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The Supreme Court just temporarily restored access to mifepristone by mail, telehealth, and pharmacies after a federal appeals court attempted to make it harder to access one of the most commonly used medications for abortion and miscarriage care in the U.S. 

On May 1, a federal appeals court blocked clinicians from prescribing abortion medication via telehealth and dispensing it by mail, following a lawsuit brought by Louisiana. Just three days later, on May 4, the Supreme Court restored broad access to mifepristone, blocking the ruling that threatened to upend one of the primary ways abortion is now provided in the U.S.—including in states with bans. 

The lower court’s ruling had nothing to do with mifepristone being unsafe. The decision was ideological. 

A panel of the New Orleans-based 5th U.S. Circuit Court of Appeals wrote in its ruling, “Every abortion facilitated by [the Food and Drug Administration] action cancels Louisiana’s ban on medical abortions and undermines its policy that ‘every unborn child is human being from the moment of conception and is, therefore, a legal person.’”

Right now, we are witnessing ongoing attacks on abortion care from all levels of government. Republican lawmakers don’t care about their constituents’ access to care, and even after Roe v. Wade was overturned, anti-abortion extremists have continued their relentless crusade to further ban abortion nationwide.

Mifepristone has an extremely low rate of serious complications. It is one of the safest medications we use in reproductive health care. Serious complications occur in fewer than 0.5% of cases, and the risk of death is less than 1 in 100,000, making mifepristone safer than ibuprofen, penicillin, and Viagra. And yet it’s being singled out and restricted in ways that other medications are not.

Mifepristone is also not controversial in medicine. It has been used reliably for more than 25 years. The FDA removed the in-person requirement after reviewing extensive data showing that mailing it after a telehealth visit was just as secure. The American College of Obstetricians and Gynecologists has been clear about this too, writing earlier this year: “The overwhelming weight of scientific evidence and two decades of medical practice show that mifepristone is safe and effective, and that its strong safety profile persists whether distributed in person or by mail.” 

The lower court’s efforts to upend abortion access wasn’t about safety. It was about control.

Currently, more than 1 in 4 abortions in the U.S. are provided through telehealth. This is not a niche pathway—it accounts for 27% of care. In 2025 alone, 91,000 people accessed abortion care this way.

For many people, telehealth is the only real option for accessing care. Receiving medication through the mail means not having to take days off work, not having to arrange child care, and not having to travel long distances. When you take this option away, you have made abortion care even harder to access in a country already overrun with bans and purposefully confusing and restrictive state laws.

It’s worth noting that restricting mifepristone is also wildly unpopular. A 2025 national survey of over 1,000 registered voters conducted for the American Civil Liberties Union found that most support medication abortion, most oppose restrictions on it, and a majority agree that forcing people to travel just to pick up a prescription would prevent some from getting care at all. Most also agree that making abortion medication harder to access inserts politics into decisions that should be made between a patient and their provider.

Keeping mifepristone accessible isn’t a fringe view. However, restricting the medication is.

Banning abortion outright is unpopular, so making it even harder to access is easier to justify. The lower court’s ruling sounded procedural and temporary. It sounded like a technical change, rather than another devastating blow to abortion access—until you look at what it actually aimed to do.

In its emergency application filed Saturday asking the Supreme Court to lift the ruling, Danco Laboratories, the company that produces mifepristone, argued that the lower court’s ruling would cause “chaos.” 

Lawyers for the company wrote in their filing that the decision “causes immediate confusion and dramatic upheaval for manufacturers, distributors, providers, pharmacies, and patients around the country.”

More broadly, some clinics may have shifted toward misoprostol-only abortion to maintain telehealth care. Though safe and effective, working about 90% to 95% of the time when used correctly, this change would have been a dramatic shift in standard operating procedures. 

The standard regimen in the U.S. has been mifepristone with misoprostol. More than 98% of medication abortions have used that combination. It is the most common approach because it is the most streamlined and predictable for patients.

When mifepristone is restricted, clinicians often rely on a misoprostol-only regimen, which involves repeated dosing, a longer duration of the abortion process, and increased rates of side effects such as nausea, diarrhea, and heavier or more prolonged bleeding. While still effective, the use of misoprostol would not have been a medical improvement. It would be an unfortunate workaround in a political landscape that aims to ban access to abortion nationwide.

The lower court’s efforts are another example of how incremental abortion restrictions aim to operate. Not one sweeping ban, but a series of decisions that slowly erode access.

The lower court’s efforts are another example of how incremental abortion restrictions aim to operate. Not one sweeping ban, but a series of decisions that slowly erode access. Requirements are added that don’t outright eliminate care, but in practice, make abortion nearly impossible by narrowing the pathway and making access more complicated for the people who need it most.

After the Dobbs decision, pregnant people died because they could not get timely abortion care, even as the political leaders behind those bans failed to track or take responsibility for the outcomes, ProPublica reported.

Had the Supreme Court not stepped in, we would once again find ourselves watching as dire consequences unfolded in real time. The companies that manufacture mifepristone warned the Supreme Court that the lower court’s ruling was already creating “immediate confusion and upheaval” in time-sensitive medical decisions, leaving patients unsure if they would be able to access medication that was prescribed just days before.

Abortion access is essential health care. It should not depend on emergency orders, court deadlines, or whether patients happen to seek care during the one-week window when the rules are temporarily restored.

For now, mifepristone access remains in place. But the fight over who gets to control abortion care is far from over.

Editorial Team:
Tina Vasquez, Lead Editor
Lara Witt, Top Editor
Stephanie Harris, Copy Editor