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.” 

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.