President Donald Trump has done more for the pro-life movement than any president in modern American history. That is simply a fact.
He became the first sitting president to attend the March for Life. He appointed the Supreme Court justices who helped overturn Roe v. Wade. He consistently used the power of the presidency to affirm the dignity of unborn life when doing so was unpopular with much of the political establishment.
That record has earned him deep trust among pro-life voters, but they have become increasingly frustrated with some of the people carrying out policy beneath him. That is why recent reports that President Trump is preparing to replace Food and Drug Administration (FDA) Commissioner Marty Makary are so encouraging.
Recent news coverage has highlighted growing concern amongst these pro-life voters over the Food and Drug Administration’s (FDA) inaction on the Mifepristone abortion pill, exposing a widening disconnect between President Trump’s pro-life agenda and the apparent priorities of FDA Commissioner Marty Makary. Many pro-life voters expected the administration to move aggressively and transparently in reviewing the safety of this abortion pill and the Biden-era policies that dramatically expanded access to it through mail-order distribution and telehealth prescribing. Instead, they have seen drift, delay, and public indifference.
Makary’s own comments have become a major part of the problem. When the FDA commissioner says he does not “think about the abortion pill” or its safety restrictions, many pro-life Americans hear something alarming: that one of the most consequential post-Roe policy issues in the country is being treated as an afterthought by the very agency overseeing it. That is not just bad policy messaging; it is bad politics.
Pro-life voters absolutely think about Mifepristone and the continued loosening of safeguards surrounding chemical abortion. They think about the consequences of widespread mail-order distribution and about whether the federal government is taking seriously the safety concerns and moral questions surrounding a drug regimen that has now become central to the abortion industry’s strategy in post-Roe America. Increasingly, they have shared their concerns that Marty Makary is not the right person to lead the FDA at all.
President Trump appears to have reached the same conclusion.
Fair or not, perception matters in politics. Many conservatives are frustrated precisely because they still trust Trump and believe his instincts on life issues are fundamentally sound. But they do not believe the current posture of the FDA reflects the urgency or seriousness that the President himself would likely want associated with this issue. It is increasingly clear that the White House understands those risks as well.
The Republican Party cannot afford to create unnecessary disillusionment among pro-life voters heading into the midterms. These are not casual voters. They are among the party’s most reliable and motivated constituencies. They organize churches, mobilize volunteers, knock doors, and turn out consistently in elections that determine congressional control. If even a modest percentage of those voters begin feeling ignored or taken for granted, pro-life and conservative candidates for Congress will feel it in competitive House and Senate races across the country. That is why Makary’s apparently imminent departure should be welcomed.
The concerns surrounding Makary’s leadership extend beyond mifepristone alone. Many conservatives were already uneasy after he elevated Vinay Prasad into a senior FDA role despite Prasad’s well-known anti-Trump rhetoric and outspoken pro-abortion views. To many grassroots conservatives, the appointment signaled a troubling disconnect between the president’s agenda and the people being trusted to implement it.
Those concerns only intensified after Prasad’s tenure became mired in controversy and he was pushed out following backlash from conservatives and patient advocates. Rather than moving on, Makary personally pushed for Prasad’s return to the agency, only for his second stint at the FDA to result in further turmoil before he departed again – hopefully for the last time – at the end of April.
The Dobbs era changed the political landscape. Federal agencies now play a far more direct role in shaping abortion policy than they did when Roe governed the courts. That means personnel decisions at agencies like the FDA are no longer obscure bureaucratic matters. They are central political and moral questions.
President Trump understands the importance of personnel better than most presidents. His success in reshaping the judiciary proved that. But personnel matters at the FDA, too, especially when the agency oversees one of the most politically and morally consequential drugs in the country.
Marty Makary has not shown that he understands either the policy stakes or the political stakes surrounding Mifepristone. With the midterms fast approaching, President Trump would be right to replace him sooner rather than later. Because the greatest threat to Trump’s pro-life legacy is not the activist left. It is the risk that weak leadership and bureaucratic indifference inside his own administration begin alienating one of the most active and loyal voting blocs at exactly the wrong political moment.
Editor’s Note: The 2026 Midterms will determine the fate of President Trump’s America First agenda. Republicans must maintain control of both chambers of Congress.
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