Overview
Lack of access to safe, legal abortion care increases maternal and infant morbidity and mortality and has dire implications for pregnant people with acute or chronic medical conditions. In 2000, the FDA approved mifepristone as a safe, effective abortion option involving a regimen of oral medication to terminate a pregnancy. Abortion medications like mifepristone have become more widely used, particularly as a lower-cost and more accessible option for people living in abortion-restrictive states. As a result, there has been an increase in efforts by abortion-prohibitive states to ban abortion medication through state law and through litigation in federal courts. This article highlights how—between state laws, reconsideration of federal regulations, and myriad lawsuits—the legal issues surrounding abortion access remain persistent and have grown in dimension.
Mifepristone was first approved by the FDA in 2000 as a safe, effective abortion option involving a regimen of oral medication to terminate a pregnancy. Rules related to mifepristone have changed in ways that make the drug more accessible. Mifepristone was initially approved for use up to 7 weeks and is now permissible up to 11 weeks of gestation, and the FDA’s original requirement of in-person distribution under prescription by a medical doctor was reduced to permitting dispensing via telehealth and by additional types of health care providers. As a result, abortion medication became more widely used, particularly as a lower-cost option and for people living in abortion-restrictive states.
Following the 2022 Supreme Court decision inDobbs v. Jackson Women’s Health Organization, mifepristone became an important aspect of providing access to abortion for people living in states that severely restrict or prohibit abortion. Medication abortion made up 63% of all abortions performed in 2023; and in the second quarter of 2025, 27% of all abortions were medication abortions via telehealth. The positive impact of access to abortion medication through the 10th week and via telehealth has diminished as attacks on access increase.
The trend in medication abortions has led to abortion-prohibitive states seeking to ban abortion medication through state law and through litigation in federal courts. As of February 2026, there are 28 states with some state-level restrictions on the prescription, distribution, or use of abortion medication. As the 2026 legislative session wraps up for many states, new restrictions include making it a felony to advertise, distribute, or sell abortion medication in South Dakota, where the governor has signed the bill into law, and in Mississippi, where the bill is on track to the governor’s desk following concurrence between the state house and senate.
In Missouri, a bill about providing care after an attempted abortion also targets abortion medication by imposing civil penalties on supplying medicine for a person to perform a “self-induced” abortion. In Arizona, a bill to restrict the prescription and distribution of abortion medication passed the house and is under consideration in the senate. However, Arizona governor Katie Hobbs has a record of protecting reproductive freedom so there is a possibility of veto if this bill advances to the governor’s desk. The Indiana and South Carolina legislatures are considering bills restricting distribution that are making progress.
The federal regulatory landscape is murky as Secretary Kennedy stated the FDA was reviewing the safety and efficacy of mifepristone in May 2025 but the timeline around this review is not clear. In contrast, in September 2025, the FDA approved another generic form of mifepristone drawing criticism from anti-abortion advocates. There are also multiple ongoing lawsuits about FDA restrictions on mifepristone. So far, the Trump administration Department of Justice (DOJ) has sought to delay litigation while the FDA continues to perform its purported review of mifepristone.
The original lawsuit in FDA v. Alliance for Hippocratic Medicine was filed in federal district court in Texas by doctors and medical organizations opposed to abortion. The plaintiffs alleged that mifepristone significantly impacts girls’ developing reproductive systems and should be prohibited for minors; that mailing medication to pregnant people presents great risk; and that the FDA should return to 2016 regulations that only allow use up to 7 weeks of gestation, require in-person distribution, and limit prescription by medical doctors only. Following decisions against the FDA in the Northern District of Texas and on appeal at the Fifth Circuit, the Supreme Court found in June 2024 that the plaintiffs did not have standing to sue, dismissing the lawsuit. Shortly after that decision, the lawsuit was refiled in Texas by the attorneys general of Missouri, Kansas, and Idaho and was transferred to the Eastern District of Missouri in October 2025. The new Missouri case, Missouri v. FDA, is ongoing as of April 2026 and was amended to include a challenge to the most recent FDA approval of another generic form of mifepristone.
The Trump administration has also sought delay in Louisiana v. FDA. This lawsuit was filed in October 2025 by the Louisiana Attorney General and a plaintiff claiming she was coerced to take abortion medication ordered by her partner through the mail, taking a different approach to standing than the states’ case in Missouri. Plaintiffs argue for reinstating in-person dispensing requirements for mifepristone. The DOJ filed a motion in January 2026 arguing that the Louisiana suit should not move forward since the FDA is already reviewing mifepristone regulation.
In April 2026, the federal district court granted the stay requested by DOJ, which was swiftly appealed to the Fifth Circuit. On May 1, 2026, the Fifth Circuit issued a ruling ordering FDA to reinstate in-person dispensing; and on May 4, 2026, the Supreme Court issued an emergency order staying the Fifth Circuit order. The temporary stay restores mifepristone access by mail until May 11, 2026, while the Supreme Court considers the appeal of the Fifth Circuit’s decision that would restrict access to in-person dispensing while the full case is heard at trial. The Network for Public Health Law joined an amicus brief to the Supreme Court supporting access to mifepristone via telehealth.
The final pending mifepristone lawsuit is Florida v. FDA, filed in December 2025 by the attorneys general of Florida and Texas. Rather than challenging the relaxed requirements, this lawsuit challenges the original approval of mifepristone in 2000, arguing that the FDA failed to evaluate safety in its initial approval. Like the other pending cases, the DOJ filed a motion to stay or dismiss the cases pending the FDA’s review.
One thing is clear—nothing about the Dobbs decision settled law relating to access to abortion care. To the contrary, between state laws, reconsideration of federal regulations, and myriad lawsuits, legal issues surrounding abortion access remain persistent and have grown in dimension. This article demonstrates the complexities on just one issue, medication abortion, among so many. Keeping up with proposed and actual changes in this space is challenging. The Network is available for technical assistance requests related to the issues covered in this article and others related to reproductive health care access.
This post was written by Katherine Schutes, J.D., Staff Attorney, Network for Public Health Law—Eastern Region.
The Network promotes public health and health equity through non-partisan educational resources and technical assistance. These materials provided are provided solely for educational purposes and do not constitute legal advice. The Network’s provision of these materials does not create an attorney-client relationship with you or any other person and is subject to the Network’s Disclaimer. Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.
