A hearing is set for Tuesday in a federal lawsuit led by Louisiana seeking to further restrict access to mifepristone by asking the courts to stop abortion pills from being mailed across the country. 

The Department of Justice has argued plaintiffs lack standing to bring the case and asked the judge to halt legal proceedings until the Food and Drug Administration wraps up a review of the medication. 

Hundreds of studies have concluded that the drug is safe and effective for abortions early in pregnancy, but a paper released by a conservative think tank last year compelled Health and Human Services Secretary Robert F. Kennedy Jr. to order a reevaluation of mifepristone.  

The state of Louisiana and a woman who said her ex-boyfriend made her take abortion medication sued the FDA in October and asked for a preliminary injunction against a 2023 rule that allows abortion pills to be prescribed through telehealth or mailed to patients, and pharmacies to apply for certification to dispense mifepristone. 

Julie Kay, the founder and CEO of legal advocacy group Reproductive Futures, told States Newsroom the lawsuits in Louisiana and elsewhere are “thinly veiled attempts” to block access to telehealth medication abortion. 

“We’ve seen that telemedicine abortion has become incredibly popular in all 50 states and particularly vital for women in under-resourced areas,” Kay said. 

Missouri, Idaho, Kansas, Texas and Florida are also suing the FDA over mifepristone’s regulations and asking the courts to restrict or rescind approval of the drug altogether.

Nearly 30% of abortions provided in the first half of 2025 were through telehealth, according to the Society of Family Planning’s latest #WeCount report. 

By June 2025, about 15,000 abortions per month were provided by physicians shielded by state laws, allowing them to prescribe abortion medication remotely to people living in states where abortion is banned or restricted, the report found. Shield laws protecting health care professionals from out-of-state investigations have held up in court so far, despite efforts from prosecutors in Texas and Louisiana. 

Republican Louisiana Attorney General Liz Murrill vowed to defend anti-abortion laws in her state, which has had a ban with no exceptions for rape or incest since August 2022. She indicted a California doctor in January, accusing him of mailing abortion pills to Rosalie Markezich, a plaintiff in the lawsuit before federal courts. 

Lawyers for Louisiana argue that the Biden administration’s decision to nix the in-person dispensation requirement for mifepristone is an affront to states that ban abortion. 

Alliance Defending Freedom Senior Counsel Erik Baptist framed the lawsuit as an intimate partner violence issue, saying Markezich’s former boyfriend ordered abortion pills online from Dr. Rémy Coeytaux in California without any in-person interaction. 

“So what this lawsuit would do is protect women across the country, in particular in Louisiana, from this mail-order abortion scheme that enables and emboldens people in coercive situations, such as men and abusers who can now obtain these drugs through remote means,” Baptist said. 

Reproductive coercion — when an abusive partner controls a person’s bodily autonomy — has been brought up in recent legal challenges to abortion pill access by other GOP attorneys general in bids to restrict mifepristone, according to Rachel Rebouché, a University of Texas at Austin law professor who specializes in reproductive rights. 

“There’s really not evidence that people are being coerced or forced into taking pills. It’s, of course, awful if someone has felt coerced, but I’m not sure it changes the argument of what the FDA should do as an agency committed to reviewing evidence,” Rebouché said. 

For their part, DOJ attorneys have said an injunction would interfere with the FDA review and Risk Evaluation and Mitigation Strategies, setting off an avalanche of other lawsuits. 

“Plaintiffs now threaten to short circuit the agency’s orderly review and study of the safety risks of mifepristone by asking this Court for an immediate stay of the 2023 REMS Modification approved three years ago,” they wrote in a memo filed on Jan. 27 in the U.S. District Court for the Western District of Louisiana. 

Kay said she views the Trump administration’s motion to pause the case as a legal delay tactic that is more about politics than science, because most Americans believe abortion should be accessible. A Pew Research Center poll from June 2025 showed 63% of respondents said abortion should be legal in all or most cases.

“This federal administration is very aware of that popularity, and I think they’re saying they want to wait until after the midterms,” Kay said.

Baptist said the FDA can conduct their review while the in-person requirement is restored. 

Mifepristone’s manufacturers intervened in the case earlier this month, Louisiana Illuminator reported. But unlike the federal government, GenBioPro and Danco, the companies behind the generic and name brand versions of the drug, asked the court to dismiss Louisiana’s lawsuit entirely. 

In a memo filed on Tuesday, Feb. 17, lawyers for the plaintiffs argued that the 2023 regulatory change “was intended to authorize a direct attack” on anti-abortion states. 

The filing also rejects arguments that Louisiana and Markezich lack standing in the same way that a group of anti-abortion doctors did in a lawsuit against the FDA over mifepristone’s previous regulations, according to a 2024 U.S. Supreme Court ruling. Justices rebuffed the Alliance for Hippocratic Medicine’s requests but did not rule on the merits of the case.

Baptist also said judicial panels on the 5th U.S. Circuit Court of Appeals in Louisiana — a conservative-leaning court where this lawsuit could go next — have twice ruled that it was “arbitrary and capricious” for the FDA to allow abortion medication without an in-person doctor visit. 

In Louisiana’s corner are major anti-abortion players: Students for Life of America, 60 Republican members of Congress, 21 GOP attorneys general and the Ethics and Public Policy Center filed briefs backing the state. 

Rebouché, the University of Texas professor, said there would be conflict between the federal courts if the district court judge rules in favor of Louisiana. There are nearly a dozen lawsuits over abortion pills seeking to restrict and deregulate mifepristone, States Newsroom reported.

Guttmacher Institute Principal Federal Policy Adviser Anna Bernstein said in a statement Friday that reinstating the in-person dispensation requirement for mifepristone would hinder abortion access. 

“If access to telehealth and mifepristone by mail is curtailed, more patients would be pushed toward in-clinic care, straining provider capacity and increasing wait times in an already chaotic landscape,” she said. “Given that travel is out of reach for many people, the result would likely be increased delays and more people unable to get the abortion care they need and deserve.” 

Kelcie Moseley-Morris contributed to this report. 

The Trump administration is using a law Congress passed in the 1990s after a wave of deadly violence at abortion clinics to prosecute demonstrators and reporters who were at a immigration-related church protest in Minneapolis last month. 

Independent journalists Don Lemon and Georgia Fort, along with several activists, are accused of violating a 1994 law that made physically obstructing access to reproductive health clinics and places of worship a federal crime. Lemon pleaded not guilty Friday, while Fort is set to be arraigned next week and has denied any wrongdoing. Other plaintiffs have vowed to fight the charges — they’re also accused of conspiring against churchgoers’ right to worship — and maintained they were exercising their First Amendment rights. 

Some abortion opponents say the law should be repealed entirely, even though the statute also protects access to anti-abortion crisis pregnancy centers. Reproductive rights advocates say getting rid of the law altogether could spur more attacks on clinics and providers, which already increased in recent years. 

“It would give an even stronger signal to the zealots who would wish to shut us down to intimidate and harm our clinic folks and patients,” said Julie Burkhart, who owns clinics in Wyoming and Illinois. 

The Minnesota indictment is only the second time that the Department of Justice has brought charges under the religious provision tucked in the Freedom of Access to Clinic Entrances Act. In September, the federal government filed a civil complaint against pro-Palestinian groups and demonstrators, accusing them of violating the FACE Act after they protested outside a New Jersey synagogue in 2024.

During a news conference announcing the charges, Harmeet Dhillon, the assistant attorney general for the DOJ’s civil rights division, said the New Jersey case was the “first time in history” the FACE Act was used to “prosecute an attack civilly on a house of worship.”  

While the Trump administration has started to use the FACE Act in religion-related cases, it has also relaxed enforcement of the law against people who interfere with access to abortion clinics. 

Republican President Donald Trump pardoned 23 anti-abortion protesters convicted of violating the law within weeks of taking office in January 2025, and the DOJ released a memo that stated abortion-related cases should only be pursued in “extraordinary circumstances,” such as death, serious bodily harm or severe property damage. 

“This sent a very clear signal to anti-abortion extremists that this administration was OK and even encouraged anti-abortion violence, and we’ve seen the same people that were pardoned within Trump’s first week in office go right back out and start harassing abortion providers and their patients, whether that is putting together blockades or clinic invasions,” National Abortion Federation President and CEO Brittany Fonteno told States Newsroom. 

FACE Act followed murder of abortion provider, clinic sieges 

Tactics by the anti-abortion movement were starting to reach a fever pitch in the U.S. before the FACE Act’s passage. In 1988, hundreds of protesters were arrested in Georgia during the “Siege of Atlanta,” where abortion opponents staged routine clinic blockades over a three-month period. In 1991, thousands of anti-abortion protesters were arrested by local officials for invading abortion clinics in Kansas during the “Summer of Mercy.” 

“We were literally unable to do our jobs,” said Burkhart, who worked in Wichita that summer with Dr. George Tiller, a provider who was later killed by an anti-abortion extremist. 

In 1993, Dr. David Gunn was murdered by an anti-abortion protester outside a Florida clinic, and six months later, Tiller was shot outside his Kansas clinic. Tiller survived that attack, but he was assassinated at his church in 2009.  

Sen. Ted Kennedy and then-Rep. Chuck Schumer, both Democrats, introduced the FACE Act in Congress alongside former Republican Rep. Connie Morella, and President Bill Clinton signed the legislation the following year. 

Legal experts said the religious part of the reproductive health law was added to broaden legislative support for the bill. 

The law protects reproductive health clinics and places of worship from being physically obstructed or damaged, and makes it a federal crime to intentionally injure, intimidate or interfere with access to those places. Violators face up to a year in prison or a $10,000 fine, and up to six months in prison for nonviolent obstruction. A defendant could face 10 years if they inflicted bodily harm or life behind bars if someone is killed.  

Mary Ziegler, an abortion historian and professor at the University of California, Davis School of Law, said the measure was modeled on other civil rights laws, which typically include protections for religious institutions. She said Congress already had a Democratic majority at the time, but the religious part of the law could have been added to avoid accusations of viewpoint discrimination. 

“Even people who saw themselves as pro-life were disturbed by some of the violence,” Ziegler said. 

After the law took effect, violence against abortion clinics declined by 30%, according to the National Abortion Federation. 

The power of anti-abortion groups like Operation Rescue, known for orchestrating mass clinic blockades, waned. 

“The FACE Act was created to suppress civil disobedience at abortion centers, so it’s had a massively negative impact on the anti-abortion movement,” said Terrisa Bukovinac, the founder of Progressive Anti-Abortion Uprising. 

Bukovinac’s group along with Students for Life of America and Alliance Defending Freedom have called for the law’s demise since the U.S. Supreme Court overturned the federal right to an abortion in June 2022. 

Trump reconfigures enforcement while abortion opponents call for repeal

Violence against abortion clinics increased after the Dobbs v. Jackson Women’s Health Organization decision. From 2021 to 2022, clinics saw a 100% increase in arsons, a 25% increase in invasions and a 20% increase in death threats or threats of harm, according to the National Abortion Federation. 

The Biden administration pursued enforcement of the FACE Act by prosecuting people convicted of blocking access to abortion clinics in Michigan, Tennessee and Washington, D.C. 

Trump pardoned all of those defendants. But for some abortion opponents, the Republican administration’s narrow use of the FACE Act does not go far enough. 

“It should be repealed because it’s a draconian law,” Bukovinac said. “There are local laws that address trespass, disorderly conduct, disruptions of churches, and various other violations of statutes, but the FACE law adds the full weight of the federal government in these situations.” 

Ziegler said the law isn’t a trespassing statute, it’s about conduct and obstruction. No legal challenges against the law have held up in court before or after Dobbs, she said. 

“If you’re shooting someone in the head because they’re trying to go to a synagogue or they’re trying to go into an abortion clinic — or you’re threatening to kill them or you’re physically blocking all the entrances — that’s not speech protected by the First Amendment,” Ziegler said. 

Matthew Cavedon, a criminal justice and religious liberty expert at the libertarian CATO Institute, has written that the law may be unconstitutional. He said the federal government has typically defended the FACE Act’s constitutionality based on the Commerce Clause and the 14th Amendment.

“Pro-lifers have made the point that in order to defend the FACE Act under the 14th Amendment, you have to have some sort of federal constitutional right to have an abortion,” Cavedon said. “Back in 1994 when the act passed, the Supreme Court said that you did have that right. It doesn’t anymore. That’s been reversed. So I think that’s a very strong argument.” 

U.S. Rep. Chip Roy, a Texas Republican, introduced a bill last year that would repeal the law. The House Judiciary Committee advanced the measure in June, States Newsroom reported. 

Roy did not respond to requests for comment, but during a hearing for the bill, he said he has been criticized by Trump administration officials who wanted to use the law to defend churches. 

“That’s not what my goal is,” he said. “My goal is to alleviate the politicization in the first place.”

Renee Chelian, the founder and CEO of Northland Family Planning Centers in Michigan, testified before the committee about the importance of the FACE Act and the invasion of one of her clinics during the first Trump administration. 

“Once the law went into effect, the violent blockades immediately stopped. This all ended when President Trump took office for his first term, emboldening extremists to resume their attacks,” she said. 

In August 2020, a group of protesters blocked the entrance to Chelian’s Sterling Heights clinics, preventing patients and staff from entering the clinic. 

“Patients were stuck in their cars, including three women who were coming in for abortions following the detection of fatal fetal anomalies,” Chelian said. One of those patients was losing amniotic fluid and needed to get to her appointment for the second day of her procedure, but protesters surrounded her car and chanted at her, her mother and her husband, according to the DOJ. 

Trump’s decision to pardon seven people who invaded her clinic “left us reliving our trauma and feeling abandoned by the government that is supposed to protect us,” Chelian told lawmakers. 

Last month, the Center for Reproductive Rights sued the Trump administration after the government did not respond to Freedom of Information Act requests about “selective enforcement” of the FACE Act and Trump’s pardons of 23 anti-abortion protesters convicted under the law. 

“This is straight out of the anti-abortion movement’s playbook,” said Sara Outterson, the center’s chief federal legislative counsel. “They know they can’t ban abortion outright in a number of states, so they’ll try everything they can to restrict access to care, including allowing criminals to harass people as they try to go in to get care.” 

Dr. Margaret Baum (second from left), chief medical officer for Planned Parenthood Great Rivers, stands with attorneys from the Planned Parenthood Federation of America on the steps of the Jackson County Courthouse in Kansas City, Missouri, on Jan. 12, 2026, the first day of a two-week trial over abortion restrictions. (Photo by Anna Spoerre/Missouri Independent)

The outcome of two trials in the coming weeks could shape what it will look like when voters overturn state abortion bans through future ballot initiatives.

Arizona and Missouri voters in November 2024 struck down their respective near-total abortion bans. Both states added abortion access up to fetal viability as a right in their constitutions, although Arizonans approved the amendment by a much wider margin than Missouri voters.

That was just the beginning of protracted legal battles.

Amy Myrick, senior counsel at the Center for Reproductive Rights, said ballot measures are a powerful and important step in returning abortion access to a state, but success on Election Day doesn’t mean the fight is over.

“State constitutions don’t automatically repeal laws,” Myrick said. “Sometimes, even if the state isn’t doing it, other groups or legislators will jump in to try to retain these restrictions.” 

The trial over Arizona’s abortion restrictions wrapped up this week, Arizona Mirror reported. Maricopa County Superior Court Judge Gregory Como seemed unconvinced of the argument that certain laws around how abortion medication can be prescribed, waiting periods and bans on abortions in cases of fetal abnormalities should remain enforceable.

A similar trial in Missouri will wrap up on Jan. 26 after hours of testimony about more than a dozen abortion restrictions state officials are seeking to preserve. The Republican supermajority state legislature is also putting a countermeasure to reinstate the abortion ban on the ballot in November, paired with a ban on gender-affirming care for minors. 

Arizona and Missouri have what are known by abortion-rights advocates as Targeted Regulation of Abortion Providers, or TRAP, laws passed by legislatures before the U.S. Supreme Court’s Dobbs decision in 2022. Even states without bans, like Connecticut, Maryland and Rhode Island, have statutes in place that the Guttmacher Institute considers TRAP laws. Abortion providers are subject to state licensing and other medical requirements, but as of December, 25 states still have laws that impose additional regulations for clinics, according to Guttmacher, such as facility size and transfer agreement requirements, or admitting privileges at local hospitals within 30 miles.

Officials and legislators usually argue in the statehouse and in court that the extra parameters increase the safety of abortion procedures, but the safety record is strong under existing medical requirements and is safer than childbirth, according to the American College of Obstetricians and Gynecologists. Studies show the risk of maternal death associated with childbirth is about 14 times higher than the risk associated with abortion.

But there are also other laws that advocates say are meant to discourage or frustrate those seeking abortion care, such as mandatory vaginal exams, waiting periods, or a requirement that the same physician must see an abortion medication patient over two subsequent visits. Some of those laws were passed over decades and helped drive abortion providers away, including in Missouri.

As a result, even though Missourians overturned the ban, abortion care remains difficult to obtain, and many are still leaving the state to get it, according to Missouri Independent.

“Because constitutional amendments don’t overturn conflicting laws, people can still experience injuries under these laws,” said Prachi Dave, senior managing legal and policy director at If/When/How, a reproductive rights legal services and advocacy organization. “For example, if a waiting period is interfering with my ability to access the care I am guaranteed under the newly passed amendment, then I would ask a judge to affirm that the law is getting in the way of my right. In doing so, lawsuits give practical effect to constitutional amendments.”

In a Michigan lawsuit led by advocacy groups, a judge ruled in May that a mandatory waiting period was unconstitutional after voters approved an initiative codifying reproductive rights.  

Wendy Heipt, attorney for advocacy organization Legal Voice in Washington, said even if some laws were ruled unconstitutional, they may have to be litigated again because the basis for the unconstitutional argument relied on the Roe v. Wade case that the U.S. Supreme Court overturned almost four years ago.

Heipt frequently works on cases in Idaho, where many lawsuits over the state’s near-total abortion ban have taken place in the past three years. Though still in effect, there is an effort to overturn the ban via ballot in November. 

The initiative is different from those approved in Arizona and Missouri because people in Idaho cannot submit constitutional amendments — only proposed state laws — for ballot consideration directly.

Melanie Folwell, lead organizer of the reproductive rights initiative in Idaho, said even if successful, it’s only one leg of a long race in restoring access. The initiative group, Idahoans United for Women and Families, drafted a bill that would have repealed existing abortion laws, but it was too long and legally complicated for the ballot. Instead, what they’ve come up with for voters is meant to establish a right to reproductive health privacy without undue government interference and override existing laws. 

The outcome of Missouri’s trial could be instructive for Idaho abortion-rights advocates, because the political environments are similar. Idaho has a lengthy list of its own waiting periods for abortion care, mandatory counseling and ultrasound requirements, and elected officials in the Republican-led state have repeatedly signaled their opposition to abortion access, including the attorney general. The legislature also has a Republican supermajority.

And since it can’t be a constitutional amendment, any new law may be more vulnerable to legal challenges. 

“There are things to learn from every one of the states that have reproductive access on the ballot, which is 17 states at this point,” Folwell said. “It is always instructive for us to see what plays out in that state’s legislature, what plays out with their courts.”

Myrick said the legal battles can feel discouraging, but voters shouldn’t let it stop them from using their voices to make their policy preferences known.

“Ballot measures are not the silver bullet. We need a lot of follow-up to make these rights real. And the attempts to keep these restrictions after the voters have spoken are blatantly anti-democratic, but they’re still happening,” Myrick said.

A trial over Missouri’s abortion regulations began Monday at the Jackson County Courthouse in Kansas City, Mo. Experts are watching the case, which could impact abortion access across the Midwest and South. (Photo by Kevin Hardy/Stateline)

KANSAS CITY, Mo. — The outcome of a trial over Missouri’s abortion regulations could ripple far beyond the state, potentially creating new availability for women in the Midwest and South who can’t access abortion close to home.

As a judge weighs the constitutionality of a litany of state restrictions on abortion, the stakes are clear for Missouri women: The decision could hamper access for nearly everyone in the state — or greatly broaden it in ways not seen in decades. That would allow women in a dozen nearby states with abortion bans to travel a shorter distance to access the procedure.

“Opening and reestablishing rights in the state of Missouri would help to alleviate some of the pressure that other states have since so many Southern states have banned abortion,” said Julie Burkhart, the co-owner of Hope Clinic in Granite City, Illinois. “It just seems logical that we would see a shift in migration patterns of patients in the country.”

At her clinic, about a 15-minute drive from downtown St. Louis, Missourians account for about half of all patients, Burkhart said. Though Missouri voters in 2024 enshrined a right to abortion in the state constitution, access has remained highly limited because of restrictive state laws. Only procedural abortions are available on a limited basis across three Planned Parenthood clinics in the state.

Many of those state laws face legal scrutiny this week as a Missouri judge weighs the constitutionality of regulations targeting abortion providers. Those include a 72-hour waiting period between initial appointments and procedures, mandatory pelvic exams for medication abortions and a ban on telemedicine appointments for medication abortions.

Planned Parenthood affiliates in Missouri argue state restrictions are unconstitutional under 2024’s voter-approved constitutional amendment. Over decades, state restrictions have gutted Missouri’s provider networks, limited appointment availability and ultimately forced abortions to a halt in 2022, before a limited number resumed after the 2024 vote.

Experts and advocates are closely monitoring the Missouri case, which is expected to be appealed regardless of the outcome, because of its practical implications on access in the region. While many women now rely on abortion medication, procedural abortion is still crucial for those seeking later-term abortions or who prefer an in-clinic procedure.

But the two-week bench trial in downtown Kansas City also tests lawmakers’ ability to put in place rules so restrictive that they effectively ban abortion — a practice used by anti-abortion lawmakers in other states looking to limit access to the procedure.

“Judges do not operate in a vacuum,” Burkhart said, “ … and we know for a fact that judges look outside the borders of their state for information and for guidance. I do see this as having national importance.”

That’s especially true in other states also litigating abortion access, including Arizona, Michigan and Ohio, said Rebecca Reingold, an associate director at Georgetown University’s O’Neill Institute for National and Global Health Law.

While state judges are not bound by the decisions of judges in other states, their deliberations can be informed by court rulings, particularly involving novel legal questions or areas of the law that are evolving.

“There is little doubt that advocates and decision-makers in other states navigating similar legal challenges are closely monitoring the litigation over Missouri’s abortion regulations,” Reingold said.

Restrictions targeting abortion

In the first days of the trial, Planned Parenthood leaders argued that ever-changing state laws and agency regulations have drastically limited access, caused needless red tape and posed privacy risk for their patients.

Dr. Margaret Baum, chief medical officer with St. Louis-based Planned Parenthood Great Rivers, said the Missouri requirements specifically target abortion rather than all other kinds of medical care.

“I provide vasectomies routinely. … And I am not required to have a complication plan, contact a primary care physician, even ask the patient how many miles they live from the health center.”

Opening day of Missouri abortion-rights trial focuses on decades of state restrictions

Baum said state-mandated reporting rules unique to abortion require clinicians to ask the race, education level, marital status and specific location of each patient — none of which is relevant to their care.

Planned Parenthood Great Rivers would like to offer abortion services in Springfield, Baum testified. Access in that region would provide an option for rural Missourians, and also could help serve residents in nearby Arkansas, Oklahoma and Texas, where abortion is almost universally banned.

But the organization’s facilities there do not meet state abortion regulations for physical attributes, including hallway size, doorway size and the number of recliners in recovery rooms, Baum testified.

Lawyers for the state defended Missouri’s restrictions as commonsense safeguards aimed at protecting vulnerable women. The attorney general’s office argued that complication risks of abortion justify additional state regulation — despite professional medical associations saying it’s generally safe. The AG’s office also maintained that Planned Parenthood faced a conflict of interest because of its financial motivations.

“Abortion is a business,” Deputy Solicitor General Peter Donohue said during a procedural argument on Monday. “Your Honor, the plaintiffs are asking to deregulate their profession in order to make more money.”

The state was expected to call as witnesses anti-abortion doctors and activists later in the trial.

Patients traveling for care

Since the U.S. Supreme Court’s ruling that overturned federal constitutional protections for abortion in June 2022, the number of abortions has increased slightly across the country, according to the health research nonprofit KFF.

The group points to expanded telehealth, which can offer medication abortion more affordably through virtual appointments.

Since the 2022 ruling and subsequent state abortion bans, patients have experienced higher travel costs for abortions and delays in care, according to research published in the American Journal of Public Health in July.

Researchers from the University of California, San Francisco found that travel time to access abortion increased from 2.8 hours to 11.3 hours for residents in states with abortion bans. Travel costs increased from $179 to $372. And more than half of survey respondents said their abortion care required an overnight hotel stay, compared with 5% before an abortion ban.

In 2024, an estimated 7,880 Missourians traveled to Illinois and 3,960 traveled to Kansas to access abortion, according to the Guttmacher Institute, a research and policy organization focused on advancing reproductive rights.

Those Missourians were among the approximate 155,000 people who crossed state lines to access abortion care that year, representing 15% of all abortions provided in states without total bans.

Ongoing uncertainty

Regardless of its outcome, the Missouri case is expected to be appealed. Even if the plaintiffs are ultimately successful, it may take a long time to restore care networks across the state, said Isaac Maddow-Zimet, a data scientist at the Guttmacher Institute.

“And that’s particularly the case when there are states that have a lot of legal uncertainty or restrictions coming into effect and then coming out of effect,” he said. “It’s not quick to open up a clinic. It’s not quick to even necessarily expand the kinds of services, or the kinds of the number of people that a clinic can see.”

Kimya Forouzan, the organization’s principal state policy adviser, said Missouri’s landscape is evidence that lawmakers can drastically curb abortion access without total bans. And despite an overwhelming vote to amend the constitution, legal battles can follow.

Even if the state’s laws are found unconstitutional, Forouzan said, lawmakers will likely still push anti-abortion measures. She noted that several bills have already been introduced in this year’s just-convened legislative session, and that Republican lawmakers are pushing a ballot measure to repeal 2024’s reproductive rights amendment.

“There’s very much a push to pass as many restrictions as possible and kind of see what happens later and how things shape up later. … Time will tell, but we do know that they’re still pushing forth restrictions,” she said.

Stateline reporter Kevin Hardy can be reached at khardy@stateline.org. Missouri Independent reporter Anna Spoerre can be reached at aspoerre@missouriindependent.com.

The William L. Guy Federal Building in Bismarck. A North Dakota-based Christian employers group filed a lawsuit against the Equal Employment Opportunity Commission a year ago over Biden-era regulations related to abortion and gender identity. (Photo by Michael Achterling/North Dakota Monitor)

The U.S. Equal Employment Opportunity Commission reached an agreement this month with a Christian business group to ignore regulations that allowed employees to receive abortion-related accommodations and barred workplace discrimination based on gender identity. 

Christian Employers Alliance President Margaret Iuculano, whose organization sued the EEOC over the two provisions in January 2025, said in a statement Monday that the deal was a “major win” for businesses looking to operate in accordance with their religion. The CEOs of Hobby Lobby, Regent Bank and AllBetter Health are on the board of the North Dakota-based nonprofit, which has more than 22,000 members across the country. 

The regulations, issued under former President Joe Biden’s administration, were already invalidated last year by federal courts, but the deal struck by the EEOC could foreshadow a move to rescind or rewrite rules for enforcing a landmark pregnant workers law. A spokesperson for the EEOC did not respond to requests for comment Tuesday. 

“As attacks on women’s reproductive choice continue to escalate, we are disappointed, but not surprised, that the Equal Employment Opportunity Commission has sided with the Christian Employers Alliance in federal court, relieving many large Christian employers of their obligation to protect employees seeking an abortion,” Inimai Chettiar, president of A Better Balance, said in a statement provided to States Newsroom. 

The Pregnant Workers Fairness Act, which took effect in 2023, requires employers with 15 or more staff to provide reasonable accommodations — additional restroom breaks, a stool to sit on and time off for doctors’ appointments, for example — as long as the requests don’t place “undue hardship” on the company. 

According to a Jan. 9 court order signed by a North Dakota district judge, the EEOC agreed that current and future members of the alliance will not be penalized for declining to accommodate abortion, making employees follow gender-specific dress codes or directing staff to use private spaces that don’t align with their gender identity. 

Under the stipulations, the agreement will expire if the EEOC issues new regulations for the Pregnant Workers Fairness Act and revises or rescinds gender identity-related guidance for complying with Title VII of the Civil Rights Act of 1965, which bars workplace discrimination. 

“The agreement does not prevent the EEOC from investigating allegations of unlawful conduct not specifically covered by this agreement, even if they are alleged within the same charge that alleges non-enforcement conduct against CEA or its members,” the order states. 

Andrea Lucas, the chair of the EEOC, has said she supports the pregnant workers law overall but disagrees that abortion should be included in the definition of “pregnancy, childbirth or related medical conditions” when interpreting the measure. 

She has also said the agency will reconsider regulations for the law once there was a Republican quorum reestablished on the commission. The Senate approved the confirmation of Brittany Bull Panuccio, the newest commissioner, in October during the federal government shutdown. 

Lucas also opposed harassment guidance issued by Biden administration officials that said employers should respect workers’ pronouns and allow staff to use bathrooms that align with their gender identity. 

Chettiar, A Better Balance’s president, said the laws’ regulations “clearly cover workers’ ability to receive reasonable accommodations for ‘pregnancy-related conditions,’ which has long been interpreted to include abortion as well as other essential reproductive healthcare like IVF. We will continue to fight to keep the regulations for the PWFA intact and as strong as possible as the EEOC appears poised to reopen them and potentially narrow the scope of the law.”  

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.

Abortion-rights advocate Kristin Hady helps a car navigate past protesters toward  A Preferred Women’s Health Center of Atlanta in Forest Park, Georgia, in August 2023. Independent clinics are facing fresh challenges, and at least 23 more closed this year, bringing the total to 100 since the Dobbs decision. (Photo by Ross Williams/Georgia Recorder) 

When Wisconsin Planned Parenthood clinics temporarily paused abortion services in October because of a new law halting federal Medicaid reimbursements, patients turned to the state’s two independent clinics for care. 

Demand at Affiliated Medical Services in Milwaukee quadrupled, according to clinic director Dabbie Phonekeo. 

“It happened all of a sudden. We were all scrambling to figure out what we needed to do and how we were going to accept all patients,” Phonekeo said. 

The staff secured additional funding to meet need before Wisconsin’s Planned Parenthood clinics resumed abortions, adapting under a law that bans certain reproductive health care providers from receiving federal funding until July 2026. 

“This was a reminder of why it’s so important to have independent clinics and abortion access overall,” Phonekeo said. 

At least 23 independent clinics have closed this year, according to a report released Tuesday by Abortion Care Network, compared with 12 last year.

Most were in states with abortion-rights protections, the report found. 

Independent providers face less recognition than Planned Parenthood and ongoing barriers to funding. Donations to abortion clinics and funds have waned, leading to more out-of-pocket costs for patients, States Newsroom reported last year.  

Independent clinics provide 58% of all abortions nationwide, while Planned Parenthood provides 38%, hospitals 3%, and 1% occur at physicians’ offices, according to the latest Abortion Care Network findings. 

Medication abortion, allowed during the first 10 weeks of pregnancy, has been a focus of abortion-rights advocates and opponents this year. But independent clinics are more likely to offer legal procedural abortions after that. 

More than 60% of all U.S. clinics that offer abortion care after the first trimester are independent, 85% that provide abortion at 22 weeks or later are independent, and all clinics that perform the procedure after 26 weeks are independent, according to the report. 

“While both medication and in-clinic abortion are safe and effective, people may need or prefer one method over another,” the report states. “This is especially true for patients for whom it’s not safe or feasible to terminate outside the clinic — including those experiencing intimate partner violence, minors without support at home, people experiencing homelessness, and patients who cannot take time off from work or caretaking.” 

The latest clinic closures come more than three years after the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision forced many to cease operations: 100 independent clinics closed between 2022 and 2025. 

Affiliated Medical Services in Wisconsin is one of the few independent abortion providers that was able to reopen after closing the day the nation’s highest court overturned federal abortion rights on June 24, 2022. 

The clinic reopened in March 2024 a few months after a Wisconsin judge ruled that a 19th century abortion ban was invalid, Wisconsin Examiner reported. 

Phonekeo said people were initially hesitant to book appointments at the clinic. 

“Most of our patients that we saw had asked, ‘Is this legal? Am I going to go to jail if I have an abortion today? Can we do this in Wisconsin?’ So I think a lot of patients were still afraid to be seen,” she said. 

Independent clinics could become even more significant to reproductive health care access if lawmakers permanently bar Planned Parenthood from receiving federal resources.  

Some anti-abortion groups have urged the Trump administration to disqualify Planned Parenthood as a federal vendor, States Newsroom reported in November. 

Nearly 50 Planned Parenthood clinics closed this year due to federal health officials’ cuts to Title X and Medicaid. At least 20 closed since a federal “defunding” provision that halts Medicaid funds for reproductive health care providers that offer abortion and received more than $800,000 in fiscal year 2023 took effect, according to a tally released on Nov. 12 by the national organization. 

Some of the clinics that closed did not offer abortion. And under the law, federal funding only covers abortions in extreme circumstances, so the Medicaid reimbursement ban primarily affects patients who go to Planned Parenthood for other services, like birth control, cervical cancer screening and treatment for sexually transmitted infections. 

Some independent clinics offer non-abortion care, too, but many don’t accept Medicaid, clinic directors said at a Wednesday news briefing. 

Amber Gavin is the vice president of advocacy of operations at A Woman’s Choice, an organization that has three clinics in North Carolina and one each in Florida and Virginia. She said staff members at the Charlotte location have seen an uptick in patients seeking STI testing and related services. 

Karishma Oza, chief of staff at DuPont Clinic in Washington, D.C., also said providers there have seen an increase in patients who are uninsured or underinsured since the Medicaid ban, which mostly affects Planned Parenthood, took effect. 

Phonekeo said the Wisconsin clinic hasn’t dealt with more demand for reproductive health care services beyond abortion. Still, Affiliated Medical Services offers birth control pills, IUDs, STI testing and treatment, miscarriage care and even follow-up care for medication abortion provided through online-only clinics such as Hey Jane. 

While all three clinic leaders said they don’t accept Medicaid, they offer sliding-scale payments for people who cannot afford the full cost of care. 

“We’re more than just abortion providers,” Phonekeo said.