A federal appeals court in the US has delivered a significant blow to abortion access, restricting the distribution of mifepristone, a key medication used for early pregnancies, by blocking its mail-order prescription. This marks the most substantial shift in US abortion policy since the overturning of Roe v. Wade.

The unanimous decision from the New Orleans-based 5th US Circuit Court of Appeals represents a considerable triumph for anti-abortion campaigners. They argue that online prescriptions for abortion pills undermine state-level bans on the procedure.

The ruling mandates that mifepristone can now only be dispensed in person at clinics, effectively overturning existing regulations set by the federal Food and Drug Administration. This pivotal judgment is widely anticipated to face an appeal before the US Supreme Court.

Here’s what to know.

Impact extends beyond states with abortion bans

Frustrated with a lack of federal action against medicated abortions, Louisiana Attorney General Liz Murrill sued the FDA last month, saying its regulations undermined the state’s ban on abortions at all stages of pregnancy.

“The regulation creates an effective way for an out-of-state prescriber to place the drug in the hands of Louisianans in defiance of Louisiana law,” Judge Kyle Duncan, who was appointed by President Donald Trump, wrote in the ruling.

FDA officials have said the agency is conducting a new review of mifepristone’s safety, but the appeals court noted that there was no timeline for its completion.

Friday’s ruling is in effect while the case works its way through the courts. It affects all states, even those without abortion restrictions.

There is little precedent for a federal court overruling the scientific regulations of the FDA, and it remains to be seen how the decision could impact how the drug is dispensed long-term.

Murrill, a Republican, celebrated the ruling as a “victory for life” while other anti-abortion advocates cheered the reversal of rules finalized under President Joe Biden that ended a longstanding requirement that the pills be obtained at an in-person doctor’s visit.

Representatives for the FDA and the US Department of Justice did not immediately respond to requests for comment.

Mifepristone long considered safe and effective

Danco Laboratories, a mifepristone manufacturer and defendant in the lawsuit, has asked the appeals court to put its order on hold for one week to give the company time to seek relief from the Supreme Court.

Mifepristone was approved in 2000 as a safe and effective way to end early pregnancies. It is typically used in combination with a second drug, misoprostol, which is not affected by the ruling but is less effective on its own.

Surveys have found that the majority of abortions in the US are administered using pills and that about one in four abortions nationally are prescribed via telehealth. Providers have suggested that its availability through telehealth is a reason why the number of abortions in the US has not fallen since Roe was overturned in 2022.

As a result, abortion pills and those who prescribe them out of state have become key targets of abortion opponents.

Some Democratic-led states have adopted laws that aim to protect providers who prescribe via telehealth and mail the pills to states with bans. Those so-called shield laws are being tested through civil and criminal cases in Louisiana and Texas.

One telehealth provider in a state with a shield law, Dr. Angel Foster, was working with legal experts to understand how the ruling would impact her organization, The Massachusetts Medication Abortion Project.

“We will do everything in our power to continue providing care to people in all 50 states,” she said.

Abortion policy could come into play in the midterms

The case could again make abortion a key issue in the midterm elections as Democrats aim to take back control of the US House and Republicans fight to hold on to a narrow majority.

Recent electoral results suggest that voters seeking to maintain abortion access have the political momentum. Since Roe was overturned, abortion has been on the ballot directly in 17 states. Voters have sided with the abortion-rights side in 14 of those questions.

Abortion-rights supporter Fatima Goss Graves, president and CEO of the National Women’s Law Center, slammed the ruling as “deeply out of step with both the public and fact-based science.”

Trump received criticism after the ruling from some anti-abortion advocates who expressed frustration that he did not take action himself to block distribution of the pill.

The FDA under Trump approved another generic version of mifepristone last year, which peeved some allies of the Republican president.

“It’s shameful that the Trump administration’s inaction has forced pro-life states to take their battle to the federal courts,” said Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, who also applauded the ruling.