A federal appeals court has restricted a common abortion method by prohibiting the mailing of mifepristone and ordering that the drug be dispensed only in person at clinics. A panel of the New Orleans-based 5th U.S. Circuit Court of Appeals said allowing mail delivery undercuts Louisiana’s ban on medical abortions and the state’s policy that an unborn child is a legal person from conception.
Since the Supreme Court’s 2022 decision overturning Roe v. Wade, mailed prescriptions and telemedicine became a primary way many people access medication abortions, including those living in states with bans. The appeals court ruling is expected to be appealed to the U.S. Supreme Court.
The judges pointed out that the Food and Drug Administration is conducting a review of mifepristone’s safety at the direction of President Donald Trump and said the agency could not say when that review would conclude. In court filings, Louisiana’s attorney general and a woman who said she had been coerced into taking abortion pills urged courts to restore older FDA rules that required mifepristone be prescribed and dispensed only after an in-person appointment with a certified provider.
A federal judge in Louisiana last month found that the FDA’s relaxed dispensing allowances undermined the state’s abortion ban, but that ruling did not immediately reinstate the stricter regulations. Legal observers say the appeals court decision will further set up a likely Supreme Court review of the underlying questions.
Advocates warn the decision will reduce access to abortion and miscarriage care nationwide, with disproportionate effects on rural residents, people with low incomes, people with disabilities, survivors of intimate partner violence, and communities of color who rely on telemedicine and mail delivery to obtain mifepristone.
Mifepristone was approved by the FDA in 2000 as a safe and effective option to end early pregnancies, typically used in combination with misoprostol. Because of rare instances of heavy bleeding, early FDA rules limited who could prescribe and dispense it—initially only specially certified physicians and only after an in-person visit. During the COVID-19 pandemic, those in-person requirements were relaxed, and after more than two decades of monitoring and reviewing evidence, FDA officials under President Joe Biden concluded that people could use mifepristone safely without direct supervision.
The appeals court decision contrasts with a 2024 Supreme Court action that preserved access to mifepristone, though that high court ruling avoided resolving the core legal issues by finding the anti-abortion doctors who challenged the drug lacked standing to sue. The current 5th Circuit order again raises prospects that the nation’s highest court will have to address the broader legal and regulatory questions surrounding mifepristone and how medication abortion is delivered.