Mifepristone tablets sit on a table at a Planned Parenthood clinic in Ames, Iowa, on July 18, 2024. Charlie Neibergall/AP
A federal appeals court has restricted access to a common method of abortion by blocking the mailing of mifepristone, requiring the pill to be distributed only in person at clinics. A panel of the New Orleans-based 5th U.S. Circuit Court of Appeals said that allowing mail delivery undermines 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 that overturned Roe v. Wade and allowed states to enforce abortion bans, mailed prescriptions and telemedicine have become a major way abortions are provided, including for people living in states with bans. The appeals court ruling is likely to be appealed to the Supreme Court.
The judges noted 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 be complete. In filings, Louisiana’s attorney general and a woman who said she was coerced into taking abortion pills asked courts to roll back FDA rules to a time when mifepristone had to be prescribed and dispensed only after an in-person appointment.
A Louisiana-based federal judge last month ruled that the FDA’s loosened allowances undermined the state’s abortion ban but did not immediately undo the regulations. Advocates warn the appeals court decision will affect patients’ access to abortion and miscarriage care nationwide, with disproportionate harm to rural communities, people with low incomes, people with disabilities, survivors of intimate partner violence and communities of color.
Mifepristone was approved in 2000 as a safe and effective way to end early pregnancies, typically used with misoprostol. Because of rare cases of heavy bleeding, the FDA originally limited who could prescribe and dispense it—only specially certified physicians and only after an in-person appointment. During the COVID-19 pandemic, those requirements were relaxed. FDA officials under President Joe Biden, after more than 20 years of monitoring and reviewing studies, concluded people could safely use mifepristone without direct supervision.
The appeals court decision sets up a likely Supreme Court review. In 2024 the conservative-majority high court unanimously preserved access to mifepristone, but that ruling avoided the core legal issues by finding the anti-abortion doctors who challenged the drug lacked standing to sue.