Why Medication Abortion Is the Top Target for Anti-Abortion Groups in 2026

This week would have marked the 53rd anniversary of Roe v. Wadethe 1973 Supreme Court decision that legalized abortion nationwide — that is, until 2022, when the court overturned it. Since then, abortion has been banned in 13 states and severely restricted in 10 others.

Yet anti-abortion activists remain frustrated, in some cases even more so than before. Roe deer was overthrown.

For what? Because despite the new legal restrictions, abortions have not stopped taking place, even in states that are completely banned. In fact, the number of abortions has not decreased at all, according to the latest statistics.

“Indeed, abortions have tragically increased in Louisiana and other pro-life states,” Louisiana Attorney General Liz Murrill said at a Senate Health, Education, Labor and Pensions Committee hearing this month.

This is largely due to the easier availability of medical abortion, which uses a combination of drugs mifepristone and misoprostol, and particularly the availability of pills by mail after a telehealth visit with a licensed health care professional.

Allowing telehealth access was a major change originally made on a temporary basis during the covid pandemic, when visits to a doctor’s office were largely unavailable. Before that, unlike most medications, mifepristone could only be dispensed directly and only by a healthcare professional individually certified by the Food and Drug Administration.

The Biden administration later permanently eliminated the in-person visit requirement — a change that the second Trump administration did not reverse.

While the percentage of medication abortions has increased every year since 2000, when the FDA first approved mifepristone for pregnancy termination, the Biden administration’s decision to drop the in-person delivery requirement has boosted its use. More than 60% of all abortions were performed using medication rather than a procedure in 2023, the most recent year for which statistics are available. That year, more than a quarter of all abortions were managed via telehealth.

Separately, President Donald Trump’s FDA approved a second generic version of mifepristone in October, angering abortion opponents. FDA officials said at the time that they had no choice: As long as the original drug remains approved, federal law requires them to accept copies that are “bioequivalent” to the approved drug.

It is clear that slowing down, or even reversing, the approval of pregnancy-terminating drugs is a top priority for abortion opponents. This month, Susan B. Anthony Pro-Life America called abortion drugs “the new public health crisis in the United States,” referencing their growing use to end pregnancies as well as allegations of safety concerns — such as the risk that a woman might receive these drugs unknowingly or suffer serious complications. Decades of research and experience show that medical abortion is safe and complications are rare.

Another group, Students for Life, has attempted to argue that biological waste from mifepristone use is contaminating the nation’s water supplies, although environmental scientists refute this claim.

Yet the groups are most frustrated not with abortion rights supporters but with the Trump administration. The object of most of their anger is the FDA, which they say is dragging its feet on the promised review of the abortion pill and the Biden administration’s relaxed requirements for its availability.

President Joe Biden’s Covid-era policy allowing abortion medications to be mailed “should have been reversed on the first day of the administration,” SBA Pro-Life America President Marjorie Dannenfelser said in a recent statement. Instead, nearly a year later, she continued, “pro-life states are completely weakened in their ability to enforce the laws they passed.”

Lawmakers who oppose abortion access are also putting pressure on the administration. “At an absolute minimum, previous in-person safeguards must be reinstated immediately,” Senate HELP Committee Chairman Bill Cassidy said during the hearing with Murrill and other witnesses who want to see the availability of abortion pills reduced.

Sen. Jim Banks (R-Ind.) said during the hearing that he hopes “the rumors are false” that “the agency is intentionally slowing down its study of the health risks of mifepristone.”

The White House and Department of Health and Human Services spokesmen have denied that the review was deliberately delayed.

“FDA’s scientific review process is thorough and takes the time necessary to ensure that decisions are based on gold standard science,” HHS spokesperson Emily Hilliard said in an emailed response to KFF Health News. “Dr Makary meets this standard as part of the ministry’s commitment to rigorous, evidence-based review. » This is a reference to Marty Makary, the FDA commissioner.

Revoking access to the abortion pill may not be as easy as supporters hoped when Trump returned to the White House. While the president achieved many of the goals of his anti-abortion supporters during his first term, particularly the confirmation of the Supreme Court justices who overturned Roe deer It’s possible, he was much less doctrinaire during his second round.

Earlier this month, Trump angered some of his supporters by advising House Republicans that lawmakers “need to be a little flexible” on the Hyde Amendment to please voters, referring to a decades-old appropriations rule that bars most federal funding for abortion and that some Republicans have pushed to apply more broadly.

And even though, on the anniversary of Trump’s inauguration, many analysts are emphasizing how well the Heritage Foundation’s 2025 project has been accomplished, the most notable parts on reproductive health have not yet been adopted. The Trump administration has not, for example, revoked the approval of mifepristone for termination of pregnancy, nor invoked the Comstock Act of 1873, which could effectively ban abortion nationwide by stopping not only the mailing of abortion pills, but anything used to perform abortions.

Yet abortion opponents have decades of experience holding out hope — and playing the long game.

HealthBent, a regular KFF Health News feature, offers insight and analysis on policies and policies from KFF Health News’ chief Washington correspondent Julie Rovner, who has covered health care for more than 30 years.