The Biggest Attack on Abortion Since the End of Roe

A federal court wants to end mifepristone by mail—it's not happening

Yesterday, a federal court temporarily blocked the FDA rule that allows mifepristone to be prescribed without an in-person visit. The notoriously conservative Fifth Circuit of Appeals ruled in favor of Louisiana Attorney General Liz Murrill, who argued telehealth access to the abortion medication harms her Republican state by allowing women to sidestep its ban.

The decision is the biggest legal blow to abortion rights since the end of Roe, and conservatives hope it will end the shipping of abortion pills nationwide.

Let me be clear: that is not going to happen. Patients will continue to seek out abortion pills, and providers will continue to ship them. Nothing in this ruling criminalizes patients who use abortion medication, and women can still legally obtain abortion pills by mail—either by using a misoprostol-only regimen or connecting with a provider who will ship both medications.

That’s right: while conservatives want Americans to believe they can no longer get mifepristone by mail, multiple legal experts tell Abortion, Every Day that’s just not the case. Some providers plan to keep shipping mifepristone while the litigation plays out—relying on shield state protections that Democratic governors have put in place.

“We anticipated this moment and have worked hard with our allies at the state level to create the legal landscape and legislation to empower states to protect access to abortion nationwide,” says Julie F. Kay, founder Reproductive Futures.

To put it plainly: We are not going back.

Still, I won’t downplay the situation: this decision is a chilling attack on women’s ability to access care. With this ruling, the federal court has allowed Louisiana extremists to dictate abortion rights for the entire country—overriding laws in pro-choice states. As Reproductive Freedom for All president Mini Timmaraju put it, “The court’s decision moves us one step closer to a national abortion ban.”

Remember—telemedicine accounts for almost 30% of American abortions, and for nearly every abortion that happens in banned states. Abortion pills by mail are largely the reason the national abortion rate hasn’t dipped since the end of Roe, and telemedicine has been one of the most important tools we have holding access together.

That’s why conservatives have been hitting abortion medication so hard: they’re furious that it allows women to sidestep their draconian bans. They want to control us, and abortion pills make that much, much, harder.

I waited until now to publish for a reason: there are a lot of moving parts, things are moving quickly, and I don’t want to feed into chaos and confusion. If/When/How tells AED that their legal helpline has already been inundated with calls from patients worried that taking abortion pills is illegal. That is exactly what the anti-abortion movement wants: patients afraid, and us overwhelmed.

Since last night, I’ve been on the phone with legal experts, providers, and abortion rights leaders—and while there are different opinions about what might happen next, everyone agrees on this: what we do next needs to be steady, considered, and strategic.

And when I say “we,” I mean it. The folks who read this newsletter are activists, providers, journalists, researchers, lawyers, legislators, and organizers. Even if you don’t work in this space, chances are you’re the person a friend or neighbor comes to when they have a question about abortion. Every single one of us has a tremendous amount of influence in our own communities, and it’s vital that we’re using it wisely.

Every day that you’ve read this newsletter has prepared you for a moment like this one, and now it’s time for us to get to work.

Below is an explainer of the case, the ruling, what it means, what happens next, and what we can do. Feel free to skip around using the headers.

What is Louisiana v. FDA? - How has the Trump administration responded? - What does the federal ruling say? - Will providers really keep shipping mifepristone? - What about miso-only abortions? - How will the ruling change access to abortion? - What happens next? - How can I help?

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What is Louisiana v. FDA?

Louisiana Attorney General Liz Murrill filed a lawsuit against the FDA last year, asking the court to reinstate a requirement that patients obtain mifepristone in person from their doctor. (The Biden FDA suspended that requirement during COVID, and made the change permanent in 2023.)

Murrill argues abortion pills are unsafe—citing a widely-debunked ‘study’—and claims telehealth access allows abusers to surreptitiously poison women with abortion pills. Cynically co-opting ‘coercion’ has become central to attacks on abortion medication: it allows Republicans to pretend as if they’re protecting women—which is a whole lot more popular than restricting abortion.

Murrill also says that Louisiana suffers “sovereign and financial harms” as a result of telemedicine access. This last argument is important, because the Supreme Court unanimously threw out a challenge to mifepristone in 2024, ruling that the anti-abortion doctors who brought the suit couldn’t show that they’d been personally harmed:

SCOTUS Ruling: Mifepristone Access Remains the Same, For Now

Murrill didn’t want the same thing happening in her case, so she claims Louisiana is being forced to spend Medicaid dollars treating women who’ve had complications from mifepristone (financial harm), and that the FDA’s rules nullify the state’s ban (sovereign harm).

It’s also important to know that this suit—and yesterday’s ruling affirming it—isn’t just about attacking abortion pills. It’s about eliminating shield laws. Republican attorneys general have been in a race to get blue state abortion protections to the Supreme Court; with this decision, the Louisiana AG is leading the charge.

How has the Trump administration responded?

We haven’t heard from the administration on yesterday’s ruling yet, but I’m betting they’re not very happy with having to deal with abortion ahead of the midterms.

That’s why Trump’s FDA asked the court to pause Murrill’s suit in January. The administration argued that the agency needed time to finish its bogus ‘safety review’ of mifepristone—but the truth is that they were desperate to delay a high-profile abortion fight until after the midterms. Republicans—Trump, especially—know this is a loser issue for them.

Still, that doesn’t mean that Trump plans to leave abortion pills alone entirely: in its request to pause the case, the administration did not disagree with Louisiana’s core argument. In fact, they even suggested the FDA could end telehealth access to mifepristone itself, depending on the outcome of its review.

In other words, they want to restrict mifepristone on their own terms and timeline. And last month, a judge gave Trump’s FDA the stay it asked for.

Yesterday’s ruling upended that plan, forcing the administration into a precarious position: either alienating the anti-abortion movement by appealing the ruling, or pissing off voters by going along with a national abortion restriction.

As law professor Mary Ziegler told The New York Times, “This ruling will put abortion back on the map as an election issue.”

What does the federal ruling say?

You can read the full decision here, but the short version is that the judges agreed with Murrill. Trump appointee Judge Kyle Duncan wrote that the FDA rules “cancel 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.’”

The ruling temporarily pauses the 2023 FDA rules that allow mifepristone to be dispensed without an in-person visit to a medical provider.

In other words, a radical attorney general in Louisiana and Trump-appointed judges are trying to control what abortion rights look like for the entire country. So much for leaving abortion to the states!

As Sen. Patty Murray put it:

“Three judges on the most extreme appeals court in the country sided with anti-abortion politicians over the FDA's career scientists, over a quarter-century of safety data, over millions of American women who have safely used mifepristone, and over practically every major medical association in the United States.”

Will providers really keep shipping mifepristone?

Some will, yes. Telehealth abortion providers across the country are weighing their next steps right now. Providers aren’t a monolith: some will keep shipping mifepristone, while others switch to miso-only protocols while the case plays out. They’ll be making decisions based on what state they’re in, what their shield law looks like, what kinds of resources they have access to, and what their risk aversion is.

It would also help, I’m sure, if pro-choice leaders—attorneys general and governors, specifically—came out immediately to make clear that they will continue to protect providers who ship abortion pills, and that the status quo will hold while litigation continues.

AED’s legal sources point out that yesterday’s ruling is a regulatory one: it applies to the FDA, and the FDA can decide what to do next. Crucially, the agency’s enforcement authority is typically directed toward manufacturers and distributors—not providers.

“In the meantime, the people who have mife already on hand, labeled correctly and FDA compliant when they received it, could decide to continue on course until told otherwise by a federal agency,” says Rachel Rebouché, professor at University of Texas School of Law.

That’s not to downplay the risk providers have to weigh: it’s not nothing to go up against a federal ruling or the FDA—should the agency decide to go along with the Fifth Circuit’s decision. But the legal implications of shipping mifepristone in light of this ruling are not nearly as clear-cut as conservatives would like Americans to think.

What about miso-only abortions?

Even without mifepristone, you can still have a safe and effective medication abortion using just misoprostol—which was not impacted by yesterday’s ruling. Planned Parenthood has a guide to miso-only abortion here.

And while it’s important to spread the word that miso-only abortions are available, let’s be real: there’s a reason that the recommended regimen is mifepristone and misoprostol. Miso-only abortions are often longer and less comfortable. A few advocates I spoke to worried that we’d see more ER visits because of miso-only abortions—not because the regimen isn’t safe, but because patients will be in more pain.

It’s added cruelty from the anti-abortion movement.

How will the ruling change access to abortion?

Right now, two things are true at the same time: patients can still get abortion pills by mail, but this ruling is also primed to upend access to abortion and miscarriage care.

We have our work cut out for us, because we need to make sure our communities understand both. We need to thread the needle of relaying what a big deal this decision is, and how it’s a major attack on national access—but also reminding people that they can still get care, and that there are advocates across the country dedicated to helping them get it.

After years of covering this issue, I have a tremendous amount of faith that all of the worst-case scenario planning that advocates and providers have done will kick in. As Lizzy Hinkley, legal director for the Abortion Coalition for Telemedicine (ACT) says, “Shield law providers have been preparing for this moment, with support from ACT, and together we are working to ensure there are no gaps in access.”

We also know that people have already been going through informal channels to access care—like international telehealth, community networks, and websites that sell pills. This decision won’t impact those resources.

Still, let’s be clear-eyed: if the ruling stands, it will have a massive chilling effect on care. Not everyone will be able to connect with the advocates who can help them get pills by mail. Some patients will be forced to travel hundreds of miles just to pick up a prescription. Others will have to forgo abortions altogether.

What I’m most worried about? Republicans have done an unfortunately excellent job instilling fear across the country. There’s a reason states have passed laws that classify shipping abortion pills as “drug trafficking,” or have criminalized “aiding and abetting.”

That chilling effect has been made much worse by the very public moves towards criminalization more generally. American voters can see that women are being arrested for their miscarriages—why would they feel safe seeking out abortions?

No matter what happens next, the anti-abortion movement is already getting something it wants: chaos and confusion.

What happens next?

A lot will depend on what the U.S. Supreme Court and the Trump administration decide to do.

Mifepristone manufacturer Danco Laboratories has already asked SCOTUS for emergency relief, petitioning the court today to block the Fifth Circuit’s ruling. Democratic attorneys general are also expected to go directly to the Supreme Court—though it’s unclear if they’ll move quickly or wait for a response to Danco’s filing. AED sources say the AGs will seek to limit the scope of the ruling; I’ll let you know as soon as I find out.

If the Trump administration appeals, they’ll likely offer the same argument they did when asking for the stay: a defense of the FDA’s authority.

Some of my sources, however, aren’t convinced they’ll challenge the ruling at all. They think there’s a chance the administration lets it stand—giving them the opportunity to restrict abortion medication while shifting political blame onto the courts. After all, the administration is packed with Heritage Foundation maniacs—extremists not just interested in banning abortion, but birth control, IVF, and anything else that aids in women’s freedom.

And even if the administration is scared enough of abortion to hold off until after the midterms—what happens then?

Similarly, while some feel confident that the FDA’s integrity will hold through the agency’s supposed “safety study” of mifepristone, others find that idea naive.

How can I help?

Make sure your communities—online and off—know they can still legally use abortion pills. Need language for social media? I’ve got you covered:

• This ruling does not make it a crime to use or seek abortion pills. If you’ve already ordered abortion pills, you’ve done nothing illegal or wrong. You can continue as planned. If you need abortion pills now, you can still get them. Go to websites like Plan C Pills or I Need An A.

Abortion, Every Day also has a robust resources page that you can share—with links to providers, legal and medical help, abortion funds, and more.

If you live in a shield state, contact your governor and attorney general. Thank them for their continued commitment to reproductive rights and women’s autonomy, tell them you don’t want Louisiana extremists dictating what happens in your state, and let them know how important it is that they protect providers who ship abortion pills across state lines.

If you live in New York, encourage Gov. Kathy Hochul to sign S8544/A9217, which further protects providers if the FDA’s approval status for mifepristone changes. (California passed a similar law last year.)

Support your local abortion fund and providers. As a result of this ruling, more patients will seek out in-person care, necessitating money for travel, lodging, child care, and the procedures themselves.

Remind people this is why elections matter. I know that can feel like a hollow thing to say when we’re watching courts dismantle rights in real time. But the anti-abortion movement has been playing a long game for fifty years—stacking courts, electing AGs, flipping state legislatures. And it’s working. We need voters to show up with the same focus and fury—especially because we have the power of the people on our side.