Introduction

Since Roe v. Wade was overturned in 2022, requests for abortion pills via telemedicine have doubled in the U.S. One in four abortions are now provided via telehealth—making mail-access medication abortion a lifeline for millions of people.

This has also made medication abortion a primary target of anti-abortion extremists, who want to push abortion completely out of reach. Today, the Trump administration is under heavy political pressure from these extremists to make it harder to get mifepristone (mife), a safe and effective medication used in nearly two-thirds of U.S. abortions, as well as for miscarriage care.

To be clear: the safety and efficacy of mifepristone has been settled for more than two decades, and there is no medical or scientific justification for restricting access to it. In the 25 years since its approval by the Food and Drug Administration (FDA), more than 7.5 million women in the U.S. have used mifepristone safely—with serious adverse events characterized as “exceedingly rare.” Current evidence and ongoing research show that mifepristone continues to be safe and effective, including when accessed through telemedicine.

Slashing access to mifepristone would sever this crucial lifeline, causing disproportionate harm to people with low incomes; people living in rural areas or far away from the nearest abortion provider; young people; and other vulnerable people and communities, such as survivors of intimate partner violence and people with disabilities.

Anti-abortion extremists are doing everything in their power to pressure the FDA into taking this harmful action, including by filing lawsuits that threaten both telemedicine access to mifepristone and mifepristone’s FDA approval.

Louisiana v. FDA

Louisiana v. FDA 

Louisiana v. FDA (W.D. La.) was filed by the anti-rights group Alliance Defending Freedom on behalf of Louisiana and an individual woman in October 2025. It seeks to reinstate a medically unnecessary In-Person Dispensing Requirement for mifepristone.  

On December 17, 2025, Louisiana filed an emergency motion for a court order that would reinstate the in-person dispensing requirement while the case is being litigated. In response to this motion, the FDA asked the court to put the case on hold while it continues its ongoing review of mifepristone regulations. A hearing was held on February 24, 2026. Read the amicus briefs submitted in this case by a broad range of experts, including the Center for Reproductive Rights, here.  

On April 7, 2026, the court granted the FDA’s request to put the case on hold while the FDA conducts its review. This decision means that there will be no immediate changes to the federal rules governing mifepristone. The court did not set a deadline for the FDA to complete its review, but did order the FDA to file a status report within six months (no later than October 7, 2026) updating the court on the FDA’s progress.   

The court denied Louisiana’s request to reinstate the in-person dispensing requirement, but left the door open for the state to renew it if the FDA doesn’t complete the review in an expeditious manner. Louisiana may now attempt to seek review of this decision by a higher court.  

What Louisiana is trying to do:

• Reinstate the In-Person Dispensing Requirement for mifepristone, which would force patients across the country to travel to a health center to be handed the medication.
• Stop pharmacies from filling prescriptions for mifepristone.
• Stop mail distribution of mifepristone in the U.S.

What that would mean:

• Everyone would need to go to a health center in order to get mifepristone. Some patients would have to travel hundreds of miles.
• Nobody, not even patients who need mifepristone for miscarriage management, would be able to get it from a pharmacy.

Missouri v. FDA

Missouri v. FDA 

Missouri v FDA (E.D. Mo.) is a continuation of a case filed by the anti-abortion group Alliance for Hippocratic Medicine in November 2022. After the U.S. Supreme Court held that the group lacked standing, Missouri, Idaho, and Kansas were permitted to intervene in January 2024. The case was transferred to Missouri in October 2025. The states are not challenging the FDA’s initial approval of mifepristone, but are seeking to invalidate every FDA action on mifepristone since that initial approval more than 25 years ago.

What Missouri, Idaho, and Kansas are trying to do:

• Invalidate every FDA decision on mifepristone since 2000, the year the FDA first approved mifepristone.
• Introduce new restrictions on the use of mifepristone by minors.

What that would mean:

• In addition to all of the consequences listed above for Louisiana v. FDA;
• Fewer health care providers would be authorized to prescribe mifepristone, making medication abortion harder to access.
• The two generic versions of mifepristone would no longer be available, making mifepristone harder to access.

Florida v. FDA

Florida v. FDA 

Florida v. FDA (N.D. Tx.) was filed by Florida and Texas in December 2025. Florida and Texas claim that the FDA has not thoroughly reevaluated safety data on the drug since its initial approval in 2000. They seek to end all nationwide access to mifepristone by directing the FDA to withdraw its approval for this safe and effective medication.

What Florida and Texas are trying to do:

• Get the FDA to withdraw its decades-old approval of mifepristone.
• Invalidate every FDA decision on mifepristone since 2000, the year the FDA first approved the drug

What that would mean:

• Mifepristone—a medication used in more than 60% of abortions in the U.S.—would be banned across the country.
• Some patients seeking medication abortion would be able to use a different, misoprostol-only regimen, a less common protocol in the U.S. that is used more commonly in the global setting.
• Other patients who would otherwise choose medication abortion might end up needing to have procedural care instead, which could further tax clinics’ already-strained resources and could mean longer wait times and fewer appointment slots for all patients, not just abortion patients.

FDA review

FDA Review

Sustained external pressure on the Trump Administration from anti-abortion advocates and politicians recently led Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. to ask FDA Commissioner Marty Makary to “review” the latest data on mifepristone.

Due to a ruling in Louisiana v. FDA, the FDA will be required to file a status report on the review’s progress no later than October 7, 2026.

What the FDA is doing:

The FDA has announced publicly that it is conducting a “safety study” of mifepristone; specifically:

“As of February 2026, the FDA continues to work on the collection of the robust and timely data that is necessary for a well-controlled study with adequate statistical power. The next steps of the mifepristone safety study will be data exploration, evaluation of data integrity, and implementation of the analyses, validation, and peer-review. Once the FDA finishes its analysis of the data, the agency will decide whether to make substantive changes to the [risk evaluation and mitigation strategy] REMS [for mifepristone]. If the FDA determines that changes to the REMS are warranted, then the agency will take appropriate action.”

This so-called “mifepristone safety study” is highly concerning. Mifepristone has a 25-year safety track record. Generally speaking, the FDA does not conduct its own clinical studies but is instead best positioned to conduct reviews of existing data from external studies. The Trump Administration’s review appears to be prompted by a thoroughly debunked, self-published position paper peddled by anti-abortion extremists. To date, neither HHS nor the FDA has provided any clarity or transparency regarding the basis of agency “review” of mifepristone, including what data sources they are using to conduct this “review,” despite repeated calls from the public, including from the Center and other advocacy organizations, as well as from Congress.

What that will mean:

Unfortunately, it is hard to say or predict with any specificity what could come of the FDA’s review. The FDA ultimately makes decisions about the safety and efficacy of drugs approved for use in the U.S.

Based on mifepristone’s robust 25-year safety record, there is no justifiable reason for imposing more restrictions on mifepristone if a purely scientific review, protected from political interference and based on FDA’s own regulations and guidelines, was occurring at the FDA. But in this highly-politicized, norm-shattering environment, we cannot rule out any of the outcomes—especially if, as HHS Secretary Robert F. Kennedy stated in congressional testimony, the agency will ultimately defer to the decision making of President Trump, rather than the scientific and medical analysis of its own experts.