Mail-order abortion has been a major concern in the abortion debate since the Supreme Court overturned Roe v. Wade in 2022. Since then, 13 states, including Louisiana, entirely prohibit elective abortion. Mifepristone is used in nearly two-thirds of the more than 1.1 million abortions in the United States each year.

The FDA removed in-person screening requirements for the abortion pill in 2023 under the Biden administration, more than 20 years after it was initially approved for commercial use by the agency. 

In his opinion, Duncan agreed with Louisiana that the state is “suffering irreparable harm” by the FDA’s change, arguing that the possibility of obtaining the pills online effectively nullifies state law prohibiting elective abortion. 

“Every abortion facilitated by the FDA’s action cancels Louisiana’s ban on medical abortion and undermines its policy that ‘every unborn child is human being from the moment of conception and is therefore, a legal person.’”

Louisiana Attorney General Liz Murrill, alongside the Christian legal advocacy group Alliance Defending Freedom, sued the FDA last fall in order to require the FDA to reinstate the in-person dispensing requirement. Earlier this month, a federal district court paused Murrill’s lawsuit in an attempt to give the agency more time to complete its long-promised safety review of the abortifacient, which the district court said has a bearing on the outcome of the case. 

Health and Human Services Secretary Robert F. Kennedy Jr. and FDA Commissioner Dr. Marty Makary promised during their confirmation hearings last year that the agency would conduct a new safety review of the medication following the removal of the in-person dispensing protocols. 

The 5th Circuit’s opinion, however, highlights that the FDA removed the in-person screening requirement for mifepristone in 2023 with the intention of expanding access to abortion, which the Court cites as evidence of “causation and redressability.” 

“By ending the in-person dispensing requirement, FDA opened the door for mifepristone to be remotely prescribed to Louisiana women,” Duncan wrote. 

Duncan said that Louisiana has standing to sue the FDA because of financial damages from mifepristone being shipped into the state.

In its complaint, Louisiana identified $92,000 in Medicaid costs to treat two women who needed emergency medical treatment in 2025 from complications caused by mail-order abortion pills. 

Medicaid, the low-income insurance program administered by all states and partially funded by the federal government, covers more than 40% of Louisiana’s population, including 3 in 10 adults.

“Such costs will almost certainly continue because nearly 1,000 women monthly—many of whom are on Medicaid—have mifepristone-induced abortions in Louisiana,” Duncan wrote. 

Murrill issued a statement following the circulation of the opinion, saying that she looks forward “to continuing to defend women and babies as this case continues.”

“The Biden abortion cartel facilitated the deaths of thousands of Louisiana babies (and millions in other states) through illegal mail-order abortion pills,” Murrill said. “Today, that nightmare is over.” 

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Sen. Bill Cassidy (R-LA), a staunch anti-abortion advocate facing a tough primary competition this election cycle, also celebrated the ruling on X Friday evening.

“Women in Louisiana have been coerced into taking these drugs shipped in from out of state without medical oversight,” Cassidy said. “This ruling is a victory for mothers and babies in Louisiana.”