz Murrill, challenging the FDA’s 2023 decision to allow telehealth dispensation of mifepristone. The Department of Justice defended the FDA’s position in court, arguing that Louisiana did not have standing to challenge the government’s mifepristone decision, and that court intervention could disrupt the federal review of the drug’s approval. 

“HHS and the FDA are unmoved. They could easily, today, reestablish in-person dispensing and get the drug out of the mail,” Dannenfelser said. “They are deaf to the cries of the House, and the Senate, attorneys general in half of their states, and of women and unborn children.”

Lila Rose, head of the anti-abortion group Live Action, also criticized the administration’s inaction on the mifepristone.

“The FDA has the authority and responsibility to act now in defense of mothers and their children,” Rose said in a statement sent before the speech. “Revoke mifepristone’s approval as an abortifacient, and until that happens, immediately require in-person exams, full medical screening, and real follow-up care. We demand action now.”

SBA has committed to spending $80 million on midterm races this year, suggesting it could withhold funding from candidates who don’t prioritize abortion restrictions. The White House has argued that anti-abortion voters will continue to back Republicans, including this November, by suggesting that the alternative — Democrats who largely support abortion rights — will be too unpalatable.

Still, some in the anti-abortion movement have been underwhelmed — and are looking past Trump.

“The undercurrent over the last year has been, we showed up at the polls and what have you given us?” Brown said. But many are already looking at potential successors — including Vice President JD Vance and Secretary of State Marco Rubio — who may be more supportive of aggressive abortion restrictions.

“The mistake is thinking because Trump can roll pro-lifers, future Republicans can do the same thing,” he added.