Medication abortion uses a two-drug regimen to end a pregnancy. Mifepristone blocks the hormone progesterone, and misoprostol — taken 24-48 hours later — causes uterine contractions. The FDA approved the regimen in 2000 for use through 10 weeks of pregnancy. It now accounts for the majority of all clinician-provided abortions in states without bans.
After Dobbs eliminated federal abortion protections, medication abortion became the primary remaining access pathway for patients in ban states. Providers in shield-law states can prescribe the drugs via telehealth and ship them by mail, creating a workaround that ban states have struggled to block.
The FDA regulates mifepristone through a Risk Evaluation and Mitigation Strategy (REMS), which requires certified prescribers and pharmacies. In January 2023, the FDA loosened REMS requirements to allow mail delivery and remove the in-person dispensing mandate. These regulatory changes have become the central legal battleground — with multiple state and federal lawsuits challenging whether the FDA followed proper procedures and whether the Comstock Act bars mailing the drugs.
Medication abortion has become the most contested area of reproductive health policy because it can cross state lines through the mail. How courts and regulators handle access to these drugs will determine whether abortion bans can be fully enforced or whether telehealth and mail delivery create a permanent workaround.
People sometimes confuse medication abortion with emergency contraception (the "morning-after pill"). They're different. Emergency contraception prevents pregnancy before it starts. Medication abortion ends an existing pregnancy. They use different drugs, work through different mechanisms, and are regulated under entirely separate legal frameworks.
Medication abortion has become the most contested area of reproductive health policy because it can cross state lines through the mail. How courts and regulators handle access to these drugs will determine whether abortion bans can be fully enforced or whether telehealth and mail delivery create a permanent workaround.
People sometimes confuse medication abortion with emergency contraception (the "morning-after pill"). They're different. Emergency contraception prevents pregnancy before it starts. Medication abortion ends an existing pregnancy. They use different drugs, work through different mechanisms, and are regulated under entirely separate legal frameworks.