US Court Restricts Mail-Order Access to Mifepristone
A US court has issued an order significantly limiting access to the abortion pill mifepristone via mail.
On Friday, the Fifth Circuit Court of Appeals temporarily reinstated a requirement that abortion pills must be obtained in person, rather than allowing them to be acquired by post or at a pharmacy through telemedicine.
This decision particularly restricts access to abortion pills—the most common method of terminating pregnancies in the US—in states where abortion is banned.
The ruling originates from a lawsuit filed by the state of Louisiana and pauses a 2023 Food and Drug Administration (FDA) regulation that permitted doctors to send pills without an in-person patient visit.
"Every abortion facilitated by FDA's action cancels Louisiana's ban on medical abortions and undermines its policy that 'every unborn child is human being from the moment of conception and is, therefore, a legal person,'" the appeals court stated in the order.
The order will remain effective while the case proceeds.
Background on Mifepristone and Regulatory Changes
Mifepristone is the first of a two-pill regimen recommended by the FDA to terminate a pregnancy. It is widely accessible in states where abortion is legal.
In April 2021, the FDA expanded the availability of these drugs by lifting the in-person dispensing requirement for mifepristone for the duration of the Covid-19 pandemic. In 2023, the FDA made this change permanent, allowing the medication to be mailed.
In 2024, the US Supreme Court unanimously rejected an attempt to restrict access to mifepristone. However, this decision, which came two years after the court overturned the nationwide abortion right, left open the possibility for other efforts to limit the drug's availability.
Friday's appellate ruling overrides a lower court decision from earlier in the month that paused the case while the Trump administration conducted an FDA review.
Reactions from Officials and Advocacy Groups
Louisiana Attorney General Liz Murrill praised the court's decision, stating that the Biden-era rule "facilitated the deaths of thousands of Louisiana babies (and millions in other states)."
"I look forward to continuing to defend women and babies as this case continues," she added.
Conversely, Julia Kaye, an attorney with the American Civil Liberties Union (ACLU), criticized the ruling.
"This decision defies clear science and settled law and advances an anti-abortion agenda that is deeply unpopular with the American people," she said.
New York Attorney General Letitia James affirmed that abortion access remains legal in her state despite the appellate court's ruling.
"In New York, our laws ensure that anyone who needs abortion care can seek it here. That has not changed, and we will continue to protect access to abortion, including medication abortion," she stated.
Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, described the ruling as "a huge victory for victims and survivors of Biden's reckless mail-order abortion drug regime."
Medical Information on Mifepristone and Misoprostol
Mifepristone functions by blocking progesterone, a hormone essential for pregnancy continuation. The second drug in the regimen, misoprostol, induces uterine contractions to expel pregnancy tissue.
The US first approved mifepristone for medical termination of pregnancy up to seven weeks gestation in September 2000. Its approved use was extended to 10 weeks of pregnancy in 2016.
Misoprostol has been prescribed for decades to treat stomach ulcers and manage postpartum hemorrhaging. Its non-pregnancy related uses likely contribute to it attracting less controversy than mifepristone.
Mifepristone is also utilized to treat women experiencing miscarriages and those with Cushing syndrome, a hormone-related disorder.
Between 2000 and 2018, over 3.7 million women in the US used mifepristone, according to FDA data.
The American College of Obstetricians and Gynecologists (ACOG) and other leading medical organizations state that both mifepristone and misoprostol are safe.
US studies indicate that the two-step medication regimen is approximately 95% effective in terminating pregnancy and requires further medical follow-up less than 1% of the time.
