Opponents of abortion are increasingly targeting the accessibility of abortion pills, which have become the most prevalent method for terminating pregnancies in the United States.
Recently, the Texas Attorney General’s office initiated a lawsuit against a doctor in New York, claiming she contravened Texas law by prescribing abortion pills through telemedicine to a Texas patient.
This case marks a significant legal challenge and may test the adequacy of New York’s protections for providers who assist patients in states where abortion is prohibited.
Additionally, anti-abortion activists are pursuing various legislative and legal measures to further limit access to these medications.
Abortion rights advocates express concern that the incoming administration could impose further restrictions on access to abortion pills if they choose to do so.

By the time the U.S. Supreme Court overturned Roe v. Wade in 2022, the use of medication abortions surged, with more than half of all abortions in the country performed via pills, typically a combination of mifepristone and misoprostol.
It’s essential to differentiate these drugs from emergency contraceptives like Plan B, which are taken shortly after potential conception and well before many women realize they are pregnant.
Research indicates that medication abortions are generally safe and effectively result in a completed abortion more than 97% of the time, although they are not as effective as surgical procedures.
According to data from the Guttmacher Institute, by last year, nearly two-thirds of abortions were performed using medication.
This trend has intensified due to the increase in telehealth services, with a survey revealing that such prescriptions made up about 10% of abortions in the first half of 2024.
This spike is attributed to several Democratic-led states enacting laws to protect medical providers who prescribe abortion pills through telemedicine to patients in states with bans.
“Telehealth for abortion has been incredibly effective,” noted Ushma Upadhyay, a professor at the University of California, San Francisco.

Texas has adopted a novel tactic in this ongoing debate by filing a lawsuit against Dr. Maggie Carpenter from New York, alleging she improperly prescribed abortion pills to a Texas resident.
New York is among at least eight states where legislation exists to safeguard medical providers who prescribe these medications.
If Texas succeeds in enforcing a ruling against Carpenter, the implications for New York’s protective law remain uncertain, as it may not hold in that state, according to David Cohen, a law professor at Drexel University.
He predicts that any judicial decision is unlikely to significantly deter other physicians from providing prescriptions to out-of-state patients.
Cohen believes that, akin to the trade in illegal drugs, abortion pills will remain accessible as long as there is demand.
“Even if he manages to close one avenue, it’s unlikely he’ll be able to block them all,” he stated about Attorney General Paxton’s efforts.

In a different legal approach, some states have been assessing new ways to limit access to abortion pills.
Earlier in the year, the U.S. Supreme Court ruled that a coalition of anti-abortion doctors lacked the standing to challenge federal approval of mifepristone.
In October, attorneys general from Idaho, Kansas, and Missouri filed a legal claim asserting their entitlement to push for discussions around modifications in the FDA’s approval timeline that permits the drug’s use within the first 10 weeks of pregnancy via telemedicine.
The outcome of their case remains pending, and any ruling is expected to face appeals.

States are also proactively crafting legislation targeting abortion pills.
This year, Louisiana became the pioneer in passing a law reclassifying mifepristone and misoprostol as “controlled dangerous substances.”
Although the drugs remain permissible, the revised classification necessitates additional procedural hurdles for healthcare providers.
Some doctors have asserted in a legal dispute that this change could lead to delays in emergency situations where these pills are required, including instances of post-birth hemorrhaging.
Dr. Jennifer Avengo, leading the New Orleans Health Department, mentioned that no significant issues regarding timely access to these medications were reported during the initial enforcement period.
More states are expected to explore means to tighten regulations on abortion pills during their upcoming legislative sessions in 2025.

In Tennessee, a Republican lawmaker has introduced a bill imposing a $5 million civil liability against those involved in distributing or facilitating access to abortion pills aimed at terminating pregnancies.
Rep. Gino Bulso disclosed that the motivation behind the bill arose from discovering that abortion pills were being sent to Tennessee, defying state law.
“I started contemplating how we could create an additional deterrent for companies that violate our criminal statutes while also providing recourse for the families of unborn children,” he articulated.
A proposal in Missouri additionally seeks to criminalize the delivery of mifepristone and similar drugs intended for abortions.
Following a constitutional amendment adopted by voters in November to allow abortion until fetal viability—estimated to be past 21 weeks of pregnancy but without a precise cutoff—these discussions are unfolding.

Furthermore, the federal government could also influence the status of these pills.
There have been concerns voiced by abortion rights advocates regarding potential actions from the Trump administration to enforce an 1873 statute banning the mailing of medications related to abortion.
The Biden administration has thus far refrained from implementing such measures.
Additionally, the FDA retains the authority to readjust its drug approvals without waiting for judicial intervention.
During his presidential campaign, Trump expressed fluctuating positions on abortion policy, at times distancing himself from hardline anti-abortion views.
However, since taking office, he has appointed individuals opposed to abortion to key positions within his administration.
In a recent interview with Time magazine, he provided vague responses regarding abortion pill policies, indicating a desire to maintain access while also suggesting he may reconsider his stance.