Mifepristone tablets sit on a table at a Planned Parenthood clinic in Ames, Iowa, on July 18, 2024.
Charlie Neibergall/AP
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Charlie Neibergall/AP
A federal appeals court has imposed restrictions on one of the most common methods of abortion in the United States by halting the mailing of mifepristone. The 5th U.S. Circuit Court of Appeals, based in New Orleans, has ruled that the abortion pill must be dispensed only in-person at clinics. Since the Supreme Court’s decision in 2022 to overturn Roe v. Wade, allowing abortion bans to be enforced, mail prescriptions have become a primary method for obtaining abortions, even in states with bans. This ruling is expected to be appealed to the Supreme Court.
The federal appeals court’s decision to block the mailing of mifepristone prescriptions limits access to one of the most widely used abortion methods in the U.S. The New Orleans-based 5th U.S. Circuit Court of Appeals has mandated that the abortion pill be distributed exclusively at clinics in person. The ruling highlights that “every abortion facilitated by FDA’s action cancels Louisiana’s ban on medical abortions and undermines its policy that ‘every unborn child is a human being from the moment of conception and is, therefore, a legal person.'” Historically, judges have deferred to the Food and Drug Administration’s expertise in determining drug safety and regulation.
FDA officials during President Donald Trump’s administration repeatedly asserted that the agency was conducting a new safety review of mifepristone, as directed by the president. The judges noted in their decision that the FDA “could not say when that review might be complete and admitted it was still collecting data.”
In a court filing, Louisiana’s attorney general, along with a woman who claims she was coerced into taking abortion pills, requested that the FDA rules revert to when the pills were only allowed to be prescribed and dispensed in person.
Last month, a federal judge in Louisiana ruled that these allowances undermined the state’s abortion ban but did not immediately overturn the regulations. Following the Supreme Court’s 2022 decision to overturn Roe v. Wade, mail prescriptions have become a significant means of providing abortions, even in states with bans.
Julia Kaye, an ACLU lawyer, stated, “This is going to affect patients’ access to abortion and miscarriage care in every state in the nation. When telemedicine is restricted, rural communities, people with low incomes, people with disabilities, survivors of intimate partner violence, and communities of color suffer the most.”
Approved in 2000, mifepristone is a safe and effective method to terminate early pregnancies, typically used alongside a second drug, misoprostol. Due to rare cases of excessive bleeding, the FDA initially imposed stringent restrictions on who could prescribe and distribute the pill—only specially certified physicians and only after an in-person appointment. These requirements were lifted during the COVID-19 pandemic. At that time, FDA officials under President Joe Biden noted that after more than two decades of monitoring mifepristone’s use and reviewing numerous studies, it was evident that women could safely use the pill without direct supervision.
The recent ruling is expected to be appealed to the Supreme Court. The conservative-majority high court overturned abortion as a nationwide right in 2022 but unanimously preserved access to mifepristone two years later. The 2024 decision, however, avoided addressing the core issues by determining that the anti-abortion doctors involved in the case lacked legal standing to sue.
