Medication abortion: Decisions from federal courts, the FDA or Trump’s Department of Justice could try to end access via telehealth

Roughly two-thirds of Americans end their pregnancies by taking two abortion medications – 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.

In recent years, anti-abortion 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.

I am a law professor who researches and writes on reproductive health and abortion law. Here’s the abortion news I’m monitoring for the rest of 2026:

The most imminent threat to mailed abortion pills is the court case Louisiana v. FDA.

Louisiana sued the FDA 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. In April 2026, at the FDA’s request, a district court in Louisiana paused the case, halting the litigation.

Louisiana appealed to the 5th Circuit, which agreed with the state. On May 1, it reinstated the previous in-person prescription and dispensing requirement for mifepristone – a ruling with nationwide consequences. That weekend, patients across the U.S., regardless of the abortion laws in their state, could no longer get mifepristone through telehealth, the mail or in pharmacies.

Two pharmaceutical companies that manufacture mifepristone asked the Supreme Court to intervene, and on May 14, the justices blocked the 5th Circuit’s decision. That emergency order allows providers to again prescribe mifepristone via telehealth while the litigation proceeds in Louisiana.

By the end of summer, its docketing schedule shows, the 5th Circuit will consider Louisiana’s appeal of the district court’s decision to deny the state a preliminary injunction against the FDA.

Past statements in this case signal how the 5th Circuit might rule. In May, Judge Kyle Duncan, a Trump appointee, wrote that the FDA “conceded it had failed to adequately study whether remotely prescribing mifepristone is safe,” which “resulted in numerous illegal abortions in Louisiana and in Louisiana paying thousands in Medicaid bills for women harmed by mifepristone.”

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. When the Supreme Court intervened in May, it wasn’t deciding the case’s substantive issues but rather on a procedural matter. Whether the justices are willing to decide the future of medication abortion based on what could be a sweeping ruling from the 5th Circuit is an open question.

The FDA is also reconsidering the regulation of mifepristone, following concerted political pressure from anti-abortion doctors and lawmakers.

To justify reviewing a drug with an established 25-year safety record, Health Secretary Robert F. Kennedy Jr. in May 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 anti-abortion 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.”

This process uses the FDA’s Sentinel system – which collects safety information from large electronic health databases of health records, insurance claims, administrative data and registries – to assess possible safety concerns. A status report is due this fall.

The evidence overwhelmingly cuts against reimposing restrictions. A January 2026 JAMA – Journal of the American Medical Association – study of over 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 in Purcell v. Kennedy, 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 Donald 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 all 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.

During the 72 hours the 5th Circuit’s ruling was in effect, that’s what some providers did.

Taking misoprostol alone is a safe and effective option endorsed by both the World Health Organization and American College of Obstetricians and Gynecologists. People end pregnancies with misoprostol throughout the world, though it differs from the two-drug combination.

Misoprostol alone is slightly less effective than a two-drug regimen. Misoprostol clears all pregnancy tissue in roughly 85% to 90% of cases, versus 95% when paired with mifepristone. It also takes longer to work – up to three days, compared with 24 hours with mifepristone – and may cause more diarrhea and fever.

Researchers are also exploring additional drug combinations to boost misoprostol’s efficacy without mifepristone, including pairing it with drugs that are otherwise prescribed for non-abortion purposes.

Even with in-person pickup of mifepristone, pregnant people could continue to get legal two-drug medication abortions by traveling out of state. Informal abortion-support networks, which rely on national and international sources to obtain mifepristone, would continue to operate in ban states.

The 5th Circuit Court of Appeals and the FDA present the most imminent challenges to medication abortion access. But others are waiting in the wings.

Both anti-abortion groups and Supreme Court 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 to be tapped for the first time in more than a century, mailing abortion pills would be considered a violation of federal criminal law. And unlike an FDA restriction 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 could expose recipients to violation of federal law.

Two wrongful death lawsuits filed in Texas have already 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 in places where it is banned.

Shield laws in 22 states and Washington have allowed mailed medication abortion to proliferate in recent years. Eight of those states protect telehealth for medication abortion no matter where the patient lives. Shield providers in those eight states 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.

Beyond the Texas wrongful death suits, 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 have called on 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 a national effort to end abortion nationwide.

But by anchoring its campaign to the legal system, the movement has ceded terrain on the ground. While anti-abortion 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 v. Wade in 2022.

In my view, abortion pills won’t disappear, no matter what the courts or the executive branch does.

This article was published in collaboration with Rewire News Group, a nonprofit news outlet that covers reproductive health.

This article is republished from The Conversation, a nonprofit, independent news organization bringing you facts and trustworthy analysis to help you make sense of our complex world. It was written by: Rachel Rebouché, The University of Texas at Austin

Rachel Rebouché does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.