Access to mifepristone, the FDA-approved medication used to end pregnancy, could become severely limited following a ruling from US appeals court on Friday, which temporarily blocked the drug from being dispensed through the mail.

The decision is for now the most sweeping threat to abortion access since the supreme court rolled back abortion rights in 2022, said Kelly Baden, vice-president at the Guttmacher Institute, an abortion rights advocacy group.

“If allowed to stand, it would severely restrict access to mifepristone in every state, including those where abortion is broadly legal and where voters have acted to protect abortion rights,” she said.

The so-called “abortion pill” is part of a two-drug regimen backed by decades of evidence for its efficacy and safety, and is used in the majority of abortions in the US.

Usage has risen in recent years, especially in the aftermath of the 2022 ruling from the supreme court that overturned federal protections for a right to an abortion. In the year after that decision, the FDA formally modified its regulations to allow the drug to be prescribed online, expanding its use even in states where abortion care was being constricted.

The drug has become a key target for the anti-abortion movement, and a series of lawsuits have challenged the drug’s initial approval in 2000 and the subsequent rules making it easier to obtain.

Friday’s ruling came in response to a Louisiana lawsuit against the FDA. The state sought to pause distribution of the drug through the mail while the litigation proceeds.

A conservative three-judge panel of the fifth US circuit court of appeals in New Orleans agreed with Louisiana that the FDA had failed to justify eliminating the in-person dispensing requirement.

The ruling was hailed by Louisiana’s Republican attorney general, Liz Murrill, who in a statement said she would “look forward to continuing to defend women and babies as this case continues”.

Meanwhile, with the FDA now under Trump, the agency has opened a review of the medication. Once this analysis is completed, officials at the agency said, they will determine if changes to its regulations are warranted.

Reproductive rights advocates have voiced concerns that the review could further limit mifepristone’s use, despite the evidence supporting its safety.

Developed in France in the 1980s, mifepristone is used around the world and is authorized in 96 countries. Its use is backed by roughly four decades of peer-reviewed research, according to a 2025 brief written by public health experts at the Johns Hopkins School of Medicine.

“Anti-abortion politicians have just made it much harder for people everywhere in the country to get a medication that abortion and miscarriage patients have been safely using for more than 25 years,” Julia Kaye, a senior staff attorney for the Reproductive Freedom Project of the ACLU, said in a statement.

“Louisiana’s legal attack on mifepristone shamelessly packaged lies and propaganda as an excuse to restrict abortion – and the fifth circuit rubber-stamped it.”

Use of mifepristone has enabled abortions to continue in states that have enacted bans, including 9,350 provided via telehealth in Louisiana in 2025, according to Guttmacher. This ruling, however, will have a far wider impact.

“The decision is a stunning and deeply alarming development,” Baden said. “Reimposing medically unnecessary in-person dispensing requirements for mifepristone will send shockwaves of chaos and confusion across the country and dramatically upend patients’ ability to obtain abortion care.

Reuters contributed reporting.