A federal judge in Louisiana ruled Tuesday that access to a drug used in abortions can remain as it is nationally for the moment. But the 37-page ruling by Judge David C. Joseph is far from an endorsement of telehealth abortion, which has become far more common in the past few years, now accounting for more than one in four abortions in the U.S.
The judge granted a request from the Food and Drug Administration to put a hold on the case for now while the agency completes its own review of the safety of mifepristone, a medication that's been available in the U.S. for more than 25 years and is now widely prescribed by medical providers through telehealth appointments.
While the ruling is sympathetic to Louisiana's arguments about the harms it suffers from mifepristone being available via telemedicine, "ultimately it is FDA, not this Court, that possesses the expertise to evaluate scientific evidence and make public health judgments," writes Joseph, a Trump appointee.
By granting a stay in the case, he says the FDA should be allowed to complete its safety review, and orders the agency to update the court on its progress in six months.
A split in Trump's support
When it comes to abortion, "we're seeing a kind of civil war between Republicans about how quickly and how far to go that the Louisiana case exemplifies," says Mary Ziegler, legal history professor at the University of California, Davis. "Abortion opponents [are] trying to force the president and Congress into more of an absolute stand instead of letting them fudge their position as they have, to some degree, to date."
The issue is complex for President Trump. In this case, his FDA is being sued for a regulation put in place by the Biden administration. In asking for the stay, Trump's FDA also signaled that it would be taking a harder line against mifepristone, possibly reversing some of what Biden's FDA did to maximize access to telehealth abortion.
Ziegler says the Trump administration got what it wanted, which was a delay, but it's temporary, and there's now new pressure on the FDA to complete the mifepristone review.
Trump faced pushback earlier this year from congressional Republicans when he suggested they be "flexible" about abortion restrictions in health care legislation. Abortion was also notably absent from Trump's State of the Union address in February. Opposition to abortion is popular with Trump's base, but independent voters, who were key to his win, favor abortion rights.
Anti-abortion Republicans in Congress have begun to be more aggressive about putting restrictions on the drug in recent weeks. Sen. Josh Hawley, R.-Mo., introduced a bill to remove the full approval of mifepristone, and Sen. Bill Cassidy, R.-La. announced an investigation into the drugmakers behind mifepristone.
Who's who in the case
The lead plaintiff in the case is the state of Louisiana. The complaint asked the judge to undo a change the FDA made in 2023 to how mifepristone is prescribed. Previously, an in-person appointment was required to get mifepristone. In 2023, the FDA changed the rules for mifepristone to allow patients to meet with a doctor virtually and receive medications through the mail.
Louisiana resident Rosalie Markezich is the other named plaintiff. The complaint says: "She became a victim of FDA's mail-order abortion scheme in October 2023 when her boyfriend ordered FDA-approved abortion drugs from a California doctor, and, by her boyfriend's actions, she felt coerced to take them."
The complaint, filed last October, argues that by removing the in-person appointment requirement, the Biden Administration attempted to undermine Dobbs, the Supreme Court decision that overturned Roe v. Wade, "by facilitating the mailing of mifepristone into every pro-life state, thus harming Louisiana and causing women like Rosalie immense suffering."
The defendant in the case is the FDA, and the judge allowed two mifepristone drugmakers, GenBioPro and Danco Laboratories, to intervene in the case to defend their medications.
Louisiana on the vanguard
As the first state to schedule mifepristone as a controlled substance and to criminally indict an out-of-state physician providing telemedicine abortion, Louisiana is on the vanguard of anti-abortion actions, says Ziegler.
The state is also trying to be more strategic after legal setbacks for abortion restrictions, including a mifepristone case that the Supreme Court unanimously rejected in 2024.
"I think there's some deliberate effort to try to fix the mistakes that doomed the first mifepristone lawsuit," she says. Offering more than one possible plaintiff is one way, in case the judge was unconvinced by one of the plaintiff's arguments for standing, she explains.
In his decision, Joseph determined that the state did have standing and did not analyze whether Markezich would also have standing in the case.
Another change is in the scale of the demands, Ziegler says. The previous case sought to take mifepristone off the market after more than two decades of use.
"Focusing on the in-person dispensation requirement is more politically modest-seeming," Ziegler says. However, Joseph acknowledged in the decision that changing the prescribing rules that have been in place for several years would have had a "sweeping effect" across states with and without abortion bans, which is part of why he decided to stay the case for now.
Grateful for access
E. is 31 and lives in New Orleans. She had two abortions by receiving medications in the mail since Louisiana's abortion ban took effect in 2022. E. requested NPR use only her first initial because she fears legal and safety repercussions for sharing her story.
She says living in a state that's so assertive about restricting abortion "does feel just very depressing, like your government hates you." She's grateful she still had access to abortion at home, despite Louisiana's ban, because of the telemedicine rules.
She's currently pregnant, due in September, and she says it was empowering to decide to become a parent. "I chose this Louisiana, not you, on my clock and my time," she says.
Abortions continue, despite bans
Even before Roe v. Wade was overturned, researchers of global health determined that countries with abortion bans and those without tend to have similar abortion rates. In other words, banning abortion does not stop abortions from happening, although it does make it more difficult for patients.
Likewise, the number of abortions in the U.S. did not decline after the Supreme Court overturned Roe v. Wade in 2022, even with a huge portion of the country's population living in states with abortion bans. The most recent estimate from the Guttmacher Institute, a nonprofit research organization that supports abortion access, found that there were 1.1 million abortions in the U.S. in 2025, virtually unchanged from the year before.
In Louisiana, Guttmacher found there were about 2,500 abortions in 2023, and last year there were more than 9,000. Overall, 91,000 patients in states with bans received telehealth abortions in 2025.
Copyright 2026 NPR
