In recent years, antiabortion groups and lawmakers have seeded a number of challenges to medication abortion. This year, several are coming to fruition.
In 2026, decisions from either the courts, Food and Drug Administration or Department of Justice could end telehealth for medication abortion.
Roughly two-thirds of Americans who end their pregnancies do so by taking two drugs — misoprostol and mifepristone. Because these safe, effective medications can be prescribed via telehealth, without an in-office visit, they are how most patients terminate pregnancies in states that ban abortion.
The most imminent threat to mailed abortion pills is the court case Louisiana vs. FDA.
Louisiana sued the Food and Drug Administration in October 2025 over the agency’s 2023 decision to remove an in-person dispensing requirement for mifepristone.
The state alleges that the rule change was unlawful, purportedly because the FDA failed to weigh the dangers of the drug. Louisiana, which has a near-total abortion ban, claims that it has suffered direct economic harm and threats to its state sovereignty when providers in protective states legally prescribe abortion pills to pregnant Louisianans across state lines.
This case has moved quickly — and already appeared before the Supreme Court in May, when justices acted to maintain access while the case proceeds.
By the end of summer, the 5th Circuit Court of Appeals will consider Louisiana’s appeal of a district court’s decision to deny the state a preliminary injunction against the FDA. However the 5th Circuit rules, the losing party is likely to appeal to the Supreme Court.
There is no guarantee that the court would hear this case, but it could have the opportunity to decide the future of medication abortion.
The FDA is also reconsidering the regulation of mifepristone, following concerted political pressure from antiabortion doctors, lawyers and lawmakers.
To justify reviewing a drug with an established 25-year safety record, Health Secretary Robert F. Kennedy Jr. in May 2025 cited a widely debunked study by the Ethics and Public Policy Center, a conservative think tank. More than 260 researchers have denounced it for deep scientific flaws and a lack of peer review.
Then, little happened, and antiabortion lawmakers accused then-FDA head Marty Makary of dragging his feet. In May, Makary was fired, and in early June it was reported that the FDA would begin its “safety study.” A status report is due this fall.
The evidence overwhelmingly cuts against reimposing restrictions. A January study in the Journal of the American Medical Assn., reviewing more than 5,000 pages of internal FDA documents, confirmed the agency’s decisions regarding mifepristone were consistently science-based except in two instances — when the agency imposed stricter rules on the drug.
And in October 2025, a federal court in Hawaii questioned the existing restrictions on mifepristone as unsupported by the evidence, directing the FDA to reconsider mifepristone’s regulation.
Contradicting both its own decision-making and a federal court ruling would make the FDA vulnerable to court challenge as “arbitrary and capricious” under federal administrative law.
But Kennedy has stated that his agency defers to President Trump’s decision-making, so a decision rooted in science and evidence cannot be taken for granted.
Reinstating the in-person requirements on mifepristone would not stop abortion pills from being mailed. Providers would still be free to prescribe and send misoprostol, which has no such restrictions and can safely terminate a pregnancy on its own.
Even with a federal ban on receiving mifepristone by mail, pregnant people could continue to get legal two-dose abortions by traveling out of state. People will order the pills from international pharmacies and informal support networks would continue to operate in ban states.
The 5th Circuit and the FDA present the most imminent challenges to medication abortion access. But others are waiting in the wings.
Both antiabortion groups and Justice Clarence Thomas have urged the Justice Department to enforce the 1873 Comstock Act, an anti-obscenity law that bans using the mail to distribute “lewd” or “indecent” content.
If the dormant Comstock Act were revived for the first time in more than a century, mailing abortion pills would be considered a violation of federal criminal law. Unlike the restrictions on mifepristone, Comstock enforcement would bar the mailing of all abortion-related materials — including misoprostol. International pharmacies could still prescribe and mail abortion pills, but their shipments would risk interception by U.S. customs and be subject to federal drug laws.
Two wrongful death lawsuits filed in Texas have invoked the Comstock Act as a basis for tort claims against so-called shield providers. These are doctors who practice in states where state shield law protects them against criminal prosecution, civil liability or professional discipline in their home state for facilitating abortion services out of state. Twenty-two states and the District of Columbia have passed such laws.
Shield laws in eight states protect telehealth services and have allowed mailed medication abortion to proliferate in recent years, including in ban states. Shield providers facilitated nearly 15,000 abortions per month in the second quarter of 2025 — mostly in states that outlaw abortion.
Shield laws and shield providers also are under challenges.
Louisiana has issued arrest warrants in all 50 states for at least one shield provider, a doctor in New York. Texas sued the same doctor for civil damages. And Republican attorneys general want Congress to pass a federal law that would override shield laws.
Once again, if shield laws fall, abortion medication would not end: People could continue to order the pills from other sources; enforcement would be costly and difficult. But the repercussions for abortion access would be significant.
Limiting access to medication abortion is one clear step in an effort to end abortion nationwide.
But by anchoring its campaign to the legal system, the movement has ceded some ground. While antiabortion advocates wait on judges and regulators, the abortion rights movement is adapting its own strategy and rerouting care around restrictions, as it has done since the Supreme Court overturned Roe vs. Wade in 2022.
In my view, abortion pills won’t disappear, no matter what the courts or the executive branch does.
Rachel Rebouché is a professor at the University of Texas at Austin School of Law. This article was produced in collaboration with the Conversation and Rewire News Group, two nonprofit news organizations.
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