The fall 2024 elections are critical to maintaining access to abortion pills.
Updated Monday, April 1, at 5:05 p.m. PT.
On March 26, the Supreme Court heard oral arguments in FDA v. Alliance for Hippocratic Medicine, a lawsuit attempting to remove the abortion pill mifepristone from the U.S. market. Mifepristone is now used in approximately two-thirds of abortions in the U.S. While members of the Supreme Court appeared likely to dismiss the case, abortion opponents are working on several other fronts to achieve their goal of banning abortion pills nationwide or restricting access by eliminating telemedicine abortion, an increasingly popular way for women to access abortion.
Legal experts predict the Supreme Court will dismiss the case for lack of standing, but even if they do, Republicans have alternative plans to ban abortion pills nationwide.
They say as much in a detailed policy agenda produced by Project 2025, a coalition of 100 right-wing organizations, that calls on the next Republican president to direct the FDA to remove the abortion pill mifepristone from the market nationwide.
According to an Accountable.US review, conservative donors linked to Leonard Leo and the Koch network have contributed over $55 million to Project 2025.
“Accountable.US has been closely tracking the expansion of Leo’s efforts as he deploys his $1.6 billion slush fund to reshape America,” said Accountable.US president Caroline Ciccone. “Leo continues to expand his influence beyond his court capture campaign, now bankrolling the ‘MAGA blueprint’ for the future of the conservative movement and coordinating allies to push back on necessary oversight.”
Project 2025 and Banning Mifepristone
The Project 2025 policy agenda states:
“Now that the Supreme Court has acknowledged that the Constitution contains no right to an abortion, the FDA is ethically and legally obliged to revisit and withdraw its initial approval [of mifepristone].”
p. 458
In 2023, 63 percent of abortions were done with medications—up from 39 percent in 2017.
At a minimum, Project 2025 calls on the next Republican president to “reinstate earlier safety protocols” for mifepristone, including an in-person dispensing requirement (p. 459), which would ban telemedicine abortion, first allowed in 2020 and now accounting for 16 percent of all abortions.
Project 2025 demands enforcement of an 1873 anti-obscenity law called the Comstock Act (18 U.S. Code §§ 1461 and 1462) to ban mailing abortion pills. They want the next Republican president direct the Department of Justice to enforce the Comstock law by:
“Announcing a Campaign to Enforce the Criminal Prohibitions in 18 U.S. Code §§ 1461 and 1462 Against Providers and Distributors of Abortion Pills That Use the Mail. Federal law prohibits mailing ‘[e]very article, instrument, substance, drug, medicine, or thing which is advertised or described in a manner calculated to lead another to use or apply it for producing abortion.’ Following the Supreme Court’s decision in Dobbs, there is now no federal prohibition on the enforcement of this statute. The Department of Justice in the next conservative Administration should therefore announce its intent to enforce federal law against providers and distributors of such pills.”
p. 562
This policy would not only block clinicians from mailing abortion pills to patients, but it would block pill manufacturers Danco and GenBioPro from mailing mifepristone to clinicians and pharmacies, creating a de facto nationwide ban on mifepristone.
The FDA has just recently allowed brick-and-mortar pharmacies to dispense mifepristone, which promises to vastly expand abortion pill access. Project 2025 calls for the federal government to withdraw recent guidance requiring retail pharmacies to maintain the privacy of patients obtaining abortion pills and prohibiting discrimination based on sex with regard to dispensing abortion pills.
Restriction on Medication Abortion
Any restriction on mailing abortion pills might also apply to the second drug used for medication abortion—misoprostol—a commonly-used ulcer medication, which in fact can be used alone for abortion. Blocking the mailing of misoprostol nationwide would affect not only people seeking abortion, but people using the medication for treatment of ulcers.
Project 2025 targets for elimination telemedicine abortion provider shield laws recently passed in six states that allow clinicians in these states to serve patients living in states with abortion bans. Project 2025 calls on the next Republican president to “legally define the locus of service as where the provider is located during the telehealth visit rather than where the patient is”—a policy that could preempt telemedicine provider shield laws from protecting clinicians serving people in states restricting abortion.
Project 2025 also calls for increased surveillance of the abortion pill’s sponsors, Danco and GenBioPro, as well as facilities that manufacture the pills—a harbinger that a Republican Department of Justice would target and harass these companies.
Medication abortion is a significant factor in increasing access to abortion and a critical resource for women living in states banning abortion. Abortion pills undermine the anti-abortion movement’s central strategy of restricting abortion to a limited number of brick and mortar clinics that they can then target with harassment, violence and terroristic threats.
Abortion Landscape in the U.S.
Abortion opponents also place anti-abortion “crisis pregnancy centers” nearby abortion clinics in order to lure patients and coerce them to continue unwanted pregnancies by inundating them misinformation about abortion.
Despite the overturn of Roe v. Wade, and 14 states entirely banning abortion, the number of abortions in 2023 increased significantly from previous years, largely due to increased access to abortion pills fueled by telemedicine.
There were 1,026,690 abortions in the U.S. in 2023, the highest rate since 2012, a recent Guttmacher Institute study reported. The report says that 63 percent were done with abortion pills—an increase from 54 percent in 2020 and 39 percent in 2017. These numbers do not include shield state providers mailing pills to people in states with bans, so the actual number of abortions and the percent of abortions done with pills is likely much higher because shield state providers are mailing abortion pills to approximately 12,000 people a month these days.
The FDA policy changes to remove medically unnecessary barriers to abortion pills, including allowing telemedicine abortion, has spurred this increase in the number of abortions in the U.S. and the dramatic shift toward medication abortion.
After Tuesday’s oral arguments, abortion rights supporters should have some hope that the Supreme Court will dismiss its mifepristone case, but the Court is only one front in the multi-pronged attack on abortion pills. As the Project 2025 report makes clear, if Republicans win the fall election, they will eliminate legal access to abortion pills through the healthcare system and no doubt go after the robust alternative supply networks now proliferating across the country. The fall 2024 elections are critical to maintaining access to abortion pills.
Several organizations and resources exist for those seeking abortion pills and those in need of assistance:
- To find providers who mail pills to all states, visit plancpills.org or ineedana.com.
- To find verified abortion care, use AbortionFinder.org.
- To access medical support, visit the M+A Hotline.
- To access peer support, head to Reprocare.com.
- To access free, confidential legal services, visit or call the Repro Legal Helpline.
- For help finding the money for an abortion, people can ask the telehealth provider or reach out to a local abortion fund.
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