Louisiana continues its battle against mail-order chemical abortion pills, citing state sovereignty, economic burden  

The legality of mail-order abortion pills will be before the 5th U.S. Circuit Court of Appeals again Wednesday, and the state of Louisiana is defending its autonomy to enforce state laws.

“The number of abortions in Louisiana should be zero. The number of women suffering those complications should be zero, but Louisiana is unable to enforce its laws because of mail-order abortion drugs,” Gabriella McIntyre, legal counsel for Alliance Defending Freedom, which represents the named plaintiff in the case, told Heartlander News Friday in an interview. 

The national shipment of mifepristone, the chemical abortion drug, undermines Louisiana’s total ban on abortion, the lawsuit argues. In 2023, the Biden Food and Drug Administration lifted significant regulations of mifepristone, allowing the pill to be ordered online and shipped to any state without an in-person doctor’s visit or prior consultation.

Louisiana is arguing that the FDA changes were unlawful because the national shipment of abortion pills violates state sovereignty and poses economic injury to the state.

“Louisiana is unable to enforce its pro-life laws because of that being inundated and flooded by these mail-order abortion drugs,” McIntyre said.

The shipment of mifepristone not only violates Louisiana law but also financially harms the state when complications require major medical intervention and expenses, she explained. Louisiana spent more than $92,000 in Medicaid treatments for only two women who suffered emergency complications after taking mifepristone, according to the case brief.

Additionally, without an in-person doctor’s visit, many women are forced to take mifepristone against their will, the lawsuit argues. Rosalie Markezich, a plaintiff alongside Louisiana, lost her baby after her boyfriend ordered mifepristone and pressured her into taking the drugs.

“And then you have women like Rosalie who are suffering abuse because anyone with five minutes to spare and internet access can get their hands on these drugs,” McIntyre said. “That’s abusers. That’s traffickers. That’s third parties who aren’t even pregnant. And that is the regime that the FDA has been facilitating with these mail-order abortion drugs.”

The FDA has also admitted that the abolition of protections in 2023 was unlawful and based on inadequate studies, the lawsuit says.

“The FDA itself conceded at that time that the studies it relied on were not adequate on their own, and that the adverse event data it relied on could not actually be relied on for the purpose it used it for,” McIntyre said.

Attorney General Todd Blanche also condemned the Biden administration’s policy changes, saying the Department of Health and Human Services and the FDA are conducting a study to take “a real look at what’s happening with some of these abortion pills and whether they’re actually safe or not.”

“We want to get to a good result, consistent with President Trump’s administrative directive and priorities, and we very much believe that the Biden rules were wrong,” Blanche said.

McIntyre applauded the study but clarified that no findings will remedy the unlawfulness of the Biden FDA’s removal of protections. Even if the study found mifepristone was unsafe, the “regulatory process” suggests no “on the ground changes” would likely come until the end of 2027 or 2028, she explained.

“With 1,000 abortion drugs entering into Louisiana and nearly 1,000 lives taken every month, that just would be an unacceptable situation,” McIntyre said, calling the lack of regulation “the wild west of abortion by mail.”

While the district court ruled against Louisiana in April, the 5th Circuit Court of Appeals unanimously paused the shipment of mifepristone after Louisiana sought emergency relief in May. But two weeks later, the U.S. Supreme Court overturned that temporary pause after the drug companies also submitted an emergency request.

Wednesday’s hearing before the 5th Circuit considers the case in full and whether the unregulated shipment of mifepristone violates Louisiana’s laws and imposes economic injuries, McIntyre explained.

The Supreme Court returned the abortion decision to the states in 2022 in Dobbs v. Jackson Women’s Health, but Biden’s FDA quickly undermined that decision through the suspension of regulations for mifepristone. More than seven in 10 Americans, however, believe an in-person doctor’s visit should be required for the prescription of mifepristone, according to a 2025 study.

This case could restore the Supreme Court’s original purpose under Dobbs, McIntyre said, allowing states to establish their own laws on abortion, according to the people’s votes.

“If Louisiana wins, we’re going to see for the first time what it actually looks like for pro-life states to be able to enforce their pro-life laws for the promise of Dobbs to be in place and not be a hollow promise,” she said. “Because the states, particularly like Louisiana, were told that they’d be able to decide for themselves how to regulate abortion, and so this case again, if Louisiana wins, could restore that promise and allow these pro-life states to save lives within their borders.”