An appeals court is considering a push to restrict most common abortion method

A panel of federal judges heard arguments Wednesday over whether prescribing rules should be tightened for a key drug used in the most common abortion method in the United States, one of several ongoing efforts to restrict abortion access four years after the U.S. Supreme Court allowed states to decide the issue.

The case before the New Orleans-based 5th U.S. Circuit Court of Appeals is one of three making its way through the courts as abortion opponents try to block providers in states where abortion is legal from sending drugs for medication abortions into states where it is not.

The U.S. Food and Drug Administration also says it's reviewing the rules and could call for a change — and that the agency process should take precedence over court action.

It comes in a midterm election year in which President Donald Trump's anti-abortion supporters are frustrated that a legal workaround to abortion bans remains. At the same time, most voters favor legal abortion access in most cases.

At least 3 in 5 U.S. abortions are now obtained using a two-drug combination. At issue before the appeals court is just one: mifepristone.

Wednesday’s arguments were part of a case brought by Louisiana Attorney General Liz Murrill and Rosalie Markezich, who says she was coerced into taking abortion pills. A survey conducted for the Society of Family Planning, which supports legal abortion access, estimates that between 770 and 900 women in Louisiana obtained abortions each month in 2025 by using pills prescribed online or by doctors or nurse practitioners in other states that have “shield laws” intended to protect those prescribers.

The three judges hearing the case are two nominated by Democratic presidents Barack Obama and Joe Biden and one nominated by Republican George W. Bush.

Three other three-judge panels on the 5th Circuit — one in this case and two in an earlier one — and two district courts have already agreed that rules for prescribing mifepristone are too loose.

But the Supreme Court unanimously rejected an effort to roll back availability in 2024 — not because of the core legal argument, but because the court found the anti-abortion groups who brought the challenge didn’t have legal standing to make it.

On Wednesday, lawyers for the FDA and mifepristone manufacturers argued that Louisiana also lacks legal standing. One of the judges, Stephen Higginson, questioned whether the FDA's role is a reason pills are flowing into Louisiana. “Those are state shield laws,” he said. “The government has nothing to do with the shield laws.”

Benjamin Aguinaga, Louisiana's solicitor general, said the state is impacted, though, because some women who use the pills seek treatment for complications and, he said, perhaps half also have state-funded Medicaid health coverage.

Another ruling from the 5th Circuit would not immediately change the landscape because the Supreme Court has also blocked changes to the prescribing rules until it sees the case again. Even if the FDA makes changes without court approval, such an action would surely be challenged.

Other GOP state officials are also challenging the FDA’s rules. The attorneys general of Florida and Texas have filed one lawsuit and the top government lawyers of Idaho, Kansas and Missouri have another. Separately, Louisiana and Texas have attacked shield laws by bringing criminal and civil cases against some out-of-state providers.

Meanwhile, over the past year, federal judges in Hawaii and Virginia found that current FDA rules for mifepristone prescribing are too restrictive.

Abortion pills were already widely used before the Supreme Court overturned Roe v. Wade in the 2022 Dobbs v. Jackson Women's Health Organization case that allowed states to enforce abortion bans.

Currently, 13 states ban abortion at all stages of pregnancy. Another four do so after about the first six weeks, before many women realize they're pregnant.

Opponents say the shield laws in some Democratic-controlled states, along with the rules allowing mifepristone to be mailed to patients, have undermined the bans.

“This case is going to have a huge impact,” said Gabriella McIntyre, legal counsel at Alliance Defending Freedom, which is representing Murrill and the other plaintiff in the case. “The promise of the Dobbs decision was that states would be able to decide on their own how to regulate abortion.”

A lawyer for mifepristone maker Danco Laboratories, though, told judges Wednesday that the 2023 rules were not intended to do so.

Abortion rights advocates also believe major consequences would arise if Louisiana eventually prevails. “They're asking to restore an in-person requirement for every person across the country to access this medication regardless of whether they live in a state with strong legal protection for abortion access,” said Amanda Allen, executive director of the Abortion Coalition for Telemedicine.

Anti-abortion groups who want to rein in pill access have been Trump's key supporters.

Abortion opponents have called on the FDA to settle the lawsuit with Louisiana and roll back prescribing rules to how they were before telehealth prescriptions were allowed. They also want the administration to enforce an 1873 “anti-vice” law to bar mailing the pills.

Some states, including Mississippi and Texas, have adopted laws with civil or criminal penalties for those who prescribe abortion pills.

But on state ballot questions and in public opinion polls, voters have generally supported legal abortion access in most cases.

The administration has been mostly quiet through the legal battles, even though the FDA, whose scientists have repeatedly found mifepristone to be safe and effective, is the defendant in the cases.

The FDA says it’s studying mifepristone’s safety and reviewing prescribing rules around the drug. But Trump’s latest nominee to head the agency, Dr. Heidi Overton, the deputy director of the White House Domestic Policy Council, has publicly criticized the agency for relaxing its prescribing rules for the drug — the most recent change coming in 2023.

One judge ordered the agency to provide a status update by Oct. 7, less than a month before the midterm elections in which control of Congress is in play. It's not clear how detailed an update might be — or when the full study could be completed.

Even if mifepristone access is curtailed, advocates say it won't end access to abortion pills.

The most common regimen for pills in the U.S. is a combination of mifepristone and misoprostol. Misoprostol, which is commonly used to treat stomach ulcers and has never been formally approved for abortion, can cause abortions on its own. According to the FDA label on mifepristone, the combination completes medical abortion 97.4% of the time. Some studies have found misoprostol’s individual effectiveness at around 80% or higher.

Organizations that prescribe abortion pills by telehealth for women who are in states with bans say they would shift to sending misoprostol alone if mifepristone could be dispensed only at medical clinics rather than at pharmacies and through the mail.

FILE - Bottles of abortion pills mifepristone, left, and misoprostol, right, are displayed at a clinic in Des Moines, Iowa, Sept. 22, 2010. (AP Photo/Charlie Neibergall, File)

JEFFERSON CITY, Mo. (AP) — A battle over Missouri’s congressional districts vaulted back to the U.S. Supreme Court on Wednesday, two months before a pivotal November election that will determine control of Congress and affect the fate of President Donald Trump’s agenda.

A series of conflicting court rulings has left a scar on Missouri — and left voters befuddled and unsure which U.S. House districts they will be voting in and which candidates will appear on their ballots.

A federal appeals court panel on Wednesday sided with Republicans, declining to halt a federal judge’s order favoring a new map backed by Trump. But that decision immediately was appealed to the U.S. Supreme Court, which just a day earlier had let stand a ruling by Missouri's top court against the Trump-backed districts.

Time is rapidly expiring to figure it out. Federal law sets a Sept. 19 deadline to mail absentee ballots to overseas citizens and military voters.

Here's a look at how Missouri arrived at this point and the difficulties it now faces.

Trump urged Republican-led states last year to redraw congressional districts to their advantage ahead of the midterm elections. Texas went first. Missouri was the second GOP state to act. State lawmakers passed new U.S. House districts last September targeting a Kansas City-based seat held by Democratic Rep. Emanuel Cleaver.

The new districts were intended to help Republicans win seven of the state's eight House seats in the midterm elections — a gain of one seat.

Redistricting opponents collected hundreds of thousands of petition signatures seeking to force a statewide vote on the new districts. They submitted the signatures in December. But Republican Secretary of State Denny Hoskins waited until August — on the same day as Missouri's primary — to reject the petition. Hoskins asserted that a referendum petition could not be used for congressional redistricting.

The delay by Hoskins was intentional. It allowed Missouri's new congressional districts to be used in the primaries.

The Missouri Supreme Court said Hoskins was wrong. It ordered him to put the redistricting referendum on the November ballot, which he did. But more than that, the court said the new districts never became law and instead were suspended retroactively to the December petition submission.

The court barred Hoskins from using the new map and said the old map — passed by Republican lawmakers in 2022 after the last census — must be used in the November election. The U.S. Supreme Court on Tuesday declined to hear an appeal.

Mere minutes after the U.S. Supreme Court's action, federal District Judge Stephen Clark of Missouri issued a contradictory decision. He temporarily barred Hoskins from using any map other than the new congressional districts in the November election. Clark said switching districts between the primary and general election could violate voters' federal rights.

Redistricting opponents asked the 8th U.S. Circuit Court of Appeals to reverse Clark's order, but it declined to do so. So they quickly asked the U.S. Supreme Court to intervene.

Redistricting opponents also have asked the Missouri Supreme Court to hold Hoskins in contempt for taking steps to use the new districts in November. The court set a contempt hearing for Thursday.

State attorneys for Hoskins, meanwhile, want the federal judge to block the contempt hearing. They contend Hoskins was merely following orders, arguing that a federal court order — based on the U.S. Constitution — supersedes a state order based on the state constitution.

After a U.S. Supreme Court ruling in April weakened the federal Voting Rights Act, Alabama lawmakers voted to change some of their congressional districts. The high court allowed it to happen, even though voting had occurred in a May primary. Alabama instead held a new primary for the revised districts in August.

A similar scenario unfolded in Texas three decades ago. After Texas held its 1996 primaries, a federal court struck down several congressional districts. The state subsequently held an open primary for those districts in the November election, putting candidates from both parties on the same ballot. If no one got a majority, the top two advanced to a runoff.

In Missouri's case, no court has suggested redoing the primary. Candidates who won in August already have been certified for the November ballot according to the number of the district that they won.

“Here in Missouri, we’ve witnessed a series of unprecedented actions, one after another,” said Travis Crum, a law professor at Washington University in St. Louis, who specializes in election law.

Do voters have a right for congressional district boundaries to stay the same from the primary to the general election? “That is a tough and complicated legal question, and there is no definitive ruling from the Supreme Court that one could point to for an answer,” Crum said.

Candidates knew of the ongoing litigation when they signed up to seek office.

“The fact that the district lines changed, that was a chance that you take when you run,” said Michael Wolff, a former Missouri chief justice who later served as dean of the Saint Louis University Law School.

Over the past year, more than a dozen lawsuits have been filed over Missouri's redistricting. Some voters have rallied against it at the state Capitol and courthouses. Others have winced in confusion when listening to explanations about which district they reside in.

Toby Thacker, who lives on a farm near Sedalia, has shifted from the 4th District, currently held by Republican Rep. Mark Alford, to Cleaver's 5th District under the new map. Thacker said he generally supports Republicans, who redrew the map.

But “I'm not very happy with them for doing that,” Thacker recently told The Associated Press.

Cliff Keith, of Washington, Missouri, recently joined protesters outside the Missouri Capitol.

“They have absolutely no business redrawing the districts right now, just before an election,” Keith said.

In this photo taken with a smartphone, Steve Dakopolos demonstrates in front of the state Capitol in Jefferson City, Mo., Wednesday, Sept. 2, 2026, in support of a referendum petition seeking a statewide vote on a congressional redistricting plan. (AP Photo/David A. Lieb)