A federal appeals court has restricted access to one of the most common abortion methods in the United States by blocking prescriptions for mifepristone from being mailed.
Friday’s unanimous ruling by a three-judge panel of the New Orleans-based 5th U.S. Circuit Court of Appeals overturns regulations set by the federal Food and Drug Administration that require abortion pills to be distributed only in person and in clinics.
The decision, which will likely be appealed to the U.S. Supreme Court, is the biggest shock to American abortion policy since the 2022 Supreme Court decision that struck down Roe v. Wade and allowed states to enforce abortion bans.
In his ruling, Judge Kyle Duncan, appointed by President Donald Trump, agreed with Louisiana’s argument that allowing the drugs to be mailed would invalidate the state’s ban on abortion at all stages of pregnancy.
“All abortions facilitated by the FDA’s action would undo Louisiana’s ban on medical abortions and undermine Louisiana’s policy that ‘all fetuses are human beings and, therefore, legal entities, from the moment of conception,'” the ruling states.
Mifepristone is involved in most abortions in the US
Mifepristone was approved in 2000 as a safe and effective way to end early pregnancies. It is usually used in combination with a second drug, misoprostol.
The study found that the majority of abortions in the United States are provided by pill, and about one in four abortions nationwide are prescribed through telemedicine.
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One survey of abortion providers last year estimated that more women receive abortions that way in states with abortion bans than by traveling to other states.
Some Democratic-led states have enacted laws to protect health care providers who prescribe to patients via telemedicine where it is prohibited.
This increased visibility has led abortion opponents to target abortion pills with legislation and lawsuits.
This ruling runs counter to how courts typically view FDA decisions.
There is little precedent for a federal court overturning the FDA’s scientific regulations, and it was not immediately clear how quickly or completely the decision would affect drug shipments across the United States.
Judges have long deferred to authorities regarding the safety and appropriate regulation of drugs.
FDA officials under the Trump administration have repeatedly said the agency is conducting a new review of mifepristone’s safety at the president’s direction.
The justices, all appointed by Republican presidents, noted in their ruling that the FDA “cannot say when its review will be completed and acknowledged that it is still collecting data.”
Because excessive bleeding occurs infrequently, the FDA initially placed strict restrictions on who could prescribe and distribute the pill, allowing only specially qualified physicians and only after an in-person appointment to receive the pill.
Both of these requirements have been removed due to COVID-19. At the time, FDA officials under President Joe Biden said that after monitoring mifepristone’s use for more than two decades and reviewing dozens of studies involving thousands of women, it was clear that women can safely use mifepristone without direct supervision.
GenBioPro, which makes generic mifepristone, said in a statement that the court’s decision “ignores the FDA’s rigorous science and decades of safe use of mifepristone in lawsuits pursued by abortion extremists.”
The impact isn’t just in states where it’s banned.
In a court filing, Louisiana’s attorney general and a woman who says she was forced to take abortion pills asked that FDA rules be returned to when the pills were only allowed to be prescribed and dispensed in person.
A federal judge based in Louisiana ruled last month that the benefits undermined the state’s abortion ban, but stopped short of immediately reversing the ban.
Friday’s ruling takes effect as the lawsuit moves through the courts and expands beyond Louisiana and other states where abortion is prohibited.
Telemedicine prescriptions are common even in states where abortion is allowed, but the ruling blocks them there as well.
“This will impact patients’ access to abortion and miscarriage care in every state across the country,” said ACLU attorney Julia Kay. “When telehealth is restricted, rural areas, low-income people, people with disabilities, victims of intimate partner violence, and communities of color suffer the most.”
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The National Right to Life Commission said the ruling “restores an important layer of oversight” to women’s health.
“Women deserve better than a mail-in abortion system that prioritizes ideology over safety,” said Carol Tobias, the group’s president.
The next step could be an appeal to the nation’s highest court.
Danko Laboratories, another manufacturer of mifepristone and a defendant in the case, asked the Court of Appeals on Friday after the ruling to put the order on hold for a week to give the company time to “seek relief” from the Supreme Court. If the court does not approve the request, the company said it plans to file an emergency appeal to the High Court.
The conservative-controlled Supreme Court overturned abortion as a right nationwide in 2022, but unanimously upheld access to mifepristone two years later.
But the 2024 ruling sidestepped the core issue by ruling that the anti-abortion doctors behind the case had no legal standing to sue.
“I look forward to continuing to protect the woman and her infant as this case continues,” Louisiana Attorney General Liz Murrill (R) said in a statement.
Representatives from the FDA and the U.S. Department of Justice did not immediately respond to requests for comment Friday night.
Meanwhile, anti-abortion groups are celebrating Friday’s ruling. Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, hailed the ruling as “a huge victory for the victims and survivors of Biden’s reckless mail-order abortion pill regime.” She also criticized the Trump administration for taking so long to conduct its own review of mifepristone, saying the slow movement is forcing states to take action.
“Women and children are suffering, and national sovereignty is being violated every day. The FDA is allowing abortion pills to arrive in the mail in bulk,” Dannenfelser said.
— Jeff Mulvihill and Hannah Schoenbaum. Associated Press writers John Hanna, Matthew Perrone and Lindsey Whitehurst contributed.
