February 28, 2022 2:22 PM EST

As President Joe Biden prepares to give his first State of the Union address amid the Russian invasion of Ukraine, he faces a number of conflicts within his own party back at home—from battles over COVID-19 rules to what to do about rising inflation. Among these intra-party battles is the issue of abortion access. Many progressives argue the nation is facing the largest crisis in abortion rights in half a century, and that the President must give the matter more attention on Tuesday as he delineates his priorities.

“The urgency of this moment really demands it from the President and from the Biden administration writ large,” says Morgan Hopkins, political strategies director at abortion rights group All* Above All. “We need creative and bold solutions that will address the realities of what people across the country are facing.”

Abortion rights advocates are unlikely to get everything they want. While Biden campaigned on protecting reproductive rights, some progressive groups say they are frustrated that he appears personally uncomfortable discussing the issue and that his Administration has yet to explore all options for helping people access abortion now or to outline a plan for how it would protect abortion access in the future. The President’s hesitancy, they say, is mismatched with this political and judicial moment, in which access to abortion hangs in the balance.

The Supreme Court is currently considering a case in which it may decide, as early as this spring, to either overturn or significantly unravel the landmark 1973 decision Roe v. Wade, which legalized abortion nationwide. Tuesday also marks six months since Texas successfully outlawed abortion after about six weeks into pregnancy, becoming the first state to implement such a ban since Roe. Other states are currently following Texas’ lead or passing other restrictions on abortion.

Abortion rights advocates, who cheered Biden’s election after four years of Donald Trump, say they appreciate that the Administration has unwound some of Trump’s policies including the restoring funding for reproductive health programs abroad and removing restrictions on family planning programs at home. But, they say, in this pitched political moment, Biden has an additional obligation to sound the alarm—and to signal that he is ready to buttress reproductive rights in what may soon be a post-Roe world.

“Depending on where you live right now, getting an abortion is next to impossible,” Hopkins says. “So we really need the whole-of-government approach that they’ve pledged.”

Biden’s evolving position on abortion

While Biden campaigned in 2020 on codifying Roe vs. Wade into law, his own record on abortion is mixed. When he joined the Senate in 1973, he voted for an amendment that would have allowed states to overturn the Supreme Court decision, saying at the time that he thought the justices went “too far” on abortion rights. For many years, he also supported the Congressional ban on federal funding for abortions known as the Hyde Amendment, which prevents people on government health plans like Medicaid from having insurance coverage for most abortions. As the Democratic primary season heated up in 2019, Biden reversed his support for the ban under pressure from abortion rights activists.

Still, Biden, a practicing Catholic, frequently appears uncomfortable talking about abortion. He often avoids mentioning the topic directly, opting instead for phrases such as “a woman’s constitutional right,” or “access to reproductive health care.” Biden did not use the word “abortion” until 224 days into his presidency, when it appeared in two written statements responding to the Texas abortion ban, according to a count by Renee Bracey Sherman, executive director of We Testify, a group that aims to share the stories of people who’ve had abortions. The President also included the word “abortion” in a tweet on the Texas law that day, but, to Bracey Sherman’s knowledge, he has not ever said “abortion” in oral remarks.

Read More: States Push New Abortion Bans, Preempting the Supreme Court

A coalition of more than 120 reproductive rights organizations recently signed an open letter to Biden urging him to be more vocal in his support for abortion rights during the State of the Union address. “It’s extremely disappointing,” says Bracey Sherman, whose organization signed onto the letter. “We have a President of the United States who says that he is pro-choice and as he says, supports Roe v. Wade, but will not use the word ‘abortion.’ That is spreading stigma. That is actually telling people who have abortions that he may or may not have our back—he’s not actually going to give us the full throated support that we need.”

The White House declined to comment on the record, but pointed to the three statements including the word abortion, to the Administration’s record of undoing Trump’s restrictions on abortion, and to the lawsuit the Justice Department filed against Texas over its abortion ban, among other actions.

The Biden Administration has taken steps to undo the Trump Administration’s anti-abortion policies. On Jan. 28, 2021, Biden rescinded the Mexico City Policy, which prohibits organizations that receive U.S. foreign aid from providing abortions or abortion counseling, and in October, he reversed a Trump-era rule that barred U.S. health care providers from receiving federal funds under the Title X program if they discussed abortion with patients.

Biden also dropped the Hyde Amendment from his presidential budget proposal and has announced his support for the Women’s Health Protection Act, which would protect the right to abortion in federal law. After Texas’ six-week abortion ban took effect in September, the Justice Department sued the state and the Department of Health and Human Services (HHS) gave grants to help Texas clinics expand emergency contraception and family planning services. The Food and Drug Administration said in December it would loosen regulations around abortion pills to allow people to receive them by mail. And in January, HHS announced a task force on “reproductive healthcare access.”

Many abortion rights activists who spoke with TIME said they were pleased to see these actions and noted that the Administration has stepped up strongly to protect abortion access where it can. But like the Supreme Court decision, several of these initiatives are out of Biden’s hands. Democrats are not close to having the support to pass the Women’s Health Protection Act, and it is unlikely Republicans will allow them to pass a budget without the Hyde Amendment either.

Read More: Justices Seem Poised to Weaken Roe v. Wade

As the country heads toward a future without a national right to abortion, some advocates said they want to see Biden move beyond unwinding Trump’s actions and take more of a leadership role in crafting a proactive response.

“We’re facing a crisis with abortion access. So we’re looking for a proportionate response from all levels—from the Biden administration, Congress, state legislative officials, governors, and so we definitely include the executive branch in who we want to be able to speak to this moment,” says Jacqueline Ayers, senior vice president of policy, organizing, and campaigns at Planned Parenthood Federation of America. “There’s a lot that’s already been happening, and yet, we still need more. We have a lot of retreat on these issues from the last administration. And so to make that up, we want them to use their bully pulpit to focus on the abortion crisis.”

‘How abortion stigma plays out in policy’

Using the bully pulpit of the presidency is important for combatting the stigma around abortion, advocates argue, but it can also influence policy more immediately. Even without congressional support for changing the federal laws around abortion, international reproductive rights groups say that the Biden Administration could be taking more action to ensure that the U.S. backs up its support for reproductive rights on the world stage.

The Administration, for example, has yet to address a law known as the Helms Amendment, passed in 1976, which bars international organizations that receive U.S. aid from providing abortions as part of family planning services. In theory, it allows U.S. funding for abortions in the case of rape, incest or a threat to the mother’s life, as well as for information about abortions. But in reality, it ices all funding for abortion of any kind, advocates say. The policy creates a chilling effect that prevents organizations from providing any abortion-related services because they are afraid of violating U.S. rules that are typically enforced strictly under Republican administrations, says Anu Kumar, president and CEO of Ipas, an organization that aims to expand access to safe abortion and contraception around the world. The Biden Administration has not offered guidance to clear this up, she says.

“Republican administrations have been incredibly vocal about what is prohibited under abortion restrictions like the Helms Amendment and the gag rule. Democratic administrations now need to be vocal on what is permitted,” Kumar says. “The silence on this issue is really remarkable considering how vociferous and loud the Republican administrations have been.”

Staff at Ipas have had more than 20 meetings and frequent communication with members of the White House Gender Policy Council, the State Department, USAID and HHS over the past year to urge administration officials to offer clear guidance on what services U.S. aid recipients are allowed to provide, according to correspondence reviewed by TIME. During these meetings, Kumar says she and her staff have provided fact sheets, offered examples from previous administrations and explained that issuing specific updates from the Biden Administration could empower international aid organizations to help people facing human rights abuses, in war zones, or who simply have to travel long distances in rural areas to access information and health care.

“It feels very frustrating and disappointing. This was an administration that we thought was really going to take these issues seriously. They talked about racial equity. They’ve talked about embedding equity in everything that they do. And we’ve seen that in a number of different issues. We’re just not seeing it here,” Kumar says. “So the questions are, why are they actively blocking this? Why are they not doing everything in their power to increase that access?”

“This is an example of how abortion stigma really plays out in policy,” she adds.

There’s room for more action on the domestic front, too, activists say. They acknowledge their work can feel like an uphill battle, as Republicans control the majority of governorships and state legislatures where anti-abortion activists are encouraging lawmakers to pass new limits on abortion every day. Many states are also passing voting restrictions that will make it more difficult for people to cast ballots this year.

Read More: Mississippi’s Last Abortion Clinic Faces the Supreme Court

“The opposition has worked for decades to really systematically chip away at abortion rights, to stack the federal judiciary with judges and justices hostile to reproductive freedom. So they’ve been playing this long game for a very long time. And our side really needs to be really creative in this moment,” says Kristin Ford, vice president of communications and research at NARAL.

But some Democrat-controlled states have started to pass legislation protecting the right to abortion. New Jersey recently signed a law that would protect abortion there if Roe is overturned. Vermont is moving a constitutional amendment that would guarantee the right to abortion in the state. California launched a council to develop policies that could make it a “sanctuary” for those seeking abortions in the future and is now considering a slate of bills, including ones that would cover the cost of abortions for uninsured people, help abortion clinics expand their workforce, and protect abortion patients’ medical records.

This is the kind of work advocates would like to see from Biden too. “The White House has taken these important steps and has signaled their commitments at important stages, and we want to continue to see even more of that. It’s a time to just be really bold and audacious,” Ford says. “We really need so much creativity and ingenuity and innovation right now when it comes to abortion rights.”

“Creative and bold solutions”

Not every strategy will work, activists say, but they want the federal government to try ideas it hasn’t before. That could look like new funding for people trying to leave states like Texas that have banned abortion, says Ayers at Planned Parenthood, or a stronger commitment to ensuring people can access abortions regardless of their immigration status. Three professors with expertise in reproductive rights proposed other ideas in a New York Times essay in December.

Activists also note that Biden is charismatic and passionate when he wants to be. He delivered a strong speech on voting rights last month and has frequently spoken about his support for the LGBT community. Democrats’ voting rights legislation is now dead, but abortion rights advocates are hoping that there is still time for Biden to put aside discomfort and fight for abortion before the national landscape is fully changed.

“I hope that he can actually get over that and model for the entire country what it looks like to stand up as the President and say that I believe healthcare is a human right, and abortion is part of that health care,” Bracey Sherman says. “Every single one of us loves someone who’s had an abortion, and that is why we need to make sure that everyone has access to their constitutionally protected rights, including abortion.”

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Write to Abigail Abrams at abigail.abrams@time.com.

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