On October 28, 2026, a U.S. Court of Appeals panel heard arguments from Republican lawmakers in Richmond, Virginia, to limit state access in North Carolina. This new law, if passed, would ensure that mifepristone could only be prescribed via an in-person visit and would require a similar follow-up appointment. Mifepristone, the “abortion pill,” is the main method through which women can receive safe medication-induced abortions, along with its counterpart, misoprostol, which are successful in terminating pregnancies with up to 99% efficacy within the first 70 days. The judges on the panel were skeptical of the Constitutionality of the rule preventing limits, particularly following the Dobbs decision in 2022, and were concerned that preventing restrictions would contradict the Dobbs decision.
Mifepristone has been one of the two-step drugs that has been in use in the world for over 40 years and FDA-approved since 2000. Currently, twenty-eight states in the United States have restrictions on medication abortion, which include limits on in-person appointments and follow-up appointments, and the spread of misinformation to women seeking this type of care. The misinformation can include discussions of “abortion reversal pills”, advertised to prevent women from terminating their pregnancies. California is litigating this spread of misinformation by organizations advertising these pills, as there is a dangerous risk that these pills could cause harm to women who start the abortion with mifepristone. People have also brought safety concerns about mifepristone to Congress, which has led to discussion of its safety concerns, which have been unsubstantiated. As a result, there is an ongoing FDA and Kennedy-led investigation into mifepristone. Mifepristone is used in over two-thirds of all abortions, so further limitations on its use could have widespread nationwide effects on access to abortion care throughout the country.
Reproductive rights litigation remains a challenge that many states face. In the wake of the Dobbs decision in 2022, many states enacted auto-ban laws on reproductive rights and passed legislation to further limit access to abortion care, as well as criminalizing pregnancy termination, regardless of the method used. North Carolina is a key state providing abortion care for out-of-state patients, ranking #2 in the country. The state also protects those who use telehealth to access abortion care through shield laws, which would be threatened if the bill were passed. If this were to change, the eighteen percent of abortion cases done through telehealth would diminish. This would place the burden of travel on out-of-state patients to travel to receive abortion treatment twice.
Virginia, one of the last Southern states with access to abortion care, recently put an item on the ballot to preserve reproductive rights for people within the state of Virginia. If this bill is agreed on, it will protect the right to access a broad array of healthcare services, including prenatal care, post-partum care, fertility, and miscarriage care throughout the state. Virginia has a history of passing legislation to protect reproductive rights, including the Reproductive Health Protection Act before the Dobbs decision in 2020. It will be important to keep an eye on whether the law is passed and, if it is, the effects it has on surrounding states.