On May 14th, the Supreme Court handed down a ruling in a pivotal case that had landed on its “shadow” (or emergency) docket. In Louisiana v. Food and Drug Administration (FDA), the state sought to ban mifepristone, a pill typically prescribed for those seeking a medication abortion. It specifically attempted to bar health care providers from prescribing mifepristone through telehealth options by disallowing it from being mailed to their patients. Instead, Louisiana wanted to force people to get mifepristone in person at a clinic, rather than in the mail or at a pharmacy.

Following a May 1st ruling from the notably right-wing U.S. Fifth Circuit Court of Appeals that upheld Louisiana’s position, two drug manufacturers appealed that ruling to the Supreme Court. States where abortion was legal, as well as pro-choice advocacy groups and other drug companies, filed amicus briefs in support of the manufacturers. Last Thursday, in an unsigned order, the Court effectively overrode the Fifth Circuit’s decision—not deciding the case (which the Court will hear later) but staying the Fifth Circuit’s order. Associate Justices Clarence Thomas and Samuel Alito, author of the 2022 Dobbs decision that overturned Roe v. Wade, each issued dissents.

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Louisiana v. FDA had been working its way through the federal court system since October of last year, causing confusion and disarray for abortion providers and their patients. As a state with a total ban on abortion—triggered when the Supreme Court overturned Roe v. Wade in 2022—Louisiana has continued to further restrict access to abortion care, targeting medication in its suit against the FDA. But the suit didn’t just aim to prohibit mifepristone from being mailed to people seeking a medication abortion in Louisiana. It would impact all 50 states, regardless of what abortion legislation is on the books.

Abortion is illegal in 13 states. In 28 others, there are varying bans based on gestational duration, ranging from six weeks to over 20. Data has shown that around 65 percent of all abortions are done via medication, and 25 percent of them are prescribed over telemedicine. After a person is prescribed mifepristone—and also typically misoprostol, another abortion medication—the law allows for them to be mailed to a patient or picked up at a pharmacy. With that, the medication abortion can be performed at home.

Mifepristone has consistently been shown to be safe and effective. It was approved by the FDA in 2000, and is authorized for use in 96 countries.

Mifepristone has consistently been shown to be safe and effective. It was approved by the FDA in 2000, and is authorized for use in 96 countries. Research has found that the risk of serious complications for medication abortion is less than 1 percent, and when mifepristone is combined with misoprostol, the drugs are 93 to 99 percent effective. Yet under the Trump administration, which has continued to erode policies that protect abortion access and care, the FDA has launched an investigation into the safety of mifepristone, inspired by a debunked report from a Project 2025 sponsor. The administration mostly stayed silent while Louisiana v. FDA had been moving through the courts, with the Department of Justice filing a single brief that called for the Fifth Circuit to pause the case while it continued to review mifepristone.

Prescribing abortion medication over telehealth options allows those who are unable to get to an in-person clinic to obtain the medication. Post-Roe, some clinics have been forced to close, particularly in states, like Louisiana, which have banned abortions. Nationwide, many clinics have responded to the ever-changing political battle over access to abortion by pausing and resuming abortion care as circumstances have changed. Telehealth also bridges the gap for women seeking abortion care in rural areas, those who don’t have access to reliable transportation, or live in states with a dwindling number of clinics. Reliance on telehealth can also be based on personal circumstances. “There are people who are facing intimate partner violence, and for them, it’s very difficult to visit a clinic and to get access, so medication abortion by telehealth is critically important for those individuals,” says Autumn Katz, the interim director of litigation at the Center for Reproductive Rights.

People with disabilities also frequently rely on online health care options. Beyond mifepristone’s status as a medication for abortion, it is also commonly prescribed to individuals who are experiencing miscarriage. Without the option to be prescribed such medication quickly and effectively from home, many Americans would lose what might be their only avenue for accessing care.

Black women have been and will continue to be disproportionately affected by attacks on abortion care. The majority of Black Americans (55 percent) still live in the South, where some of the most restrictive abortion bans are found, along with the worst overall health outcomes in the country.

For decades, Black women have been forced to navigate a health care system riddled with medical racism, especially in the rural South, due to the compounding effects of issues like high rates of chronic disease and provider shortages. Telehealth has been monumental in dismantling many Black residents’ long-standing inability to receive adequate care in person, especially during and after the COVID-19 pandemic.

“Teleheath, in particular, as we saw with COVID, was very helpful for Black women, girls, and gender-expansive people,” says Regina Davis Moss, president and CEO of In Our Own Voice. “It can make the difference between getting timely care and no care at all.”

Among Black women, the rate of maternal death has been incredibly high even before the impact of losing access of abortion care is factored in. Black women are three times more likely to die from pregnancy-related issues compared to white women. In 2023, research showed that 61 percent of Black women who gave birth did so in states that had banned or were slated to ban abortion. In health care settings, Black women’s reports of pain are less likely to be taken seriously, further revealing the effect of systemic racism on the treatment they receive.

For decades, the anti-abortion movement has misrepresented abortion rates among Black women and their well-being in an effort to push its extreme agenda. In 2011, a massive billboard was erected in New York City that contained a photo of a Black girl with the words “The Most Dangerous Place for an African American is in the Womb.” Black and Hispanic women do have higher abortion rates than white women, but these statistics require a nuanced analysis: Women of color are more likely to be impoverished, are more predisposed to chronic health conditions, along with other factors that impact a woman’s choice to access abortion care.

Claims of a “Black genocide,” or a conspiracy theory that views legalized abortion as a method for the ethnic cleansing of Black people, ignores the reality of systemic inequalities. These perspectives on abortion also don’t adequately reflect attitudes toward abortion in the Black community and beyond.

“When you see members of the [Black] community dying needlessly, and you’re hearing these stories, or you’re hearing about people being afraid to go to seek care because they try to manage at home, those kind of conversations about genocide don’t really track,” says Moss. “We want people to be alive, you want to survive, you want to thrive. The whole point is to make sure that we are able to raise our children in safe and sustainable environments, and that’s part of being able to make that choice about what is best for us.”

The Mifepristone Ruling Revives Pro-Choice Politics

Black women have died and will continue to die from being unable to access abortion care. Since Roe was overturned, there have been several cases in which Black women were denied or received delayed medical attention, due to laws criminalizing abortion procedures. Yet when it comes to tracking the sometimes deadly effects of abortion bans, the Trump administration’s rejection of any initiatives labeled as diversity, equity, and inclusion (DEI) has led to the eradication of research on issues related to race and gender.

Yanking funding for such projects in this anti-DEI push will have a lasting impact, says Jamila Taylor, president and CEO of the Institute for Women’s Policy Research: “It is going to have an effect on the ability of researchers to really dig deep and center on the most vulnerable communities, which are people of color that are impacted by these draconian policy decisions.

“If federal funding is on the line, as well as other institutions both within the federal government and outside of the federal government, I tend to think that this anti-DEI agenda is a strategy to invisibilize people of color and the impact of these critical policy decisions on their lives.”

Although Louisiana v. FDA has been blocked for now, access to medication abortion is still at risk: Suits brought by red states, including Texas and Missouri, aim to stop health care providers from prescribing mifepristone altogether. Regardless, people will continue to seek abortion care, and many abortion providers will keep trying to find ways to provide assistance. “One of the ways that care may continue to be available is by looking at alternate regimens, alternate medications that don’t require mifepristone,” says Katz. “Abortion providers are going to continue to do everything they can to make sure that care is still available, even if that means having to change the way that they’re providing care.”

Black women are typically the first to experience the harms of social, economic, or political issues that eventually befall all societal groups. When rates of unemployment skyrocket among Black women, for example, history has shown that the same occurs for others soon after. In much the same way, the consequences of abortion bans and restricted access to abortion medication will most certainly be felt by all who seek out reproductive care.

“This moment is bigger than this one medication [mifepristone]. There will be more efforts to chip away at our rights. There is a broader effort to control our bodies and our votes, and if we continue to look at this as only this is impacting the Black community, then it will be at our own peril,” says Moss.

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Naomi Bethune is the John Lewis Writing Fellow at The American Prospect. During her time studying philosophy and public policy at UMass Boston, she edited the opinions section of The Mass Media. Prior to joining the Prospect, she interned for Boston Review and Beacon Press.