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Court blocks mail delivery of abortion medication
A federal appeals court has temporarily barred doctors from sending the abortion pill mifepristone by mail, reviving a requirement that patients obtain it in person. The ruling, issued Friday by the Fifth Circuit Court of Appeals, suspends a 2023 Food and Drug Administration (FDA) regulation that permitted telemedicine prescriptions and postal delivery.
Impact on abortion access
The decision primarily affects states where abortion is already banned, as mifepristone remains widely available in states with legal abortion. The two-pill regimen-mifepristone followed by misoprostol-is the most common method of terminating pregnancies in the U.S. The FDA first approved mifepristone in 2000 for use up to seven weeks of gestation, later extending it to 10 weeks in 2016.
Legal and political reactions
The ruling stems from a lawsuit filed by Louisiana, which argued that the FDA's 2023 rule undermined state abortion bans. The appeals court agreed, stating that the regulation "cancels Louisiana's ban on medical abortions" and conflicts with its policy recognizing fetal personhood from conception.
"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.'"
Fifth Circuit Court of Appeals
Louisiana Attorney General Liz Murrill praised the decision, calling the Biden administration's rule a policy that "facilitated the deaths of thousands of Louisiana babies." In contrast, Julia Kaye of the American Civil Liberties Union (ACLU) criticized the ruling as "defying clear science and settled law."
Medical and regulatory background
Mifepristone blocks progesterone, a hormone essential for pregnancy continuation, while misoprostol induces uterine contractions. The FDA temporarily lifted the in-person dispensing requirement during the COVID-19 pandemic in 2021 and made the change permanent in 2023. The Supreme Court unanimously rejected a 2024 effort to restrict mifepristone access but left room for future legal challenges.
Over 3.7 million women in the U.S. used mifepristone between 2000 and 2018, according to FDA data. The American College of Obstetricians and Gynecologists (ACOG) and other medical groups consider the drug safe, with studies showing the two-pill regimen is 95% effective and requires additional medical intervention in less than 1% of cases.
State-level responses
New York Attorney General Letitia James reaffirmed that abortion access, including medication abortion, remains legal in her state. "In New York, our laws ensure that anyone who needs abortion care can seek it here," she said in a statement. Meanwhile, anti-abortion advocates, including Susan B. Anthony Pro-Life America, hailed the ruling as a "huge victory" against what they termed a "reckless mail-order abortion drug regime."
What's next
The Fifth Circuit's order will remain in effect as the case proceeds through the courts. The decision overrides a lower court's earlier pause on the lawsuit while the FDA conducts a review under the Trump administration.
