A federal appeals court this week ruled that mifepristone—a drug used in half of all U.S. abortions that has come under legal fire this year—should remain available, but with significant restrictions on its use.
The ruling has no immediate effect on the availability of mifepristone. The Supreme Court may take up the case next, meaning the drug’s fate is still in limbo and no one knows exactly how access to it could change in the future.
But what is clear, experts say, is any restriction on mifepristone would have ripple effects for the entire abortion-care system. In 2020, 53% of all facility-based U.S. abortions used medication, rather than surgical methods. If mifepristone becomes harder or impossible to access, providers would either have to change their standards of care to continue offering medication abortions, or find a way for an already overburdened clinical network to squeeze in hundreds of thousands of extra procedural-abortion appointments.
“This could ultimately be a cataclysm for U.S. abortion access,” says Caitlin Myers, who researches the issue at Middlebury College. “Or it might be nothing.”
Mifepristone was first approved by the U.S. Food and Drug Administration (FDA) in 2000. It is used as the first part of a two-drug regimen to end a pregnancy. Mifepristone is given to stop the pregnancy from progressing, while the second drug, misoprostol, causes cramping and bleeding as the uterus empties.
In November 2022, anti-abortion groups filed a lawsuit challenging the FDA’s approval of mifepristone and recent efforts to make it more accessible. A Texas judge in April sided with those plaintiffs, effectively overturning the FDA’s approval of mifepristone despite the drug’s good safety record in its 20 years of availability. The Justice Department appealed the decision and asked for a pause on its implementation while the legal process plays out. The Supreme Court granted that request, keeping mifepristone available at least temporarily.
This week, a federal appeals court in Louisiana partially broke from the Texas judge’s ruling, deciding that mifepristone should remain available but with restrictions on its use—including removing recent regulatory provisions that allow the drug to be prescribed remotely and sent through the mail; setting limits on which types of clinicians can provide it; and shortening its window of use from within 10 weeks of pregnancy to seven weeks.
