A little more than a year into the Trump administration, abortion access in the United States, like the total number of abortions, remains surprisingly unchanged. Most Americans who end pregnancies rely on the medications mifepristone and misoprostol, which account for more than half of all abortions nationwide. Recent research by the Guttmacher Institute showed that the number of abortions in the U.S. has held steady, with telehealth access explaining an increase in the number of procedures in ban states. Given that the administration seems content for the moment to do nothing about abortion, a number of conservative states have filed suit to force some kind of action. The latest federal court ruling in the critical and lengthy ongoing fight over mifepristone has allowed the administration to maintain the status quo for now. But for the longer term, last week’s federal decision out of Louisiana sends a clear warning: If the Trump administration doesn’t introduce new restrictions on abortion medication, federal judges will likely do the job instead.

In 2024 Donald Trump campaigned on the idea of letting each state set its own policy on abortion, but conservatives hoped that he was just saying what he needed to say to win. After his victory, prominent anti-abortion groups asked the incoming Trump Food and Drug Administration to impose new national restrictions on mifepristone. Most importantly, abortion foes demanded that the FDA reinstate an in-person dispensation requirement that would make it impossible for people to receive treatment via telehealth or for doctors in blue states to send pills to places that criminalize abortion. Others believed that the Trump Department of Justice would use the Comstock Act, a 19th-century obscenity law, to prosecute people for sending or receiving abortion medication by mail.

But since his second inauguration, Trump instead has done practically nothing on mifepristone. Of course, there have been other abortion-related moves. Recently, the administration announced efforts to gut Title X, which covers family planning. In passing the Big Beautiful Bill, Congress at least temporarily defunded Planned Parenthood, and the Trump administration has signaled that it won’t enforce the federal Freedom of Choice Act against anti-abortion protestors in all but the most extreme circumstances. After anti-abortion groups released their own studies, claiming to show higher mifepristone-related complication or failure rates than the FDA has previously acknowledged, the Trump FDA launched its own examination of mifepristone, even though more than 100 studies have already documented the drug’s safety.

For abortion foes, though, none of this amounts to much. Abortion rates in the United States have held steady, and abortion pills remain as available as they were when Joe Biden was president.

This has led conservative attorneys general to file a number of suits to force the president’s hand. Individuals represented by anti-abortion activists are looking for ways to get federal courts to interpret the Comstock Act as an abortion ban.

So far, the administration has responded by stonewalling. Administration attorneys have argued that conservative states don’t have standing to challenge the current rules on mifepristone. And the administration has asked courts for more time for the FDA to complete its mifepristone study.

For the moment, a Louisiana district court was willing to grant the latter request. Together with Rosalie Markezich, a woman who claims she was coerced into having an abortion by her partner, the state had sued the Trump FDA, seeking the reinstatement of the in-person dispensation requirement for mifepristone. Judge David C. Joseph, a Trump appointee, stressed the agency’s “recognition of its own shortcomings in regulating mifepristone and ongoing fulsome review” in granting it more time to study the issue. But that should hardly reassure supporters of abortion rights. Joseph made clear that Louisiana would probably win its challenge and reinstate in-person dispensation if the Trump administration doesn’t impose its own limits.

Joseph first took up the question of standing, an issue that has bedeviled previous anti-abortion litigants. Attacks on mifepristone began as soon as the Supreme Court overturned Roe v. Wade. The first major mifepristone case, FDA v. Alliance for Hippocratic Medicine, involved a group of anti-abortion physicians who argued that they were harmed by mifepristone access, but the conservative Supreme Court unanimously held that they lacked standing to sue.

Louisiana tried to make a better case on that point. The state argued first that it had standing because of “sovereign harms”—essentially, reasoning that the FDA’s rules facilitated abortions that violated the state’s criminal laws. Second, it argued that it had suffered financial harms because state Medicaid patients required emergency treatment for mifepristone complications.

The administration identified any number of weaknesses in Louisiana’s standing claim. For starters, the FDA doesn’t require Louisiana to do anything about mifepristone one way or another. As a result, the administration argued, it was impossible for Louisiana to prove that any abortion in the state (or any cost related to it) was attributable to the current FDA rules governing mifepristone. And there were lots of other factors contributing to whatever was happening in Louisiana. Shield laws, introduced by progressive states, protect doctors who mail pills into ban states. Law enforcement in red states struggles to stop pills from flowing into states. Tracing anything to the federal government’s rules on mifepristone seemed all but impossible.

Joseph disagreed. He credited the idea that the Biden administration lifted the in-person dispensation requirement because it was trying to harm the sovereign interests of anti-abortion states, all in an “effort to circumvent anti-abortion states’ ability to regulate abortion.” If the FDA had acted arbitrarily in lifting the in-person dispensation—and Joseph certainly seemed to think so—then Louisiana did have interests in enforcing its own laws, and the FDA rules had exacerbated its inability to do so. Joseph also thought that Louisiana had suffered financial injuries.

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More importantly, Joseph seemed convinced that the FDA had acted arbitrarily and capriciously in lifting the in-person dispensation requirement. He reasoned that the FDA didn’t have adequate data about adverse events or the safety of telehealth when writing the current rules on mifepristone. The court didn’t reach Louisiana’s separate argument that the Comstock Act criminalizes the mailing of mifepristone, but that doesn’t mean that he won’t embrace that claim later too.

Why, then, did Joseph side with the Trump administration—at least for now? The answer is simple: The court believed that the administration already views mifepristone to be unsafe and would soon release a study saying so.

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Joseph suggested that the FDA would do a better job weighing scientific evidence than he would, even after he suggested that the agency had failed at that task before in finding mifepristone to be safe. In practice, for Joseph, the delay seems to be a way to give the FDA time to reach the conclusions about the danger of mifepristone that he already had. And he wasn’t giving Trump a pass indefinitely. Urging the FDA to proceed with “all deliberate speed,” Joseph asked for a progress update in six months and warned that if the administration didn’t make a move, he would eventually give Louisiana the relief requested.

The Louisiana suit isn’t the only one challenging telehealth access to mifepristone. Similar suits filed by Texas, Florida, Missouri, Idaho, and Kansas are unfolding in courts across the country. So are challenges filed by individual anti-abortion attorneys on behalf of private citizens.

All of this suggests that conservative judges are willing to give Trump until after the election to do what they see as the right thing on mifepristone. And if the president still isn’t willing to pull the trigger, conservative courts will be a different story.

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