On Friday, the conservative U.S. Court of Appeals for the Fifth Circuit blocked a Food and Drug Administration rule that allows doctors to prescribe the abortion pill mifepristone via telemedicine. The decision sends a clear message: No woman in America, no matter where she lives, has total control over whether to continue or end a pregnancy. For women in red states, where abortion clinics have been forced to close, this ruling is an attempt to sever one of their final tethers to safe abortion procedures. For blue-state women who may have believed they were protected by dint of their ZIP code, it could come as a shock: A judicial panel of three men, two appointed by President Trump (one of whom was the lead counsel for a conservative group in the Supreme Court case that kneecapped the Affordable Care Act’s contraception mandate), can curtail your right to abortion, too.
Since the Supreme Court overturned Roe v. Wade in June 2022, the number of in-person abortions has declined. Instead of visiting a clinic for a surgical abortion or to collect pills that prompt an abortion, an increasing number of women are turning to telemedicine, where a doctor can prescribe the same pills, which can be sent in the mail.
In states where abortion is banned, in-person procedures are near zero, while the number of telehealth abortion prescriptions was about 9,000 a month by June 2025, according to data gathered by the Society of Family Planning. Most of these prescriptions come from doctors in blue states, which have passed shield laws to ensure that clinicians cannot be criminally charged for prescribing abortion pills to women in need, wherever in the United States those women live.
But it’s not just women in states with abortion bans who will be affected. Telehealth abortions have increased threefold in states that permit abortion, from about 4,500 in June 2022 to 14,000 in June 2025.
Many women opt for telehealth prescriptions over going to a clinic because it is simpler and more private. Others do so because, even in states that permit abortion, it can be difficult to get access to one. The impact of the Fifth’s Circuit judges’ decision will be especially acute in rural areas. Instead of phoning a trained physician and getting pills by mail as she could do as of Thursday, a woman in rural Montana may now have to drive close to 250 miles for a safe in-person abortion at an overburdened clinic, despite the procedure being legal in her state.
More than 40 percent of women who have abortions in the United States live below the poverty line. Most are already mothers. For many women, driving hundreds of miles to end a pregnancy means calling out of work and losing several days’ pay, spending money they don’t have on gas, food and hotels, scrambling to find child care and then driving for hours back home often while bleeding, cramping and exhausted.
The anti-abortion movement knows that these barriers will prevent some women from having abortions. But in legal filings, abortion opponents often couch their concerns under the guises of state sovereignty and medical safety.
Both of these pretexts are embarrassingly transparent. A principle of state sovereignty shouldn’t allow the Fifth Circuit, which covers Louisiana, Texas and Mississippi, to dictate medical care for the women of California, thousands of whom had a telehealth abortion last year. And the F.D.A. allowed mifepristone to be prescribed via telemedicine in the first place because it is so overwhelmingly safe.
It has been on the market in the United States for more than 25 years and has been studied exhaustively. Serious complications are extremely rare — far less frequent, in fact, than what we accept from other commonly prescribed medications, like Viagra. Researchers have also found that prescribing abortion pills remotely is just as safe as prescribing pills in person.
The typical abortion pill regimen has a woman first taking a mifepristone pill followed usually a day or two later by a second medication, known as misoprostol. The good news is that, even with restricted access to mifepristone, women can still safely terminate pregnancies using misoprostol alone. But misoprostol-only abortions are generally considered less effective than combination pills, meaning more women will have to either take a second round of medication to complete the abortion, or go to a clinic for an in-person procedure — logistically tough for rural women; potentially deadly for red state women where abortion bans have curtailed care for miscarriage, pregnancies gone wrong and abortion complications; and emotionally taxing for any woman whose medical procedure didn’t go as planned.
On Saturday, a manufacturer of mifepristone asked the Supreme Court to immediately restore full access to the medication.
Should the Fifth Circuit decision stand, it will be the most significant blow against abortion rights since the Supreme Court overturned Roe v. Wade. It also won’t be the end of attempts to ban abortion pills from women in red states and blue states alike. The anti-abortion movement is working hard to get abortion medication out of women’s hands. With this court decision, it has partly succeeded. But at least it’s shown us its playbook. Women and the people who care about them, in both red and blue states, would be foolish not to read it.
Jill Filipovic is a journalist, a lawyer and an author who writes at jill.substack.com.
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