In his nearly two months in office, President Donald Trump has only made small moves to advance his anti-abortion agenda. But his Justice Department’s decisions to enforce a law that protects abortion clinics from violence only in “extraordinary” cases and to stop defending a Biden-era lawsuit against Idaho that sought to protect access to emergency abortion care in hospitals send a clear signal: The federal government will not defend what curtailed abortion rights remain post-Dobbs. Now, Republican lawmakers emboldened by that message are going after their most urgent target: abortion pills.
Medication abortion, which now accounts for 63 percent of all abortions in the U.S., has been a constant thorn in conservatives’ sides since the overturn of Roe. The availability of mifepristone and misoprostol via telemedicine and online providers has allowed people to terminate their pregnancies even if their states banned the procedure. “More and more people are opting for the abortion pill,” says Ushma Upadhyay, an abortion researcher and professor for the department of obstetrics, gynecology, and reproductive science at the University of California San Francisco. “It provides them with autonomy, privacy, and the ability to have an abortion from their own homes through telehealth. The antis are worried that there is less and less that they can do about it.”
But they are certainly trying new attacks. One of the most widespread efforts has been trying to replicate Louisiana’s crackdown on abortion pills. Last year, the state, where abortion was already illegal, became the first in the nation to reclassify mifepristone and misoprostol as “controlled dangerous substances,” making it a crime to be in possession of the drugs unless someone is a licensed health provider or a pregnant person. This legislative session, at least seven states — Idaho, Indiana, Kentucky, Mississippi, Oklahoma, Tennessee, and Texas — are pushing similar bills. “These are attempts to use drug-war tactics against people who share abortion pills with others,” says Farah Diaz-Tello, senior counsel and legal director at the reproductive-justice legal nonprofit If/When/How. She adds the measures are also a way for conservative lawmakers to “cut people off from systems of care and support.”
Drugs that are classified as controlled, dangerous substances include opioids, depressants, and other highly addictive medications. But the scientific evidence is unmistakable: Abortion pills are neither addictive nor dangerous. Since mifepristone was approved 25 years ago, study after study has shown abortion pills are overwhelmingly safe and effective. Misoprostol, the ulcer medication that is the second pill in the medication-abortion regime, is also used off-label for a wide range of gynecological care. But due to the law, Louisiana hospitals have been forced to take misoprostol out of obstetric hemorrhage carts and instead store it in passcode-protected locked compartments. Any delay in obtaining the drug, doctors say, is a matter of life or death for patients who are hemorrhaging. People who’ve been prescribed misoprostol for their miscarriages have also reported having a hard time filling prescriptions at local pharmacies. Providers and patients in places that replicate Louisiana’s measure will likely face similar issues.
States are pursuing a range of other restrictions on the pills, too. “You’re seeing everything from the information that can be shared about them, the way people receive them, the way providers get them to them,” says Jennifer Driver, senior director of reproductive rights at the State Innovation Exchange. For example, after state Republican lawmakers overrode the governor’s veto this month, Wyoming is now forcing patients to get an ultrasound 48 hours before having an abortion with pills. Tennessee is seeking to impose a $5 million fine on anyone or any group that mails abortion medication, while Kentucky wants to make it a felony to ship pills into the state. And Mississippi unsuccessfully attempted to make any advertising about abortion pills illegal.
Lawmakers are even going as far as trying to thwart voters’ will in Arizona and Montana, both of which passed constitutional amendments codifying abortion rights in the last election. Arizona Republicans are pushing for onerous and medically unnecessary regulations around medication abortion, including requiring patients to obtain the pills in person, while Montana legislators introduced a bill that would regulate the drugs by setting conditions for health-care providers, assigning disposal responsibilities to manufacturers, and establishing penalties for violating the law. Even with these new constitutional protections in place, Driver doesn’t anticipate that Republicans’ attacks on pills and abortion access in general will stop. “They are no longer hiding the ball,” she says.
States have also started to directly target abortion providers in an effort to curb the use of medication abortion. In December, Texas sued Dr. Maggie Carpenter, a New York–based provider, for allegedly sending abortion pills to a patient in the Dallas suburbs. A month later, Louisiana went a step further and brought criminal charges against Carpenter for allegedly prescribing medication abortion to a teen in that state. These cases will be the first real tests of shield laws, which intend to protect providers who treat patients in banned states through telehealth, as well as abortion seekers traveling from ban states to places where the procedure is protected. Though shield laws were designed with this sort of attack in mind and New York State has vowed to defend Carpenter, going after her could still have a chilling effect among abortion providers. “They are trying to intimidate and disincentivize folks from providing that care,” says Mini Timmaraju, president of Reproductive Freedom for All.
Key to Louisiana’s case against Carpenter is the allegation that the teen’s mother coerced her into terminating her pregnancy. “Coercion” is a term that anti-abortion activists began using in earnest two years ago to promote restrictions under the guise of protecting women. Both anti-choice state lawmakers and the Trump administration seem poised to lean into this language in order to prosecute doctors and to justify making it harder for people to access medication abortions. During a recent visit to Baton Rouge, U.S. Attorney General Pam Bondi said she would “love to work with” the district attorney who charged Carpenter. Bondi’s comments alarmed experts, who say the biggest threat to abortion pills is the Comstock Act, an 1873 anti-obscenity law that anti-abortion advocates argue criminalizes the mailing of medication used to terminate a pregnancy. If Trump directed Bondi and the Justice Department to enforce the measure, that would amount to a national abortion ban without needing approval from Congress.
Another sneaky way that the Trump administration could attack access and bolster restrictions on the abortion pill is by using the federal government’s regulatory powers. At his confirmation hearings, new Health and Human Services secretary Robert F. Kennedy Jr. said he’d been directed by President Trump to look into potential “safety issues” caused by mifepristone. Dr. Marty Makary, a longtime abortion opponent who is Trump’s nominee for FDA commissioner, echoed Kennedy’s position at his own hearing last week. “RFK’s comments that the president directed him to look into the safety of medication abortion is a sign that the Trump administration is not going to ‘leave it to the states,’” says Upadhyay.
Those comments are especially concerning considering that shortly before the election, the Republican attorneys general of Missouri, Idaho, and Kansas revived a lawsuit that seeks to reinstate the requirement to administer mifepristone in person, among other pre-2016 FDA regulations. “I personally am most concerned about this lawsuit,” says Kirsten Moore, director of the advocacy group EMAA Project, which supports expanding access to medication abortion. “The attorney generals are arguing that people in their state are still getting abortions when they shouldn’t be, because while the states banned abortion, they can get mifepristone. That’s obviously a novel argument, and I have no doubt that the Supreme Court would be happy to go along.”
While the DOJ under former president Biden had filed a motion saying the attorney generals have no standing to sue, Moore predicts the Trump administration will likely take a friendlier position. Anticipating this, mifepristone’s manufacturer, GenBioPro, filed a motion last month asking to be added to the list of the defendants in the lawsuit. That’d allow the company, which is represented by the progressive legal group Democracy Forward, to lead the defense of the case. “I expect that at some point, sooner rather than later, the current Department of Justice will revoke that and say, ‘Actually, we’d like to join that lawsuit because, you know, states’ rights,’” says Moore.
Regardless of the scientific evidence or the public’s support for keeping medication abortion legal, it’s clear that state Republicans are committed to prohibiting abortion pills through any means possible. And as these lawmakers attempt to keep their attacks under the radar, it’s more important than ever that people pay attention. “The really bad bills that show up in other states are definitely coming to yours,” Driver says. “They offer us a road map of what anti-abortion legislators are trying to do.”
The Cut offers an online tool you can use to search by Zip Code for professional providers, including clinics, hospitals, and independent OB/GYNs, as well as for abortion funds, transportation options, and information for remote resources like receiving the abortion pill by mail. For legal guidance, contact Repro Legal Helpline at 844-868-2812 or the Abortion Defense Network.