Abortion opponents are increasingly focused on restricting access to pills, which are the most common way to end a pregnancy in the United States
This month, the Texas attorney general’s office filed a lawsuit against a New York doctor, claiming she violated Texas law by prescribing abortion pills to a patient there via telemedicine. The lawsuit is the first of its kind and could lead to a legal challenge to New York’s law designed to protect providers who prescribe the drugs to patients in states with abortion bans.
Abortion opponents are also taking other steps by passing laws and filing lawsuits.
Abortion rights advocates also worry that President-elect Donald Trump’s administration could take action to restrict access if it so chooses.
Pills are the most common means of abortion
When the U.S. Supreme Court ruled on Roe v. Wade repealed and gave states the ability to ban abortions, over half of all abortions were performed with medication, usually a combination of the drugs mifepristone and misoprostol.
The drugs differ from Plan B and other emergency contraceptives, which are typically taken within three days of possible conception, weeks before women realize they are pregnant. Studies have shown that they are generally unthreatening and result in completed abortions in more than 97% of cases, which is less effective than procedural abortions.
Nearly two-thirds of abortions last year were due to medication, according to a tally by the Guttmacher Institute, a research organization that supports abortion access.
Much of the growth is due to abortion pills being prescribed and shipped to patients via telemedicine. A survey commissioned by the Society of Family Planning found that such prescriptions accounted for about a tenth of abortions in the United States in the first half of 2024
That number has risen rapidly since 2023, when some Democratic-controlled states began passing laws aimed at protecting medical providers within their borders who prescribe abortion pills via telemedicine to patients in states where abortion is banned.
“Telemedicine for abortion has been a huge success,” said Ushma Upadhyay, a professor at the Center of Health and Community and the University of California San Francisco. “It has helped people in incredible ways.”
Texas is prosecuting a New York doctor despite a law intended to protect prescribers
Texas Attorney General Ken Paxton rolled out a up-to-date strategy in the pill fight this month when he called on Dr. Maggie Carpenter, who lives in New York, sued, claiming she prescribed and sent pills to a Texas woman.
New York is one of at least eight states with a law protecting medical providers who prescribe abortion pills to patients in states with bans.
If Texas prevails on a judge to block Carpenter from prescribing drugs in the state, it’s unclear what would happen next. New York’s shield law would prevent enforcement in New York, said David Cohen, a professor at Drexel University’s Thomas R. Kline School of Law.
Cohen said he expected a ruling would not have a major chilling effect on other doctors who prescribe to patients out of state. “They certainly don’t seem to be deterred by legal risks,” he said.
And he said that, like illegal drugs, they will continue to be available if there is a demand for them. Cohen said Paxton “will fill a hole if he succeeds. “There’s no way he’s going to take them all.”
Another lawsuit filed by states seeks to restrict the exploit of pills in other ways
Pill prescriptions have already withstood a decisive attempt to block them. The U.S. Supreme Court ruled this year that a group of anti-abortion doctors and the organizations they represent lacked legal authority to force the reversal of federal approval of mifepristone.
The attorneys general of Idaho, Kansas and Missouri responded with a lawsuit in October claiming they could make such an argument. Instead of focusing on the drug’s initial approval in 2000, they look at subsequent changes by the U.S. Food and Drug Administration that allow its exploit in the first 10 weeks of pregnancy and telemedicine prescriptions.
There is still no verdict in her case. If this is the case, an appeal will likely be made to a higher court.
States are also considering laws targeting abortion pills
This year, Louisiana became the first state with a law that reclassified both mifepristone and misoprostol as “controlled dangerous substances.” The medications are still allowed, but medical staff must go through additional steps to get them.
Some doctors said in a lawsuit that the change could lead to delays in administering it in emergencies, such as when a woman is bleeding after giving birth.
Dr. Jennifer Avengo, director of the New Orleans Department of Health, said that in the first few months of enforcement, she had not heard of any cases where the drugs were not available on time.
More states are considering options to restrict abortion pills in their 2025 legislative session.
In Tennessee, a Republican lawmaker has proposed imposing $5 million in civil liability against those who deliver or assist in accessing abortion pills with the intent to assist someone end a pregnancy.
Rep. Gino Bulso said he filed the bill after learning that abortion pills were being sent to Tennessee despite state law prohibiting such actions. “I started thinking about how we could further deter companies that violate criminal law while also providing relief for the families of unborn children,” he said.
A proposal in Missouri would make it a felony to distribute mifepristone or other medications with the intent to induce an abortion. In November, the state’s voters passed a constitutional amendment allowing abortions until the fetus is viable – around 21 weeks of pregnancy, although there is no set time frame.
The federal government could also take action to regulate the pills
Trump’s administration could also take action on pill policy.
One approach that abortion rights advocates have warned against – and that some abortion opponents have suggested – is to enforce an 1873 anti-pill law that bans the mailing of any medication or instrument used in abortion. President Joe Biden’s administration has rejected this.
The FDA could also change its drug approvals without being forced to do so by a court ruling.
During his campaign, Trump changed abortion policy and at times tried to distance himself from abortion opponents. Since his election victory, however, he has nominated abortion opponents for administrative positions.
In an interview with Time magazine published this month, he gave rambling answers to questions about pills. He said he wanted to maintain access but also left the door open to changing his mind.
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Associated Press reporter Kimberlee Kruesi contributed to this article.
