(Editors’ note: this article was originally published at WORLD Opinions)
The Fifth Circuit rules for Louisiana and the law in a case involving mail-order abortion drugs
Every month, almost 1,000 babies are illegally aborted in Louisiana using the abortion drug mifepristone—mailed in by out-of-state doctors in direct defiance of that state’s law. That is the human reality at the center of a major legal battle just decided—in Louisiana’s favor— by a United States Court of Appeals for the Fifth Circuit.
Last Friday, a unanimous three-judge panel held that the Biden Administration’s removal of basic safeguards for mifepristone was likely unlawful. The court granted Louisiana’s motion for a stay pending appeal, reinstating the in-person dispensing requirement for mifepristone. The stay took effect immediately. It means that pro-abortion doctors can no longer flood pro-life states with illegal and high-risk drugs—at least for now.
The stakes could hardly be higher. Mifepristone, which carries a black-box warning and sends roughly one in 25 women who use it to the emergency room, has been subject to at least minimal safety guardrails for decades. These safeguards included the requirement that a woman visit a healthcare provider in person before receiving the drug. That in-person visit served a critical protective function: It was the only opportunity to screen for ectopic pregnancies (a dangerous condition for which mifepristone is contraindicated), accurately assess gestational age to minimize risks that grow exponentially with gestational age, and ensure that a woman was not being coerced.
The Biden FDA eliminated that safeguard in 2023. It did so to preserve abortion access in pro-life states after Dobbs v. Jackson Women’s Health Organization. The 2023 REMS had the intended effect: Out-of-state prescribers in states like California and New York flooded pro-life state with abortion drugs.
The Fifth Circuit’s rejection of the 2023 REMS was unanimous and unsparing. “Every abortion facilitated by FDA’s action cancels Louisiana’s ban on medical abortions and undermines its policy that every unborn child is human being from the moment of conception,” the panel wrote. As the Court put it: “The public interest is not served by perpetuating a medical practice whose safety the agency admits was inadequately studied. Indeed, the public interest demands the opposite.”
That concession—that the FDA itself had inadequately studied the safety of remote mifepristone dispensing—was central to the ruling. Under Commissioner Marty Makary, the FDA had acknowledged a “lack of adequate consideration” for the Biden-era decision and announced its own safety review. It sought to stay the case pending its review. But the FDA admitted it was still in the “data collection phase” and could not say when the review might be complete. The Fifth Circuit found that no principle of law required Louisiana to absorb irreparable harm—in the form of nearly 1,000 unborn lives lost each month—while waiting for an agency with no timeline.
The legal case against the 2023 REMS is not a close one. Two separate Fifth Circuit panels have already examined this same agency action and found it wanting—criticizing the FDA’s “ostrich’s-head-in-the-sand approach.” The Supreme Court later reversed but solely on standing. In this case, the Fifth Circuit concluded that Louisiana had standing to bring its case for two reasons: documented sovereign injury from thousands of monthly illegal abortions within its borders, and over $92,000 in Medicaid costs from just two mifepristone-related emergency room visits in 2025 alone.
The ruling is now before the Supreme Court on emergency application. Mifepristone manufacturers Danco Laboratories and GenBioPro have filed for an immediate administrative stay at the Supreme Court. Whether the Supreme Court intervenes remains to be seen. But the Fifth Circuit’s unanimous ruling stands as a clear statement: When a federal agency weaponizes its regulatory power to circumvent state law, and then admits it never bothered to adequately study whether that action was safe, courts have both the authority and the obligation to act. The Fifth Circuit has now said, for the third time, that it will not look the other way.