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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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Ideas expressed in the piece
The article argues that abortion access in the United States in 2026 hinges heavily on medication abortion, which now accounts for a clear majority of abortions and is especially crucial in states with bans because pills can be prescribed via telehealth and mailed, allowing patients to circumvent in‑clinic restrictions and long‑distance travel.[3][5]
Building on this, the piece contends that the most immediate legal threat is the case of Louisiana vs. FDA, where Louisiana claims the FDA acted unlawfully when it removed the in‑person dispensing requirement for mifepristone; the article frames this as part of a broader strategy by antiabortion states to use federal courts to curb telehealth abortion nationwide by arguing alleged safety risks, economic costs and infringements on state sovereignty.
In addition, the article maintains that the scientific record overwhelmingly supports the safety and effectiveness of mifepristone and misoprostol, citing a 25‑year track record and recent research (including a JAMA review of internal FDA documents) that found FDA decisions on mifepristone have been consistently science‑based, except when the agency previously imposed extra restrictions.
The piece further argues that renewed FDA scrutiny of mifepristone under political pressure—prompted in part by a debunked, non–peer‑reviewed conservative think tank report and overseen by an agency leadership that has pledged deference to President Trump—raises the risk that future regulatory decisions will be driven by politics rather than evidence, potentially making the agency vulnerable to “arbitrary and capricious” challenges in court.
At the same time, the article notes that even if the FDA were to reinstate in‑person dispensing rules or limit mailing of mifepristone, abortion pills would not disappear: providers could still prescribe misoprostol‑only regimens, people could travel to other states for two‑drug protocols, and patients would likely continue to obtain pills through international pharmacies and informal support networks, as has already occurred when people stockpile or seek medication in anticipation of new bans.[2][3]
The article also highlights that a revival of the 19th‑century Comstock Act—urged by antiabortion groups and Justice Clarence Thomas, and echoed in policy agendas that seek to use Comstock to block mailing of abortion pills and equipment nationwide—would represent a far more sweeping threat, because it could criminalize mailing any abortion‑related materials, including misoprostol, and subject shipments from international pharmacies to interception and federal drug enforcement.[1]
Moreover, the piece stresses the central role of state “shield laws,” which protect clinicians in supportive states who provide telehealth abortions to patients in ban states; by describing how these laws have enabled tens of thousands of mailed abortions per month and how many states and the District of Columbia have adopted constitutional or statutory protections for abortion or reproductive freedom, the article portrays shield laws as a key counterweight to an increasingly restrictive national landscape.[2][5]
The article then warns that legal attacks on shield providers—such as Louisiana’s arrest warrants and Texas civil suits against out‑of‑state doctors, along with Republican attorneys general urging Congress to override shield laws—are designed to deter clinicians and chill cross‑state telehealth abortion, but even so, the piece suggests that enforcement will be costly and incomplete, and that people will continue to find other routes to access pills.
Finally, the article characterizes the antiabortion movement’s focus on courts, federal agencies and dormant statutes like Comstock as part of a long‑term effort to end abortion nationwide; however, it contends that this legal strategy has also created space for abortion‑rights advocates to innovate—through shield laws, telehealth, ballot measures and practical support networks—and concludes that, in the author’s view, abortion pills are unlikely to vanish regardless of what the Supreme Court, FDA or Justice Department ultimately do.[2][3][5]
Different views on the topic
From the perspective of Louisiana and allied antiabortion officials, the removal of the in‑person dispensing requirement for mifepristone is viewed not as a science‑based modernization but as an unlawful loosening of safeguards that allegedly exposes pregnant patients to heightened risk; the lawsuit against the FDA asserts that the agency failed to adequately weigh dangers and that permissive federal rules effectively undermine state abortion bans and impose economic and sovereignty harms on states trying to restrict abortion.
In parallel, antiabortion advocacy groups and conservative policymakers argue that medication abortion has expanded too far and too fast through telehealth and mail‑order services, and some maintain that regulators and courts must step in to reinstate in‑person requirements, restrict mailing of pills and tighten oversight; these critics often claim that broad access via mail makes it harder to enforce state bans and TRAP‑style clinic regulations designed to limit abortion provision.[2][5]
Additionally, conservative legal strategists and policy blueprints associated with a future Republican administration promote an aggressive reading of the Comstock Act, contending that federal law already prohibits mailing abortion drugs and related equipment nationwide; under this interpretation, they argue that an administration committed to enforcing Comstock could effectively block medication abortion even in states that have chosen to protect it, without waiting for new acts of Congress.[1]
Some Republican attorneys general and antiabortion lawmakers also see state shield laws as a direct affront to state authority and to the goal of enforcing abortion bans within their borders; from this standpoint, telehealth providers in shield states are portrayed as deliberately “aiding and abetting” violations of other states’ laws, and advocates for stronger restrictions therefore call for federal legislation that would preempt shield protections and standardize stricter rules across states.
More broadly, many supporters of post‑Dobbs abortion restrictions argue that the wave of state bans and severe limits enacted since 2022 reflects democratic will and a legitimate state interest in protecting fetal life, not merely an effort to control healthcare; in this view, expanding shield laws, telehealth abortions and constitutional protections for abortion in some states is seen as undermining what those opponents describe as hard‑won protections for the “unborn” in much of the country.[4][5]
In response to claims that medication abortion is unequivocally safe, opponents frequently point to individual adverse events, emphasize the absence of in‑person exams or ultrasounds in many telehealth protocols, and urge the FDA to treat abortion pills as uniquely risky—arguing that, even if serious complications are statistically rare, the moral and legal stakes of ending a pregnancy justify stricter federal and state oversight than for other drugs.
Finally, where the article sees abortion‑rights advocates “rerouting” care around restrictions as a form of resilience, antiabortion commentators often describe these same tactics—stockpiling pills, ordering from overseas suppliers, and using informal networks—as evidence of law evasion and regulatory failure, and therefore as justification for heightened criminal enforcement, expanded customs and postal inspections, and new civil remedies aimed at curbing cross‑border abortion access.[1][3]
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