Contributor: ATTWN Staff
Key points:
- The 5th Circuit ruling changed little in practice: Even though the court said mifepristone should require an in-person visit, abortion providers had long-prepared backup plans. They immediately pivoted to misoprostol-only regimens sent by mail, allowing medication abortions to continue nationwide.
- Misoprostol-only abortions raise serious medical and ethical concerns: Misoprostol-only abortions carry risks of increased pain, potential complications like infection and uterine rupture, and the possibility of a baby showing signs of life after failed second-trimester misoprostol abortions.
- Financial stakes for drug manufacturers and states are central: Companies like Danco have major economic incentives to keep mifepristone widely available, while states like Louisiana bear substantial medical costs from complications.
When the 5th Circuit Court of Appeals issued a ruling on May 1 that said mifepristone could only be prescribed with an in-person doctor visit, pro-life groups cheered. But it was not a win because abortions could still be done via pill with the second half of the two-pill regimen, misoprostol. In fact, Planned Parenthood said immediately after the ruling that they were already sending out to patients. And a doctor from Massachusetts told Politico that she and fellow activists were ready to deploy a plan they “had spent years preparing — a plan they tested out during the 36-hour window when the 5th Circuit’s prohibition stood. Rather than sending patients the typical bundle of mifepristone and misoprostol, two drugs that are about 98 percent effective at terminating a first-trimester pregnancy when taken together, she started sending a higher dose of just the second drug.”
“The abortion industry was not caught off guard whatsoever by this case and the 5th Circuit ruling,” said Abby Johnson, former Planned Parenthood director and founder of And Then There Were None and ProLove Ministries. “We desperately need a cultural change in our nation, one that celebrates and supports motherhood, rather than seeking to destroy it. The legal wrangling won’t stop abortion as it stands right now.”
Mail-Order Abortions and Misoprostol
The abortion pills in the United States contain both mifepristone and misoprostol. Mifepristone cuts off progesterone from the developing baby inside the womb, and then misoprostol expels the dead baby through uterine contractions. The U.S. Supreme Court put the 5th Circuit Court ruling on hold for the time being while the case goes through the lower courts, so it is currently business as usual, and abortion pills can legally be mailed to those who want them.
Before the Supreme Court even ruled on this case, Dr. Angel Foster told POLITICO magazine, “Medication abortion is still available by mail to patients in all 50 states.”
She went on to say that even if Louisiana is successful with the case and mifepristone is only available via an in-person doctor visit, abortion pills via mail would still happen, but that abortions would be “less comfortable.”
“That’s a kinder way of saying that a woman will go through even more pain than she was already going to go through with the two-pill regimen,” said Johnson. ‘There’s also a chance of the baby being born alive.”
Misoprostol-only abortions are horrific and have been used in other countries to induce labor during the second trimester in order to end the life of the unborn baby. What happens if that baby is still alive when it’s born? What kind of decision will a woman make then? The International Journal of Gynecology and Obstetrics published a study in 2007 about misoprostol-only abortions in the second trimester, revealing that there can be serious side effects, such as uterine rupture and infection, but also “that fetuses aborted after 20 weeks may show signs of life after abortion.”
Following the Money
Part of the Louisiana 5th Circuit case involves the companies that make Mifepristone.
One is Danco, which immediately appealed Louisiana’s attempt to stop its distribution in the state. The 5th Circuit Court’s ruling discussed Danco’s “substantial financial interest” in selling Mifepristone and how it did not outweigh the irreparable harm the pills caused women in the state. The 5th Circuit wrote: “Louisiana argues the district court erred by finding its irreparable harms are outweighed by FDA’s interest in continuing its review and Danco’s financial interests in selling mifepristone. We agree.”
“To no one’s surprise, abortion is about money, not women’s empowerment,” said Abby Johnson. “The companies that make the abortion pills need the courts to rule in their favor because they will lose a substantial amount of money if not.”
Part of the financial hit of the abortion pill involves the serious side effects. The largest known study on the abortion pill, released by the Ethics and Public Policy Center earlier this year, analyzed insurance claims data covering more than 865,000 Mifepristone abortions between 2017 and 2023. It found that nearly 11 percent of women experienced a serious complication, including sepsis, infection, or hemorrhage, within 45 days of the procedure. This number is 22 times higher than reported on the drug label.
Louisiana is footing the cost of medical care when the abortion pill harms women. The 5th Circuit ruling referenced the fact that Louisiana identified “$92,000 it paid in Medicaid costs from two women who needed emergency care in 2025 from complications caused by out-of-state mifepristone. Such costs will almost certainly continue because nearly 1,000 women monthly—many of whom are on Medicaid—have mifepristone-induced abortions in Louisiana.”
“In the end, the lawyers on both sides can fight all they want, but abortions are still going to happen, and pro-abortion advocates will still find ways to skirt the law in the name of ‘access,’” said Johnson. “We need to ultimately make abortion something that is so abhorrent that no one would ever consider it. It is abhorrent, but our culture puts the threat of inconvenience over innocent life.”
Legal Timeline
- On May 1, 2026, the 5th Circuit Court of Appeals reinstated in-person dispensing requirements for Mifepristone, half of the abortion pill regimen. President Biden has done away with this requirement during his administration, and today, more than 60% of all abortions are done with the abortion pill.
- On May 2, 2026, the U.S. Supreme Court temporarily halted the 5th Circuit Court ruling, reinstating Mifepristone and allowing abortion pills to be sent through the mail.
- On May 14th, the Court extended that order, allowing Mifepristone to continue to be used in mail-order abortions while the case works its way through the lower courts.