There is a content warning on page 7 of a friend-of-the-court brief recently submitted in a high-stakes abortion medication case by women who say they were injured or traumatized from taking the pills. 

“Warning: these accounts are raw, graphic and real.”

About 30 mostly anonymous people recount their medication abortions, saying they were uninformed about what they would experience mentally and physically. The graphic accounts and bloody portraits are meant to bolster the argument that the practice is a barbaric and gruesome one that states have the authority to ban. The brief argues the problem is perpetuated by telehealth abortion. 

“We call it a particularly gruesome and barbaric procedure, the pill, because Dobbs allowed particularly gruesome and barbaric procedures to be prohibited by the states,” said attorney Allan Parker of the Justice Foundation.

It’s one of many arguments made in the main complaint, though not the focus of Tuesday’s oral arguments over a preliminary injunction that could, if granted, halt access to telehealth abortion throughout the country. But it’s one with a winning history for the anti-abortion movement, whose leaders are frustrated with rising abortion rates and the Trump administration’s failure to restrict the pills. 

But reproductive legal experts who support abortion rights say the gruesome or barbaric argument mischaracterizes the realities of medication abortion, which is approved to induce a miscarriage within the first 10 weeks of pregnancy. 

Abortion opponents are focused on disrupting national access built largely on shield laws and a Biden-era policy that has allowed women to have first-trimester abortions via medication at home with a remote physician consultation, even in states with bans. 

The Justice Foundation, which co-authored the brief alongside the National Association of Christian Lawmakers, recruits women who regret their abortions to testify in court and before legislatures and has collected nearly 5,000 legally admissible affidavits, according to the brief. 

The lawsuit was originally filed last year by Louisiana Attorney General Liz Murrill and co-plaintiff Rosalie Markezich, who said her partner ordered pills without her consent and then coerced her to take them.

The complaint cited the 2007 U.S. Supreme Court decision in Gonzales v. Carhart that upheld a federal ban on an abortion procedure called intact dilation and extraction, which at the time some doctors said was a preferable method for ending certain pregnancies, typically in the second trimester, without damaging the woman’s cervix. The anti-abortion movement effectively rebranded the method “partial-birth abortion.” In upholding the ban on this method, the Supreme Court opinion, which was referenced in the 2022 Dobbs decision overturning federal abortion protections, included a reference to it as “gruesome and inhumane.” 

While the intact dilation and extraction method was used later in pregnancy and in a minority of terminations, telehealth abortions early in pregnancy made up 27% of abortions in the U.S. in the first half of December, according to the Society of Family Planning.  

“What it feels like is happening with some of these briefs is that they’re going back to the last argument that worked in shaping popular opinion,” historian and law professor Mary Ziegler said. “Because while they managed to overturn Roe, that was not a success from a popular opinion standpoint.”

The argument that abortion is barbaric and gruesome is not likely to touch public opinion the same way it did two decades ago, she said, because unlike with intact dilation and extraction abortion, most women have experienced a medication abortion or a miscarriage and know what it’s like.  

“It would be hard, I think, to convince people that a procedure that’s happening in week seven, is equally barbaric,” Ziegler said. “The whole success of partial-birth abortion as a strategy is in the name, right? The argument was, This is happening late enough in pregnancy and close enough to birth that it resembles infanticide. And with abortion pills, for many people, it’s going to much more closely resemble a very early miscarriage.”

The potential to unleash chaos

Attorneys on either side of the abortion rights divide agree that the stakes are high in the Louisiana case, because a ruling would likely apply nationally and once again shake up the abortion access landscape in the U.S. If the court grants Louisiana’s request to force the U.S. Food and Drug Administration to reinstate old restrictions while litigation continues, the action could effectively ban telehealth abortion appointments, medication dispensation at retail pharmacies, and the mailing of abortion pills even in states where abortion remains legal.

Katie Keith, founding director of the Center for Health Policy and the Law at the O’Neill Institute at Georgetown University, said a ruling in plaintiffs’ favor could “unleash chaos and confusion in the market.”

“What would happen to medication that’s already on the shelves?” she asked. “And how quickly could folks move from telehealth to in-person dispensing again? And what guidance would FDA give? And how quickly would all this get appealed?” 

It would be extremely disruptive in a year when abortion providers have already seen a lot of chaos, she said. 

Dr. Angel Foster is the co-founder of the Massachusetts Medication Abortion Access Project, which provides telehealth abortion to all 50 states. She said plaintiffs’ claims do not match up with national and international data on medication and telehealth abortion or with her experience as a provider. 

“Louisiana has taken things that are exceptional and presented them as common, has tried to put the ugliest face on the abortion process as possible, and has mischaracterized the kind of care that telemedicine medication abortion providers are offering,” Foster said. 

Her organization has served more than 40,000 patients seeking abortion care since 2023, she said, 95% in states with abortion bans. Patients are counseled on what to expect in terms of pain and what they might see, and are screened for potential coercion and other issues. 

For example, if a patient lists her husband’s email address, Foster said she would call the patient directly to confirm the abortion is her choice. She said a bad actor could try to bypass their screening and force someone to take abortion pills without consent, which is already a criminal offense under existing law. 

“I don’t think that the remedy is to say that nobody should be able to get abortion pills by mail,” Foster said.  

National domestic violence awareness groups have filed a friend-of-the-court brief in the Louisiana case asking the court to deny plaintiffs’ request for an injunction. They note that reproductive coercion is not limited to abortion pressure but can also include a partner barring access to birth control or other health care. 

Beyond the federal courts, states continue to try to pass laws to ban or further restrict medication abortion. Attorneys general in Louisiana and Texas have led the charge in suing shield law providers in states without abortion bans. Texas’ attorney general filed a new lawsuit on Tuesday against California physician Rémy Coeytaux, telehealth abortion nonprofit Aid Access and its founder Dr. Rebecca Gomperts. 

Foster said she has not yet been sued but that her attorneys have been in close communication with Massachusetts’ attorney general over whether the state’s shield law would protect their practice depending on how the judge rules. 

“Our intent is to continue to provide medication abortion care with mifepristone and misoprostol for as long as we can legally do so,” she said. 

Will a federal judge let the Trump administration delay?

For now, Louisiana v. FDA is in limbo. After Louisiana filed its preliminary injunction request, the Trump administration asked the court to delay while it continues to review abortion pill safety — a review that was prompted by pressure and controversial research from the anti-abortion movement. 

Trump-appointed district Judge David Joseph on Tuesday did not indicate when he might rule on Louisiana’s request for an injunction but gave the federal government’s attorneys seven days to file a brief explaining how the FDA would take emergency action if the agency discovered mifepristone presents a public health risk during its review.

Anti-abortion activists have been frustrated with the administration’s efforts to delay the Louisiana case. 

“We are disappointed that the Trump administration is asking the court to pause our case and deny our clients immediate relief while the FDA takes another year to study the known harms of abortion drugs,” said Erik Baptist, senior counsel at Alliance Defending Freedom, which is representing Markezich, in a written statement.

With the approaching midterm elections, Ziegler said she’s curious what the administration will finally say about its position on abortion pills. 

“It’s our first look at what the Trump administration will do if the court doesn’t respond by just giving them more time,” Ziegler said. “Because so far, they’ve been essentially just avoiding it, by saying they’re thinking about it, and they need more time, and they’re studying the matter, and, you know, not really taking a side.” 

Planned Parenthood and other providers got word in March that millions they anticipated in Title X funding would be withheld. The money was eventually released last year, though some providers say damage was still done. (Getty Images)

Planned Parenthood clinics in Utah resumed family planning services after the Trump administration unfroze millions in federal funds.

The American Civil Liberties Union on Tuesday submitted a brief to dismiss a lawsuit filed on behalf of the National Family Planning and Reproductive Health Association after the federal government notified nine Planned Parenthood affiliates and other family planning providers in March it would withhold annual Title X funding. 

Shireen Ghorbani, president and CEO of Planned Parenthood Association of Utah, said in a statement Monday that the restored funding does not erase all of the damage caused by nine months without it. Title X funds are meant to provide affordable family planning services, such as birth control, cancer screening, and STI tests and treatment. 

Ghorbani noted that the Utah affiliate has been the only Title X grant recipient in the state since 1985. 

“We are thrilled that Title X funding is restored to Utah for now, allowing more Utahns to get critical family planning services,” Ghorbani said. “But we cannot ignore the fact that too many Utahns have already felt the devastating effects of the Trump administration’s unwarranted decision to withhold this funding for the last nine months. Many of the 26,000 Utahns who rely on the program were forced to pay more for their health care or go without care altogether.”

Crucially, she said, the affiliate closed two health centers, in St. George and Logan, among dozens that have closed because of the withheld Title X funding and are unlikely to reopen, according to Planned Parenthood. 

Some grantees had their funding restored over the summer, Politico reported, while others remained under investigation for possibly violating the Trump administration’s new rules around so-called diversity, equity and inclusion practices until December. That’s when the U.S. Department of Health and Human Services informed Planned Parenthood affiliates that they would receive their promised funds dating back to last April, with no explanation beyond unspecified “clarifications made by, and actions taken by, the grantees.” 

Planned Parenthood’s Utah affiliate said that on Jan. 9 it received $2 million in Title X funding for the current grant year that had been withheld since April.

In the lawsuit over the Title X funding, plaintiffs argued that the federal government withholding 22 federal Title X grants from Planned Parenthood and other family planning organizations was illegal and unjustified. 

“Our lawsuit succeeded in holding the administration accountable for its unlawful acts, and today, NFPRHA members’ grants have been restored. We are relieved all of our members now have access to their promised funds, but we know the fight for contraceptive access in this country goes on,” said Clare Coleman, president & CEO of the National Family Planning and Reproductive Health Association, in a statement Tuesday. 

She estimated that 865 family planning service sites were unable to provide Title X-funded services to an estimated 842,000 patients across nearly two dozen states.

While some states have fought to restore Title X family planning funding, Idaho last year declined its annual $1.5 million federal Title X funding, leaving patients statewide without free and low-cost contraception and reproductive health care services.

At least 20 more Planned Parenthood clinics have also closed because of last year’s budget reconciliation bill, which effectively blocked Planned Parenthood and other nonprofit reproductive health care providers from being able to participate in Medicaid, reducing low-income health care options throughout the country. Litigation remains ongoing in several cases over that Medicaid rule.

State and federal proposals to regulate and restrict medication abortion are expected to continue in 2026 as abortion opponents claim, without strong evidence, that abortion medication is dangerous to patients and the environment. (Getty Images)

Going into the fourth year without federal abortion rights protections, groups that helped overturn Roe v. Wade are focused on cutting off access to abortion pills. As multiple lawsuits over the abortion drug mifepristone unfold, state and federal proposals to regulate and restrict medication abortion are expected to continue in 2026. Abortion opponents argue that medication abortion, despite its strong safety record, is dangerous to patients and the environment.

Abortion bans are largely unpopular, but heading into a midterm election year, some lawmakers in states with strict abortion bans have already prefiled bills to add new restrictions. Here’s a look at early legislative trends emerging in abortion-related bills recently introduced or prefiled ahead of the new year.

Proposals to restrict abortion pill or study environmental effects

Over the last few years, the national anti-abortion group Students for Life of America has spread unfounded claims that mifepristone pollutes U.S. waterways and drinking water, drafted model legislation to regulate the disposal of medication abortions, and requested environmental studies at the federal and state level. 

In 2025, lawmakers in at least seven states introduced bills to create environmental restrictions for the abortion drug mifepristone or order environmental studies. Bills introduced this year in Texas, Wisconsin and Wyoming would have required testing community water systems for traces of mifepristone. 

Bills in Maine, Montana, Pennsylvania, West Virginia, Wisconsin and Wyoming would have required providers to give patients medical waste kits to collect and return the tissue following a medication abortion. Women commonly flush the tissue associated with medication abortion and miscarriages, which typically occur during the first trimester. 

These bills, except Pennsylvania’s, would have also mandated in-person dispensing of the medication and follow-ups, effectively banning telehealth abortion. 

None of these proposals passed, but they are likely to be reintroduced in 2026 as abortion opponents continue to push for environmental regulation of abortion pills, including at the federal level. 

In June, 25 congressional Republicans sent the U.S. Environmental Protection Agency a letter inquiring about potential avenues for regulating mifepristone, as the New York Times reported. And as Politico recently reported, Students For Life lobbied the agency to add mifepristone to its recently updated list of contaminants that utilities will have to track in drinking water. It’s too late to include a new drug on the list, which is updated every five years. 

But according to Politico, EPA staffers advised anti-abortion activists to use an upcoming public comment period to drum up requests that the agency include active metabolites in mifepristone. The EPA collects nationwide data on the chemicals on this list, which could be used to set future federal limits.  

Fetal wrongful death bills 

In Florida, where abortion is banned at six weeks’ gestation, lawmakers recently advanced HB 289 ahead of the 2026 session, which would allow parents to file wrongful death lawsuits for the loss of a developing fetus and to claim damages for mental pain and loss of support. Its companion bill, SB 164, filed for the third year in a row by Republican Sen. Erin Grall, faces an uphill battle in the Florida Senate, reported the Florida Phoenix, which noted that jurors could be asked to consider the salary the fetus could have earned over its life as part of damages to which parents could be entitled. 

Groups opposing the legislation as far-reaching and likely to increase liability exposure for OB-GYNs who specialize in high-risk pregnancies include the American Civil Liberties Union of Florida, the Florida Justice Reform Institute and the Doctors Company, the nation’s largest physician-owned medical malpractice carrier.

One of the bill’s leading champions, Andrew Shirvell, founder and executive director of Florida Voice for the Unborn, told state House Judiciary Committee members they should continue expanding “civil remedies afforded under Florida law to hold accountable those who continue to take the lives of unborn children illegally in our state.”

Another bill, HB 663, would allow a family member to sue someone for providing or attempting to provide an abortion up to two years after the fact with up to $100,000 in damages, even if the woman consented or if the abortion was performed in another state or country where the procedure is legal.

Attempts to overturn or skirt abortion rights ballot measures 

Even though Missouri voters in 2024 approved an amendment to protect abortion rights in the state constitution, broad access has not returned to the state. Between January and October, there were only 80 in-clinic abortion procedures in Missouri, according to state data, with an additional 79 abortions in hospitals and identified as medical emergencies.

A trial in January could determine whether Missouri’s anti-abortion laws violate the voter-approved amendment. Meanwhile, Republican lawmakers have put a new constitutional amendment on the 2026 ballot that would ban nearly all abortions in the state with limited exceptions.   

In 2023, Ohio voters approved a constitutional amendment protecting abortion rights through fetal viability, and prohibiting the state from interfering with or penalizing someone for exercising that right. But Republicans have been advancing anti-abortion bills to create restrictions that make accessing abortion more difficult without directly flouting the amendment. 

During this legislative session, which ends Dec. 31, state Sen. Kyle Koehler introduced SB 309, which could add steps to accessing medication abortion and would require doctors to deliver a state-mandated script about the dangers of mifepristone. It would also allow patients, their parents if they’re underage, or the father of the fetus  to sue if they feel the patient was uninformed when taking the pill.

In November, the Ohio House passed HB 485, which would require students in fifth through 12th grade to watch either a “Meet Baby Oliva” fetal development video created by the national anti-abortion group Live Action, or a similar video. Live Action’s video has been criticized by reproductive health advocates for not being fully medically accurate or comprehensive. Similar bills have been introduced in dozens of states this year, and have been enacted in Idaho, Indiana, Iowa, Kansas, North Dakota and Tennessee. 

Abortion records privacy

Privacy concerns around reproductive health in the post-Roe era persist nationally. Lawmakers in states that protect abortion rights continue to try to shore up medical and data privacy protections for abortion, which is almost completely illegal in more than a dozen states. 

In Indiana, where the legislative session began in December, Sen. La Keisha Jackson introduced SB 109. Under the measure, a health care provider’s report about an abortion submitted to the Indiana health department as a medical record would be confidential and not subject to disclosure as a public record. In a state lawsuit brought by two OB-GYNs from Indianapolis, an appeals court in December upheld the privacy of these records, known as terminated pregnancy reports.

In Washington state, Democratic lawmakers are still drafting legislation that would regulate license plate readers following reports that authorities in Texas searched thousands of cameras, as far as Washington and Illinois, to find a woman they believed had a self-administered medication abortion. 

Calling for forced vasectomies for convicted rapists

State abortion restrictions typically hold health providers liable, but women have been jailed or prosecuted for their pregnancy outcomes. One Democratic lawmaker in Alabama, where abortion is banned throughout pregnancy except to save the pregnant person’s life, has introduced legislation that comes with steep penalties for men convicted of rape or incest that resulted in pregnancy. 

Democratic Rep. Juandalynn Givan’s prefiled HB 46 would authorize abortion to preserve the health of the mother or if the pregnancy resulted from rape or incest. It would also require men convicted of rape or incest to pay for the abortion, and undergo either vasectomy or castration, as determined by the court. As the Alabama Reflector reported, the bill is unlikely to be considered, but for Givan it’s really about starting a broader conversation of bodily autonomy. 

“We have already set a double standard,” Givan said. “Have you seen a bill crafted that tells a man what he cannot … do with his body? You have not, outside of the standard laws that speaks to rape and incest, and we already know that that is definitely a crime.”

Anticipated federal policy decisions during Trump’s second year 

In his first year back in office, President Donald Trump rescinded many of the Biden-era policies intended to expand abortion access, including the previous administration’s interpretation that the Emergency Medical Treatment and Labor Act covers abortions necessary to save a pregnant person’s life even in a state that has banned abortion.

More major federal policy decisions around abortion are anticipated in 2026. The Food and Drug Administration agreed to review mifepristone’s safety, but abortion opponents recently called for FDA Commissioner Martin Makary to be fired, accusing him of slow-walking the review until after the midterm elections in November. 

Just a few months before that, in July, a controversial Medicaid policy effectively defunding Planned Parenthood clinics and other nonprofit clinics that provide abortions, is slated to expire. Whether Republicans will renew the funding restriction or let it lapse — allowing the nation’s largest network of reproductive health clinics to continue serving Medicaid patients for services unrelated to abortion — remains to be seen.