color photograph of an outdoor protest. women of varying racial backgrounds and ages hold signs in support of medication abortion
Demonstrators rally in support of abortion rights at the U.S. Supreme Court in Washington, D.C., April 15, 2023. (Photo by ANDREW CABALLERO-REYNOLDS / AFP) (Photo by ANDREW CABALLERO-REYNOLDS/AFP via Getty Images)

A federal appeals court has imposed limitations on the use of mifepristone, known as the “abortion pill.” The ruling won’t take immediate effect, but experts believe the U.S. 5th Circuit Court of Appeals ruling will be appealed and make its way to the U.S. Supreme Court.

Under the new restrictions, pregnant people will not be able to access the abortion pill by mail. In addition, pregnant people must receive a prescription from a doctor and will be required to attend three in-person doctor visits to administer and address potential complications of the pill. Use of the pill has also been limited to 49 days into their pregnancy, which is down from the previous 70 days.

“The implications are dire,” said Nicole Regalado, the vice president of campaigns for UltraViolet, a leading national gender justice organization. “Many people won’t be able to access abortion, even in states where abortion is still legal and reproductive rights are protected through state constitutions, like California. This decision will be far reaching and will also impact those states as well.”

In April, a Texas judge restricted nationwide access to mifepristone in the court case Alliance for Hippocratic Medicine v. FDA. Moments after the Texas ruling, a federal judge in Washington ruled the FDA make no changes to the availability of the pill. The decision then moved on to the U.S. 5th Circuit Court of Appeals and will continue to make its way through the legal process.

The appeals court left the Food and Drug Administration’s 2000 approval of mifepristone in place, as well as its 2019 authorization of the use of a generic form of the drug. In 2020, pills accounted for more than half of all facility-based abortions in the U.S. If the case moved to the conservative-majority Supreme Court and the pill is outlawed entirely, the decision would impact everything the medication is used for—including inducing labor and managing and treating patients experiencing a miscarriage or an ectopic pregnancy. According to a report from Gender Equity Policy Institute, pregnant people are more than twice as likely to have a pregnancy-related death in states with abortion bans. Recent polling shows that 59% of voters disapprove of the court overturning the FDA’s approval of mifepristone.

Advocates say mifepristone helps people make their own private medical decisions and expands access to full reproductive care. Banning it, they say, will have a devastating impact on people’s ability to access abortion care by forcing patients to cross state lines to access procedural abortion in states already experiencing an overwhelming demand for abortion care. The situation is even more challenging for patients who do not have access to private health care as the Hyde Amendment prohibits Medicaid coverage of abortion.

In the lead-up to this decision, states like Maryland have purchased a two-and-a-half-year stockpile of mifepristone in the event that the medication is taken off the market.

“This is just the beginning,” said Regalado. “If we are not able to stop restrictions on abortion and really have an answer to these attacks—meaning we as the progressive movement, the pro-women, pro-abortion movement, abortion freedom movement—the right wing will start attacking things like access to contraception, access to IVF and other forms of reproductive health care.”

Regalado says this is not a prediction for the future, but a playbook that is being seen right now. To combat what she refers to as a “culture war” on bodily autonomy, Regalado says UltraViolet is mounting an information campaign and campaigns targeting U.S. pharmacies advocating that they move forward with FDA certification to provide misoprostol, the second of the two abortion pills. She also suggests folks harness their civic engagement and elect candidates that champion abortion rights.

“People need to not give up hope,” said Regalado. “There are ways that we can fight back, and I think the movement is coming up with very, very creative solutions: we have power as consumers, we have power as citizens to elect public officials, and making sure that we’re using that power to hold corporations accountable and to make sure that our government represents the very best interests of our community.”

Alexandra Martinez is the Senior News Reporter at Prism. She is a Cuban-American writer based in Miami, Florida, with an interest in immigration, the economy, gender justice, and the environment. Her work...