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Lawsuits and legislation around the country would restrict access to or ban mifepristone, often based on the same talking points promoted by anti-abortion groups that experts say are not rooted in scientific evidence. A hearing in the Louisiana case that could decide future telehealth access to abortion medication took place at the John M. Shaw U.S. Courthouse in Lafayette, Louisiana, in late February. (Photo by Greg LaRose/Louisiana Illuminator)
As telehealth access to abortion medication has grown in the years after the U.S. Supreme Court’s Dobbs decision, anti-abortion groups and attorneys general from states with abortion bans are accelerating efforts to ban access to the medication, including by attempting to revoke the U.S. Food and Drug Administration’s approval.
Louisiana Attorney General Liz Murrill sued the FDA in October and asked the district court to strike down a 2023 provision allowing telehealth prescriptions for mifepristone, one part of a two-drug regimen commonly used to terminate a pregnancy before 10 weeks. Included in the lawsuit is Louisiana resident Rosalie Markezich, who said her boyfriend pressured her into taking the pills.
Louisiana officials argue doctors in states without abortion bans should not be allowed to prescribe and mail the medication into a state where it is illegal, and say Markezich would not have been harmed if the 2023 provision hadn’t made it possible for the medication to be mailed to her boyfriend. Murrill asked the court to block the 2023 rule with a preliminary injunction, and if granted, it could limit access for people nationwide.
Aside from court cases, legislatures around the country are also considering legislation restricting or banning mifepristone, which is also used to treat miscarriage and high blood sugar for some patients. Louisiana designated the drug a controlled substance in the same category as Xanax and Valium, and South Carolina’s House of Representatives passed a similar bill in February.
Whether in court briefings or before state policymakers, plenty of talking points about abortion medication are repeated that are not based on scientific fact or evidence, according to experts. Here are some of the most common:
1. The rate of serious adverse events associated with mifepristone is less than 0.5%, according to extensive scientific study.
Republican lawmakers and anti-abortion interest groups have cited an April 2025 paper to argue that mifepristone is dangerous and results in a much higher rate of serious adverse events than the FDA reported. That paper, which was not peer reviewed, was published by the Ethics and Public Policy Center, a conservative advocacy group that partners with groups like Alliance Defending Freedom, the conservative legal firm that has led many anti-abortion lawsuits, including the Dobbs case.
The policy center’s report finds a nearly 11% rate of “serious adverse events” based on commercially available health claims data. Experts dispute that the center defined a serious adverse event the same way the FDA does, as a condition that requires hospitalization, is life-threatening, or causes disability and permanent damage or death.
Dr. Mitchell Creinin, an OB-GYN at the University of California Davis Health who has researched the safety of mifepristone since studies first began in 1992, said there is overwhelming evidence that the medication is safe and the rate of serious adverse events is extremely low. In a report published by the Society of Family Planning, Creinin identified errors in the way the policy center’s analysis calculated events, saying there was double counting of issues associated with the same patient, and found that the report was counting serious adverse events that don’t meet the FDA’s criteria, including going to the emergency room.
“It’s all about playing with science to make it say what you want it to say,” Creinin said.
One of Creinin’s studies from 2015 combined all relevant published studies on mifepristone and misoprostol between 2005 and 2015, a total of 20 studies with 33,846 women through 70 days of gestation, and found severe outcomes requiring blood transfusion and hospitalization occurred in less than 1% of cases.
2. Testing for Rh blood status is unnecessary in early pregnancy.
A common argument from anti-abortion groups like Students for Life of America, including in its amicus brief to the Louisiana court, is that telehealth abortion care cuts off the opportunity for doctors to test a pregnant patient’s Rh status before an abortion, which they argue can threaten the health of future pregnancies.
A doctor will test a pregnant patient’s blood at some point during pregnancy to determine if they are Rh-positive or negative. If a patient knows their blood type, such as A or O, the positive or negative sign associated with the type is the Rh factor. Sometimes the pregnant patient’s marker is positive and the fetus is negative, which can result in the patient’s body identifying the blood cells of the pregnancy as foreign. That can cause the pregnant patient to develop antibodies against the blood cells. There needs to be enough of these cells to create a reaction, which doesn’t occur until after the first trimester, around 12 weeks. A treatment can be given in those cases to prevent antibodies from forming.
Those antibodies can also form after miscarriage, ectopic pregnancy and abortion, according to the American College of Obstetricians and Gynecologists, and it could affect future pregnancies.
But the organization said in its amicus brief to the court in Louisiana that the risk of serious outcomes related to Rh issues before 12 weeks’ gestation is low, and it affects a small minority of the population, so limiting access based on that rare outcome would be a “disproportionate response.”
Creinin said research shows there aren’t enough fetal cells in early pregnancy to mount an immune response, such as a 2023 study of 506 first-trimester abortion patients in which all but one of them were below the threshold for an immune response. Most countries worldwide do not recommend treatment in a patient with the condition in early pregnancy, and that is the recommendation in the U.S. as well.
“There’s all this really good evidence that says you don’t need to do it,” Creinin said.
3. A patient doesn’t need an ultrasound before taking mifepristone.
A pregnant person is not required to have an ultrasound or be seen by a provider in person in order to obtain mifepristone, according to the FDA. Ultrasounds weren’t required even before the FDA stopped requiring in-person visits, and most pregnant patients aren’t given an ultrasound for an early pregnancy until at least eight weeks’ gestation, even if they intend to keep it. Symptoms of ectopic pregnancy, when an embryo implants in a fallopian tube instead of the uterus, usually begin by seven to eight weeks of pregnancy, and mifepristone is only approved for use up to 10 weeks.
The mortality rate of ectopic pregnancy is extremely low, at less than 50 deaths per year, and if someone has significant risk factors for ectopic pregnancy, Creinin said, they should be evaluated earlier. That’s part of the counseling involved in a telehealth appointment.
4. Taking mifepristone at home does not disproportionately result in traumatic experiences.
Anti-abortion groups such as the Justice Foundation have submitted amicus briefs to the Louisiana court about people who said taking abortion medication and managing the treatment at home led to traumatic outcomes because they weren’t prepared for what they would see.
That can happen, said Jessie Losch, director of government affairs for the American Society of Reproductive Medicine, but most doctors will counsel a patient first on what to expect and what they might see after the pills are taken, including passing fetal tissue.
Losch acknowledged that there can be a gap between hearing about what to expect and seeing it in person, but that isn’t a reason to take the option away from those who benefit from being able to choose when and where the treatment occurs. That can be especially important for victims of abuse, Losch said.
“I understand why somebody might be taken by surprise at the reality of it, but we can’t control for that with legislation,” she said.
Although there are few recent scientific studies that specifically examine at-home abortion management, one Society of Family Planning study from 2022 with more than 3,100 participants found 98.4% were satisfied with the experience and about 95% thought self-managing was the right choice for them.
5. There is no evidence to support the idea that taking mifepristone is harmful for the environment.
This argument has largely come from the anti-abortion group Students for Life of America, which says mifepristone pollutes the water supply and contends the FDA should have done an environmental review including effects on endangered species before easing restrictions on the drug. Multiple states have considered legislation to create environmental restrictions around the drug or bills requiring providers to instruct patients to collect fetal tissue in medical waste kits and return it to the provider rather than flush it.
The U.S. Environmental Protection Agency may also conduct a review that could be used to restrict access in the future, States Newsroom reported.
Losch said she hasn’t found any evidence that mifepristone is either detectable in the water supply or that it has a detrimental effect on wildlife, including the hormonal structure of fish or other aquatic animals.
In 1996, the FDA Center for Drug Evaluation and Research issued a finding of no significant impact on the water supply from mifepristone.
“The Center … has concluded that the product can be manufactured, used and disposed of without expected adverse environmental effects,” the finding stated. That included endangered or threatened species.
This story was originally produced by News From The States, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
California Democratic Gov. Gavin Newsom speaks during a press conference in Fresno, Calif., in 2024. In January, California became the first state to join the global alert network of the World Health Organization. Since then, Illinois, New York state and New York City have followed suit. (Photo by Larry Valenzuela, CalMatters/CatchLight Local)
In an extraordinary break from the federal government, the public health departments of at least three states and New York City are joining the global alert network of the World Health Organization, spurred by President Donald Trump’s decision to remove the United States from the United Nations agency responsible for coordinating international public health.
So far, the state public health departments in California, Illinois, New York, as well as the public health agency in New York City, have joined the Global Outbreak Alert and Response Network (GOARN), which is part of the World Health Organization (WHO). The U.S. officially left the WHO this past January.
California joined GOARN in January, while Illinois, New York state and New York City joined last month.
GOARN, which includes more than 310 national public health agencies, United Nations agencies, academic institutions, and nongovernmental groups, helps identify and manage infectious disease outbreaks worldwide. Since it was established in 2000, GOARN says it has helped manage more than 175 global health emergencies across 114 countries.
GOARN maintains relationships with some medical and research institutions in the U.S., including the Tulane University School of Public Health and Tropical Medicine in New Orleans and university medical centers in Nebraska and Texas. Until now, however, state public health agencies have not been members, because they relied on the U.S. government’s participation in GOARN for information on global outbreaks.
Dr. Ali Khan, a medical epidemiologist who is the dean of the College of Public Health at the University of Nebraska Medical Center and a former member of the GOARN steering committee, said the COVID-19 pandemic highlighted how “disease has no borders” and the importance of sharing information globally to quash the spread of contagious diseases.
Khan said the Trump administration’s withdrawal from the WHO “throttles the information from WHO to the U.S. government, specifically the [federal Centers for Disease Control and Prevention], and which then flows to states. Those states are now left in a position where they’re joining the GOARN.”
“Let’s be clear, it doesn’t substitute for the U.S. withdrawal from the WHO, but it does allow states to directly get information about what’s going on globally that may impact their own citizens. So it allows them to sort of keep their own radar on when the U.S. has decided to no longer participate in this global information sharing.”
We're used to just sharing information with each other, sharing knowledge. It’s not political.
– James McDonald, commissioner of the New York State Department of Health
In explaining its decision to withdraw from WHO, the Trump administration said the U.S. had “for decades carried a disproportionate share of the organization’s financial burden.” It insisted the country would “continue to ensure detection and response to infectious disease outbreaks” without being a member of the organization.
“These are the same democrat-led states and cities that imposed unscientific school closures, toddler mask mandates, and vaccine passports during the COVID era,” Andrew Nixon, a spokesperson for the U.S. Department of Health and Human Services, wrote in an email.
“They are the ones who destroyed public trust in public health that we are now restoring. We are working with the White House in a deliberative, interagency process on the path forward for global health and foreign assistance that first and foremost protects Americans.”
Dr. James McDonald, commissioner of the New York State Department of Health, told Stateline that the department’s decision to partner with GOARN was apolitical, and that it makes sense for New York because the state is “the world’s gateway to the country.”
“Everybody comes to the United States. Many come through JFK [John F. Kennedy International Airport], but an outbreak in the Democratic Republic of Congo does matter to me, so learning about it sooner helps protect New Yorkers and also helps protect the United States,” McDonald said.
McDonald added that New York is a part of a new public health consortium of Northeast states — the Northeast Public Health Collaborative — and plans to share any information it gathers from GOARN with fellow members Connecticut, Delaware, Maine, Maryland, Massachusetts, New Jersey, Pennsylvania, Rhode Island, and Vermont. New York City also is a member of the consortium.
“One of the things about scientists and health care providers is we’re used to just sharing information with each other, sharing knowledge. It’s not political,” McDonald said.
Doua Yang, a spokesperson for the California Department of Public Health, said that even before officially joining GOARN in January, the agency had been attending weekly operational calls for several months, and even made a presentation on how it has handled bird flu outbreaks.
“As the fourth-largest economy in the world, California cannot afford to let down its guard, or its people,” Yang wrote in an email. “Participating with GOARN is one step California is taking to maintain uninterrupted communication with WHO and protect the state from potential health threats.”
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
A banner of President Donald Trump is hung on the Department of Justice in February. The Justice Department is arguing it needs access to states’ voter data to ensure the security of the midterm elections. (Photo by Heather Diehl/Getty Images)
The U.S. Department of Justice has begun connecting its push to obtain sensitive personal data on millions of voters to whether the upcoming midterm elections will be fair and secure, laying the groundwork for the Trump administration to potentially cast doubt on the results.
The Justice Department has sued 29 states and the District of Columbia over their refusal to provide unredacted voter rolls that include the driver’s license and partial Social Security numbers of voters. The department has lost three of those lawsuits so far this year.
But as the Justice Department begins appealing the losses, it has filed emergency motions warning the “security and sanctity of elections” would be questioned in those states — California, Michigan and Oregon — without immediate rulings.
Election experts told Stateline that federal appellate courts are unlikely to move quickly for the Justice Department. Instead, the department’s court filings suggest that without the data, the Trump administration may question the validity of the midterm elections in November.
“Absent a final Court determination on this matter there is no other process to ensure a fair election in 2026,” the Trump administration’s motions say.
President Donald Trump has made identifying noncitizen voting, an extremely rare occurrence, a priority of his administration, and the Justice Department has said the detailed personal data is necessary to ensure states are properly maintaining their voter rolls. At least a dozen Republican-led states have provided the information.
Democratic election officials, and some Republicans, have condemned the demands as an invasion of voters’ privacy and have voiced concerns the Trump administration plans to use the information to target political opponents or create a national voter list. Other Republican election officials and the Trump administration and have downplayed privacy concerns and said the data will help ensure only eligible voters cast ballots.
The DOJ’s sense of urgency comes after the department spent months sending letters to state officials demanding voter data, followed by successive rounds of lawsuits against states that refused to comply — all in what department officials said was the pursuit of noncitizen voters.
“We know this isn’t a big problem nationwide,” said David Becker, executive director of the nonpartisan Center for Election Innovation & Research and a former senior trial attorney in the Justice Department’s Voting Section during the Clinton and George W. Bush administrations.
“We know the states have adequate safeguards,” Becker said. “We see Republicans — Republicans — coming out and saying this repeatedly. So there is no problem that urgently needs to be solved in advance of the election.”
But the Trump administration has increased its attention on elections in recent weeks. In early February, Trump voiced a desire to “nationalize” elections. He demanded Congress pass a proof of citizenship voter registration requirement and strict voter ID rules. The U.S. Senate is expected to debate the bill next week, but it is unlikely to have enough votes to advance.
The FBI has also seized ballots from the 2020 election in Fulton County, Georgia, and the Arizona Senate complied with a federal grand jury subpoena for records related to its 2020 audit of that year’s election results in Maricopa County, Arizona.
Michigan responded to the Justice Department in a March 6 court filing by asserting that its case involves no emergency. Lawyers representing Michigan Secretary of State Jocelyn Benson, a Democrat, wrote that the appeal doesn’t challenge any state election law or rule and that the outcome of the case would have little to no effect on the 2026 election.
In response to an interview request, Benson’s office referred Stateline to a news release that quoted the secretary as urging election officials across the country “to stand up to the federal government’s overreach and to safeguard citizens’ private voting information we’ve been entrusted to protect.”
Oregon Democratic Secretary of State Tobias Read said in an emailed statement to Stateline that he’s “confident in our case, and trust the courts will continue to uphold the Constitution and the privacy rights of all Oregonians.”
California Democratic Secretary of State Shirley Weber didn’t respond to an interview request.
Race against time
Federal judges have so far ruled that even though states must perform maintenance on their voter rolls, federal law doesn’t give the Justice Department authority to obtain full voter lists.
While the Justice Department now claims the security and sanctity of upcoming elections necessitates the need for speed, the department hasn’t alleged any states are violating federal voter list maintenance requirements, said Derek Clinger, senior counsel and director of partnerships at the State Democracy Research Initiative at the University of Wisconsin Law School.
“This is the first time in all the litigation that DOJ has claimed that there’s an urgent need to resolve the cases,” said Clinger, who is tracking the voter data lawsuits.
This is the first time in all the litigation that DOJ has claimed that there’s an urgent need to resolve the cases.
– Derek Clinger, State Democracy Research Initiative at the University of Wisconsin Law School
Even if courts ultimately determine that states must provide the voter data, it’s not clear that the Justice Department could make effective use of it before the midterms.
Federal law generally prohibits states from conducting significant purges of registered voters less than 90 days before primary and general elections. For example, that period will begin in Michigan on May 6 ahead of the state’s Aug. 4 primary election.
The Justice Department has asked for all court documents in its Michigan appeal to be filed by April 1. Even if the appellate court immediately ruled in the department’s favor, only 35 days would be left until the pre-primary blackout period.
Lawyers for Michigan wrote in its court filing that it is “dubious” that any serious assessment of the state’s 7.3 million voters could occur in that time frame.
Still, Rosario Palacios, a naturalized U.S. citizen who leads the good-government group Common Cause Georgia, said she’s worried the federal government could wrongly flag her or others like her as noncitizens if the Justice Department eventually obtains her state’s unredacted voter roll.
The U.S. Department of Homeland Security operates a powerful online program called SAVE (Systematic Alien Verification for Entitlements) that it uses to verify citizenship. It has previously invited states to run their voter rolls through the program, and the Trump administration in September confirmed the Justice Department is sharing state voter roll data with Homeland Security. But SAVE has faced criticism from some election officials for mistakenly flagging U.S. citizens for review.
After the department sued Georgia for refusing to turn over its data, Palacios and Common Cause intervened in the lawsuit to oppose the demand.
Palacios said in an interview she’s worried some may choose not to participate in the election. “The fear alone of this is going to make people withdraw.”
Some GOP states share voter data
The Justice Department has offered few details about how it intends to analyze the voter data it obtains. The agency didn’t answer questions from Stateline and declined to comment.
Idaho Republican Secretary of State Phil McGrane last month said he wouldn’t turn over voter data. McGrane declined an interview request, but in a Feb. 26 letter to the Justice Department he raised concerns about data security.
“While I appreciate the Department’s representations that Idaho’s data will be safeguarded, I cannot take that now-apparent risk in the absence of clear legal duty to do so,” McGrane wrote.
Some Republican election officials have decided to share their state’s data, however.
Eric Neff, the acting chief of the Justice Department’s Voting Section, wrote in a March 2 court filing that 18 states had either shared voter data or planned to do so soon. He didn’t name those states.
The Brennan Center for Justice at New York University, which tracks the voter data requests, has identified at least a dozen states that have provided the data: Alaska, Arkansas, Indiana, Kansas, Louisiana, Mississippi, Nebraska, Ohio, South Dakota, Tennessee, Texas and Wyoming.
Two of those states — Alaska and Texas — provided their voter rolls after signing a memorandum of understanding, or MOU, with the Justice Department.
The document, marked confidential, says that after the state provides its voter roll, the department agrees to test, analyze and assess the information. Each state agrees to “clean” its voter roll within 45 days by removing any ineligible voters. States would then resubmit their list.
Tennessee Elections Coordinator Mark Goins, who works under Tennessee Republican Secretary of State Tre Hargett, said in an interview that the state had shared its voter data after concluding that DOJ was entitled to it as part of its authority to enforce federal voting law. But Goins said Tennessee had decided against signing the memorandum of understanding because of concerns that the agreement conflicted with the National Voter Registration Act, which sets rules on when election officials can remove voters from their lists.
“When you’re dealing with this much data, and we have 4 million registered voters here, there could be a false flag and you certainly don’t remove anyone improperly,” Goins said.
In Texas, it’s unclear when the Justice Department will provide feedback on the state’s voter list. The state is currently in the preelection blackout period on sweeping changes to its voter registration list ahead of a May 26 primary runoff election, a spokesperson for Texas Republican Secretary of State Jane Nelson told Stateline.
Texas already ran its voter roll of more than 18 million voters through Homeland Security’s SAVE program last year, identifying 2,724 potential noncitizens registered to vote. County election officials were then left to investigate the flagged voters.
Christopher McGinn, executive director of the Texas Association of County Election Officials, said he’s unsure what would happen now, given that the state’s voter roll was recently examined by SAVE.
“Especially since those noncitizens were, in theory, cleaned up,” McGinn said.
In Alaska, the decision to share voter data has produced blowback from some state lawmakers. The state constitution guarantees a right to privacy that “shall not be infringed.”
Alaska Director of Elections Carol Beecher faced skeptical lawmakers during hearings last week that probed her refusal to waive attorney-client privilege to divulge the legal advice she received before providing the voter roll. In response to questions from Stateline, Beecher’s office referred back to her remarks to lawmakers.
“At this point, I am not willing to waive that privilege,” Beecher said at an Alaska Senate hearing.
Alaska state Sen. Bill Wielechowski, a Democrat who was among those who questioned Beecher, in an interview predicted the state will soon face lawsuits challenging the data sharing. He also said lawmakers are looking into pursuing legislation that would direct state officials to seek the return of the information from the Justice Department.
“I just think there’s a total lack of trust in what the federal government will do with this information,” Wielechowski said.
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Wisconsin Examiner, and is supported by grants and a coalition of donors as a 501c(3) public charity.
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