Multiple states are engaged in litigation against the FDA over the agency’s decision in 2023 to remove in-person screening requirements for the abortion pill mifepristone, which allowed the abortifacient to be shipped in the mail. 

The states in the cases argue that mail-order mifepristone nullifies their laws prohibiting elective abortions, as well as prevents them from protecting their citizens from coerced abortions or medical complications. 

But the Trump DOJ under Bondi has sided with the FDA in the pending litigation, arguing that the states do not have the legal claim to challenge the FDA’s drug safety decisions. 

Mifepristone, the first drug in a medication abortion, blocks the pregnant woman’s progesterone receptors, effectively preventing the embryo from obtaining nutrients to sustain life. The second medication, misoprostol, is taken up to 48 hours after mifepristone to induce contractions to expel the pregnancy tissue. 

Medication abortion is used in roughly two-thirds of the more than 1.1 million abortions in the United States each year, a share that has grown following the Supreme Court’s overturning of Roe v. Wade federal protections for abortion in 2022. 

Policy experts estimate that the main growth in abortion rates since the overturning of Roe comes from abortion pill sales online in the 20 states that have either banned abortion or implemented early gestational age limits. 

“Pro-life states cannot meaningfully enforce their laws when FDA is siding with mail-order abortionists and DOJ is siding with abortion drug manufacturers,” reads the letter from the 78 anti-abortion groups.

The letter specifically highlights the case of Rosalie Markezich, a young woman from Louisiana who was pressured into an abortion by her boyfriend, who obtained the abortion pills online. 

Markezich testified that she did not consult with a physician before taking the pills obtained by her boyfriend and that she believes a doctor would not have given her the pills if she had told them she wanted to keep her pregnancy. 

Markezich is at the heart of Louisiana’s lawsuit against the FDA, in which the state argues that it cannot protect its citizens like her from coerced abortions if abusers can obtain the pills online. 

A Trump-appointed federal judge in the Western District of Louisiana last week temporarily paused the case pending the long-awaited safety review of mifepristone promised by FDA Commissioner Dr. Marty Makary and Health and Human Services Secretary Robert F. Kennedy Jr. 

Kennedy and Makary both promised during their Senate confirmation hearings last year that they would be conducting a thorough safety review of the drug following the removal of in-person screening requirements. Anti-abortion advocates, including some members of Congress, have suggested that the Trump administration ins slow-walking the safety review until after the 2026 midterm elections.

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Marjorie Dannefelser, President of Susan B. Anthony Pro-Life America, said in a statement along with the letter that the new leadership at the DOJ could reverse course.

“The DOJ has the opportunity to stand with states seeking to uphold their laws and protect women and unborn children from the dangers of unregulated abortion drugs by mail,” Dannefelser said. “Instead, the DOJ is actively siding with the abortion industry and trying to wave away states’ valid claims.”