In the biggest jolt to abortion policy in the U.S. since the overturning of Roe v. Wade, a federal appeals court has restricted access to one of the most common ways to end early pregnancies, by blocking the mailing of mifepristone prescriptions.
The unanimous ruling Friday from the New Orleans-based 5th U.S. Circuit Court of Appeals marks a substantial victory for abortion opponents seeking to stem the flow of abortion pills prescribed online that they view as subverting state bans on the procedure.
The ruling, which is expected to be appealed to the U.S. Supreme Court, requires that mifepristone be distributed only in person and at clinics, overruling regulations set by the federal Food and Drug Administration.
“We’re now going to see, I think in a way we haven’t before, what the nation will look like when abortion bans are actually in effect,” said Mary Ziegler, an expert on abortion law and a professor at University of California at Davis School of Law.
Here’s what to know.
Impact extends beyond states with abortion bans
Frustrated with a lack of federal action against medicated abortions, Louisiana Attorney General Liz Murrill sued the FDA last month, saying its regulations undermined the state’s ban on abortions at all stages of pregnancy.
“The regulation creates an effective way for an out-of-state prescriber to place the drug in the hands of Louisianans in defiance of Louisiana law,” Judge Kyle Duncan, who was appointed by President Donald Trump, wrote in the ruling.
FDA officials have said the agency is conducting a new review of mifepristone’s safety, but the appeals court noted that there was no timeline for its completion.
Friday’s ruling is in effect while the case works its way through the courts. It affects all states, even those without abortion restrictions.
There is little precedent for a federal court overruling the scientific regulations of the FDA, and it remains to be seen how the decision could impact how the drug is dispensed long-term.
Murrill, a Republican, celebrated the ruling as a “victory for life” while other anti-abortion advocates cheered the reversal of rules finalized under President Joe Biden that ended a longstanding requirement that the pills be obtained at an in-person doctor’s visit.
Representatives for the FDA and the U.S. Department of Justice did not immediately respond to requests for comment.
Mifepristone long considered safe and effective
Danco Laboratories, a mifepristone manufacturer and defendant in the lawsuit, asked the U.S. Supreme Court on Saturday to block the 5th Circuit’s ruling while appeals are pending.
Mifepristone was approved in 2000 as a safe and effective way to end early pregnancies. It is typically used in combination with a second drug, misoprostol, which is not affected by the ruling but is less effective on its own.
Surveys have found that the majority of abortions in the U.S. are administered using pills and that about one in four abortions nationally are prescribed via telehealth. Providers have suggested that its availability through telehealth is a reason why the number of abortions in the U.S. has not fallen since Roe was overturned in 2022.
As a result, abortion pills and those who prescribe them out of state have become key targets of abortion opponents.
Some Democratic-led states have adopted laws that aim to protect providers who prescribe via telehealth and mail the pills to states with bans. Those so-called shield laws are being tested through civil and criminal cases in Louisiana and Texas.
One telehealth provider in a state with a shield law, Dr. Angel Foster, was working with legal experts to understand how the ruling would impact her organization, The Massachusetts Medication Abortion Project.
“We will do everything in our power to continue providing care to people in all 50 states,” she said.
Abortion policy could come into play in the midterms
The case could again make abortion a key issue in the midterm elections as Democrats aim to take back control of the U.S. House and Republicans fight to hold on to a narrow majority.
“This is going to be a pretty significant change in terms of how people experience abortion access, probably as significant as anything we’ve seen since Roe was overturned,” Ziegler said. “So another big question mark is going to be the extent to which voters feel that before they go to the polls, and the extent to which it becomes then an election issue.”
Ziegler said the case also “sort of puts the president in the position of having to get off the sidelines on this issue in a way we haven’t seen before.”
Recent electoral results suggest that voters seeking to maintain abortion access have the political momentum. Since Roe was overturned, abortion has been on the ballot directly in 17 states. Voters have sided with the abortion-rights side in 14 of those questions.
Abortion-rights supporter Fatima Goss Graves, president and CEO of the National Women’s Law Center, slammed the ruling as “deeply out of step with both the public and fact-based science.”
Trump received criticism after the ruling from some anti-abortion advocates who expressed frustration that he did not take action himself to block distribution of the pill.
The FDA under Trump approved another generic version of mifepristone last year, which peeved some allies of the Republican president.
“It’s shameful that the Trump administration’s inaction has forced pro-life states to take their battle to the federal courts,” said Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, who also applauded the ruling.
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AP reporter Jamie Stengle contributed to this report from Dallas.