The U.S. Supreme Court on May 4 temporarily allowed a popular abortion pill to continue to be sent in the mail after a federal appeals court ruling blocked the practice days before.
Justice Samuel Alito stayed a May 1 order of the U.S. Court of Appeals for the Fifth Circuit that halted mailing of the drug. The stay expires on May 11.
The ruling came after the maker of the brand-name version of the drug, Danco Laboratories, and the maker of the generic version, GenBioPro, asked the high court to block the Fifth Circuit ruling.
A federal court previously paused Louisiana’s lawsuit against the abortion pill to give federal regulators time to review its safety and effectiveness.
Whether mifepristone remains widely available depends on the ongoing Food and Drug Administration (FDA) review of the Biden administration’s 2023 decision to drop the requirement of an in-person doctor visit prior to dispensing the pill, as well as Louisiana’s lawsuit and legislation pending in Congress. The second Trump administration has not changed the no-doctor policy.
A medication abortion generally involves mifepristone, which blocks the hormone progesterone, and misoprostol, which induces contractions.
Louisiana, along with pro-life activists and lawmakers, argue that the no-doctor policy puts women’s health at risk, and is illegal because it was enacted without proper consideration of safety risks.
If the state wins its lawsuit to reinstate the now-repealed requirement for an in-person doctor visit, demand for medication abortions, which now account for most abortions in the United States, could drop. This is because patients who currently obtain the medication through the mail without visiting a doctor would have to do more legwork to obtain it.
Court Case
On April 7, U.S. District Judge David Joseph for the Western District of Louisiana put a hold on the litigation, staying the lawsuit until further notice, to give the FDA, now under President Donald Trump, an opportunity to review safety claims about the drug.
Federal lawyers had asked the court to stay the case to allow the FDA review to take its course.
Louisiana officials previously said they would appeal Joseph’s ruling and ask the Fifth Circuit to block the 2023 rule.
In June 2024, the Supreme Court unanimously rejected a challenge to the loosening of mifepristone regulations. Before that, the Fifth Circuit found that prior FDA rules easing access to the drug were unlawful. The Supreme Court declined to hear the case, ruling that the group that filed the challenge lacked standing, or a close enough connection to the legal controversy.
At the same time, Louisiana has been testing so-called shield laws in places such as California and New York that protect health care providers from out-of-state investigations and prosecutions. Louisiana has indicted out-of-state doctors for prescribing mifepristone to Louisiana residents.
Legal experts said before the Supreme Court acted on May 4 that whatever the Fifth Circuit eventually rules in the case is unlikely to be the final word on the issue of the abortion pill.
Former federal prosecutor Neama Rahmani predicted that the courts will issue “inconsistent rulings” on this kind of issue.
“It’s going to be an absolute mess, and I’m almost certain that the Supreme Court is going to pick it up and deal with it,” he told The Epoch Times.
David Super, a professor at Georgetown University Law Center, said the case was “paradoxical” because Louisiana is challenging a Biden administration policy that the Trump administration appears to be trying to repeal.
The fight is only over “how this policy should end, not whether it should end,” he told The Epoch Times.
“This is not really a victory for the abortion drug: It is simply a judge preferring to let the government do the work.”
Debate Over Abortion Pill
Debate over the abortion pill has intensified since the Supreme Court struck down Roe v. Wade (1973) in 2022.
Thirteen states, including Louisiana, have passed total or near-total abortion bans since that ruling, according to the Kaiser Family Foundation.
The overall number of abortions has risen since 2022, and the percentage of medication abortions is also on the rise. In 2023, medication abortions accounted for 63 percent of all clinician-provided abortions in states that don’t have total abortion bans, up from 53 percent in 2020 and 39 percent in 2017, the Guttmacher Institute reports.
As of June 2024, medication abortions were lawful in 36 states and the District of Columbia, while 14 states enforce near-total bans on mifepristone, USAFacts reports.
Louisiana, which has banned mifepristone, says the drug endangers women’s health by causing bleeding and sometimes fatal infections, so doctors should participate in the dispensing process.
Kristen Ullman, president of the conservative Eagle Forum, said her group wants “at a minimum” for safeguards to be reinstated. The current no-doctor rule is “really just a return … to back alley, bathroom abortions,” she told The Epoch Times.
Planned Parenthood, on the other hand, says the mifepristone dispensing system is sound, and the drug itself has been used effectively by more than 7.5 million women with a serious complication rate of less than 1 percent since initial FDA approval in 2000.
Daniel Schmid, associate vice president for legal affairs at Liberty Counsel, a Christian nonprofit, said it is clear that the Biden-era FDA never studied the potential impact of taking doctors out of the dispensing process.
The FDA’s relaxation of standards by allowing the mailing of abortion pills raises significant safety questions under federal law, he told The Epoch Times.
The Trump administration said it is going to do the necessary study to determine if the rule was sufficient, and the judge agreed to give the administration time to do that, Schmid said.
Trump, GOP Dispute
The Trump administration has resisted political pressure to ban mifepristone, taking the position that the abortion issue itself should be decided by the states.
The FDA under Trump approved generic versions of the drug in 2019 and in October 2025.
Bills are also now pending in Congress on mifepristone that could affect its availability in the future.
Sen. Josh Hawley (R-Mo.) introduced legislation in March to ban the drug and allow women to sue the manufacturer for alleged harms caused by it.
“The science is clear: The chemical abortion drug is inherently dangerous to women and prone to abuse,” Hawley said.
Another bill by Sen. Cindy Hyde-Smith (R-Miss.) would reinstate in-person requirements for dispensing mifepristone that were removed during the Biden administration.
A bill sponsored by Rep. Diana Harshbarger (R-Tenn.) would cancel FDA approval of mifepristone, and like Hawley’s bill, let women harmed by chemical abortions sue manufacturers.
Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, said action is needed because the Trump administration’s failure to act against the interstate flow of abortion pills helps to explain why the abortion rate is rising in the United States.
After Roe was reversed, President Joe Biden “eliminated the in-person dispensing requirement for abortion drugs—flooding the market with mail-order abortions without any meaningful medical oversight,” Dannenfelser said in January.
“Women are also paying the price, with horrifying cases of abuse and coercion emerging.”
Savannah Hulsey Pointer, Zachary Stieber, T.J. Muscaro, Sam Dorman, and Reuters contributed to this report.
This article, an explainer, by Matthew Vadum appeared May 5, 2026, in The Epoch Times.