The Supreme Court is being asked to restore access to an abortion pill by mail. Here's what to know

The New Orleans-based appeals court's unanimous ruling Friday marked a substantial victory for abortion opponents seeking to stem the flow of abortion pills prescribed online, which they view as subverting state bans on the procedure. It requires that mifepristone be distributed only in person and at clinics, overruling regulations set by the federal Food and Drug Administration.

“We’re now going to see, I think in a way we haven’t before, what the nation will look like when abortion bans are actually in effect,” said Mary Ziegler, an expert on abortion law and a professor at University of California at Davis School of Law.

Here's what to know:

Impact extends beyond states with abortion bans

Frustrated with a lack of federal action against medicated abortions, Louisiana Attorney General Liz Murrill sued the FDA last year, saying its rules allowing mifepristone to be dispensed through the mail undermined the state’s ban on abortions at all stages of pregnancy.

Friday’s ruling is in effect while the case works its way through the courts. It affects patients in all states, even those without abortion restrictions.

“This is a huge access issue for patients that haven’t got providers close by, or providers close by who are willing to prescribe,” said Josh Thorburn, owner of Eddie’s Pharmacy in Los Angeles.

There is little precedent for a federal court overruling the scientific regulations of the FDA, and it remains to be seen how the decision could impact abortion access long-term.

Murrill, a Republican, celebrated the ruling as a “victory for life” while other anti-abortion advocates cheered the reversal of rules finalized under President Joe Biden that ended a longstanding requirement that the pills be obtained at an in-person doctor’s visit.

Representatives for the FDA and the U.S. Department of Justice did not immediately respond to requests for comment.

Mifepristone long considered safe and effective

Mifepristone was approved in 2000 as a safe and effective way to end early pregnancies. It is typically used in combination with a second drug, misoprostol, which is not affected by the ruling but is less effective on its own.

Surveys have found that the majority of abortions in the U.S. are administered using pills and that about one in four abortions nationally are prescribed via telehealth. Providers have suggested that its availability through telehealth is a reason why the number of abortions in the U.S. has not fallen since Roe was overturned in 2022.

As a result, abortion pills and those who prescribe them out of state have become key targets of abortion opponents.

Some Democratic-led states have adopted laws that aim to protect providers who prescribe via telehealth and mail the pills to states with bans. Those so-called shield laws are being tested through civil and criminal cases in Louisiana and Texas.

One telehealth provider in a state with a shield law, Dr. Angel Foster, was working with legal experts to understand how the ruling would impact her organization, The Massachusetts Medication Abortion Project.

“We will do everything in our power to continue providing care to people in all 50 states,” she said.

Mini Timmaraju, president and CEO of Reproductive Freedom for All, said providers are “in limbo” as they await further court decisions but can pivot to using just misoprostol for abortion care.

“It’s got a chilling effect on providers across the country, and it’s going to have a chilling effect on patients, who are already having a hard time navigating the law state by state, and what they can get and how they can get care,” she said.

Abortion policy could come into play in the midterms

The case could again make abortion a key issue in the midterm elections as Democrats aim to take back control of the House and Republicans fight to hold on to a narrow majority.

“This is going to be a pretty significant change in terms of how people experience abortion access, probably as significant as anything we’ve seen since Roe was overturned,” Ziegler said. “So another big question mark is going to be the extent to which voters feel that before they go to the polls."

Recent electoral results suggest that voters seeking to maintain abortion access have the political momentum. Since Roe was overturned, abortion has been on the ballot directly in 17 states. Voters have sided with the abortion-rights side in 14 of those questions.

Abortion-rights supporter Fatima Goss Graves, president and CEO of the National Women’s Law Center, said the ruling is “deeply out of step with both the public and fact-based science.”

Ziegler said the case also “sort of puts the president in the position of having to get off the sidelines on this issue in a way we haven’t seen before.”

Trump received criticism after the ruling from some anti-abortion advocates who expressed frustration that he did not take action himself to block distribution of the pill.

The FDA under Trump approved another generic version of mifepristone last year, which peeved some allies of the Republican president.

“It’s shameful that the Trump administration’s inaction has forced pro-life states to take their battle to the federal courts,” said Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, who also applauded the appellate ruling.

This story has been updated to correct the name of drugmaker GenBioPro and the timing of Louisiana's lawsuit against the FDA.

Associated Press writers Jamie Stengle in Dallas and Jeff Amy in Atlanta contributed.