Abortion opponents are increasingly focusing on restricting access to pills, which are the most common way to end a pregnancy in the United States.
This month, the office of the Texas attorney general filed a lawsuit against a doctor in New York, saying she violated Texas law by prescribing abortion pills to a patient there using telemedicine. The suit represents the first lawsuit of its kind and could lead to a legal test for the New York legislation designed to protect providers in the state who prescribe the drugs to patients in states that have abortion bans.
Anti-abortion officials are taking additional steps, too, through lawsuits and legislation.
Advocates for abortion rights are also concerned that President-elect Donald Trump’s administration could take action to restrict access if it chose to. Pills are the most common form of abortion.
By the time the United States Supreme Court overturned Roe vs. Wade in 2022, opening the door for states to ban abortion, over half of all abortions were achieved using medication, usually a combination of the drugs misoprostol and mifepristone.
The drugs are different than Plan B and other contraceptives that are usually taken within three days of a possible conception, weeks before women know they are pregnant. Medical studies indicate that, in general, they are safe and result in completed abortions over 97% of the time, which is less effective than abortion procedures.
By last year, almost two-thirds of abortions were from medications, according to a tally by a research organization that supports abortion access, the Guttmacher Institute.
Much of the growth has been through abortion pills prescribed using telehealth and mailed to patients. A survey conducted for the Society of Family Planning found that by the time it was the first half of 2024, such prescriptions accounted for around one-tenth of abortions in America.
That number had risen quickly since 2024, when some Democratic-controlled states began adopting laws that seek to protect medical providers within their borders who prescribe abortion pills via telehealth to patients in states that have banned abortion.
“Telehealth for abortion has been a huge success,” said professor at the Center of Health and Community and the University of California, San Francisco, Ushma Upadhyay. “It has helped people in an incredible way.”
Texas pursuing New York doctor despite a law intended to protect prescribers
Ken Paxton, Texas Attorney General, rolled out a new strategy in the fight over pills this month when he sued Dr. Maggie Carpenter, based in New York, alleging she prescribed and sent pills to a woman in Texas.
New York is one of at least eight states with legislation intended to protect medical providers who prescribe abortion pills to patients located in states with bans.
If Texas convinces a judge to block Carpenter from prescribing in the state, it remains unclear what would happen next. New York’s shield law would block it from being enforced in New York, said David Cohen, professor at Drexel University’s Thomas R. Kline School of Law.
Cohen said he expects any ruling wouldn’t have a significant chilling effect on other doctors who prescribe out-of-state patients. “They certainly seem undeterred by legal risk,” said Cohen.
And, he said, like illegal drugs, they will continue to remain available if there is a demand for them. Cohen said Paxton “is going to plug one hole if he succeeds. There’s no way he plugs them all.”
Another state lawsuit is trying a different way to restrict pills
Pill prescribing has already withstood one crucial effort to block it. This year, the U.S. Supreme Court ruled a group of anti-abortion organizations and physicians that represent them lacked the legal standing to force the undoing of federal approvals for mifepristone.
The state attorneys general from Missouri, Idaho, and Kansas responded in October with a legal filing contending they could make such an argument. Instead of focusing on the drug’s initial approval in 2000, they are looking at later changes from the U.S. Food and Drug Administration that allow its use for telemedicine prescriptions and the first 10 weeks of pregnancy.
The case has yet to be decided. When it is, it will likely be appealed to a higher court.
States are additionally considering laws aimed at abortion pills
This year, Louisiana became the first state with a law to reclassify both misoprostol and mifepristone as “controlled dangerous substances.” Drugs are still allowed. However, medical personnel have to go through additional steps to access them.
Some physicians said in a legal challenge that the change could cause delays in administering them in emergencies, like when a woman is hemorrhaging after giving birth.
The director of the New Orleans Health Department, Dr. Jennifer Avengo, said that in the first few months of enforcement, she didn’t hear any cases where the drugs couldn’t be accessed in time.
Additionally, states are considering ways to restrict abortion pills in their 2025 legislative sessions.
A GOP state legislator in Tennessee has proposed creating a $5 million civil liability against those who deliver or help access abortion pills with the intention of helping someone end their pregnancy.
Representative Gino Bulso said he filed the legislation after learning abortion pills were being sent to Tennessee despite a state law that prohibited such actions. “I began to think about how we might be able to both provide an additional deterrent to companies violating the criminal law and provide a remedy for the family of the unborn children,” he said.
A Missouri proposal would make it a crime to deliver mifepristone or additional drugs with the intent of causing an abortion. In November, voters in the state adopted a constitutional amendment to allow abortion until the viability of the fetus — which is somewhere around 21 weeks into pregnancy, although there is no fixed timeframe.
Federal government could take steps to regulate the pills
The Trump administration could also take action on the pill policy.
One approach that advocates for abortion rights have warned about — and which some abortion opponents have suggested — includes enforcing a 1973 law against pills that ban mailing instruments or medications used in abortion. The Biden-Harris administration has declined to do so.
The FDA could additionally change its approvals of the drugs, even without being forced to do so by a court ruling.
During his campaign, Donald Trump changed his stance on abortion policy and, at points, attempted to distance himself from opponents of abortions. Since he won the election, however, he has nominated opponents of abortion to administration posts.
In a Time magazine interview published this month, Trump gave answers to questions about pills. He said he intended to maintain access but left the door open to changing his mind.
