Washington DC - Donald Trump's second presidential term could herald a new wave of attacks on abortion access across the US, with or without a Republican-controlled Congress.

Here's a closer look at the legal tools available to a future administration intent on curtailing the right – and how abortion rights defenders are preparing to fight back.

For advocates of abortion rights, the nightmare scenario is a Republican-controlled Congress enacting sweeping national restrictions or an outright ban.

The Republican former president's Supreme Court picks were pivotal in dismantling decades of legal precedent protecting the national right to abortion.

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While Trump has at times hinted at moderation during the 2024 campaign – even suggesting he might veto any anti-abortion "ban" that lands on his desk – some fear Project 2025 as the real battle plan.

Published by the ultra-conservative Heritage Foundation, the document offers a roadmap for harsher executive branch restrictions, developed with input from former Trump officials. Trump has publicly distanced himself from the document.

Experts predict abortion pills could be Trump's first target.

Mifepristone, which prevents pregnancy progression, and misoprostol, which empties the uterus, accounted for nearly two-thirds of US abortions last year, according to the Kaiser Family Foundation.

Medical abortion used to require in-clinic visits. However, President Joe Biden's government made prescription by telehealth and pills in the mail permanent in 2021.

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A Trump administration might reinstate in-person requirements or roll back other eased regulations, said George Washington University law professor Sonia Suter – a simpler step than rescinding approval, though that is also possible.

Anti-abortion activists are eyeing the Comstock Act, a 19th-century law prohibiting the mailing of "obscene" materials, including items for "producing abortion."

The US Justice Department under Biden currently interprets this law as inapplicable to approved abortion pills.

But Suter told AFP that a broad interpretation could apply to "anything used to produce an abortion – materials for surgical abortions – which could effectively create a national ban."

This could disrupt the supply chain in clinics and hospitals across states where abortion is currently legal.

A Trump administration could also seek to undo the stringent patient privacy protections put in place by Biden for women seeking abortions out-of-state, said Suter, paving the way for possible prosecutions when they return home.

Although the Supreme Court's conservative majority has already overturned Roe v Wade, experts say the power to appoint federal judges remains paramount.