U.S. Court limits mail-order abortion pills

On May 1, the U.S. Fifth Circuit Court of Appeals made a decision on the case State of Louisiana et al. v. Food and Drug Administration (FDA), ordering the FDA to reinstate regulations that the use of mifepristone pills for abortions can only be received in person, rather than through the mail.

In April 2021, the Food and Drug Administration temporarily lifted the requirement for an in-person clinic visit to receive mifepristone for the purposes of abortion in the first trimester of pregnancy. Mifepristone is the first of two pills taken for this abortion process, followed by misoprostol. Sending them via mail and not at a clinic was originally a temporary measure due to the COVID-19 pandemic but it became permanent in 2023.

People on both sides of the abortion debate see dangers in obtaining the pills through the mail, including the possibility that a woman could be forced to take them (such as by a rapist) or given them without her knowledge. As well, there is medical danger for the woman, particularly if she miscalculates the gestational age of the baby.

Roe v. Wade was overturned in June 2022. Louisiana already had the Human Life Protection Act in place -- a “trigger law” -- which meant that after the overturning of Roe v. Wade, abortion would immediately become illegal in the State of Louisiana (with an exception for the life of the mother). Abortion became illegal in Louisiana in August of 2022.

In October 2025, the State of Louisiana filed a lawsuit to reverse the FDA’s 2023 decision to make mail order abortion pills available. In April 2026, a federal judge temporarily paused the case in order for the FDA to review the regulations around mifepristone. Now, as of May 1, the Fifth Circuit Court of Appeals has ruled that the FDA needs to reinstate its restrictions (known as risk evaluation and mitigation strategy) on mail-order mifepristone pills.

The Court wrote in the order,

The Court mentions in their order that the documentation shows that approximately 1,000 women receive illegal abortions in Louisiana each month.

Attorney General Liz Murrill, wrote in a statement on May 1, “The Biden abortion cartel facilitated the deaths of thousands of Louisiana babies (and millions in other states) through illegal mail-order abortion pills.”  

Mifepristone (as well as the second pill in an abortion process misoprostol) are not exclusively used for abortions. They can also be used in treatments of postpartum hemorrhages and miscarriages.

According to the Louisiana Department of Health, both drugs remain available for these purposes in their state. In 2024, both drugs were classified as “Schedule IV” drugs, a designation that categorizes them as controlled substances.

According to the Guttmacher Institute and others, there will likely be an emergency appeal to the U.S. Supreme Court.

In a statement, the Guttmacher Institute writes, “If allowed to stand, this decision would be the most sweeping threat to abortion since the overturning of Roe.”