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A federal court has thrust the issue of abortion back into the national spotlight, just months before the midterm elections.
Voter anger about abortion rights after the Supreme Court overturned Roe v. Wade in 2022 helped propel Democrats to a series of midterm victories that year.
But when then-Vice President Kamala Harris lost the White House despite prioritizing abortion messaging, the issue took a back seat to affordability, the economy and cost-of-living concerns.
Now, the Supreme Court is again faced with a potential nationwide ban on mail-order mifepristone, creating an opening for abortion rights advocates and a political headache for the Trump administration and Republicans in tough races.
Access to mifepristone, the first in the two-drug regimen commonly used in medication abortion, has emerged as one of the most significant battles over abortion in the years since Roe v. Wade was overturned in Dobbs v. Jackson Women’s Health Organization.
But the Trump administration has stayed largely silent on the politically fraught topic, frustrating the GOP’s anti-abortion base.
A conservative federal appeals court on Friday severely curtailed abortion access when it prohibited mifepristone from being prescribed without an in-person doctor visit. Supreme Court Justice Samuel Alito then temporarily restored mail-order access— for one week.
“This is the biggest setback nationally for abortion access since Dobbs,” said Mini Timmaraju, president of the national abortion rights group Reproductive Freedom for All. “We’re relieved temporarily, but we are not out of the woods.”
The fight over abortion has continued in many states even as it has lost some potency on the national level. Reproductive rights advocates are hopeful they can use the lawsuit to help elevate the issue back into the consciousness of voters nationwide.
“This is certainly the most significant development in the courts on abortion since the Dobbs decision overturning Roe, so I think when people start to understand what’s happening, they’re going to be pretty shocked and outraged by that,” said Jessica Arons, a senior attorney at the American Civil Liberties Union.
“When voters are focused on it, they absolutely turn out to support protections for abortion rights,” Arons said.
In the aftermath of the Dobbs decision, there was a flurry of battles at the state level over abortion protections. Nearly every state that put a referendum on the ballot to protect abortion rights was successful.
Then in 2024, just months before the presidential election, the Supreme Court unanimously upheld access to mifepristone on a technicality, ruling that doctors and medical groups opposed to abortion did not have a legal right to sue.
Harris banked on abortion, but voters said they care more about inflation, the economy and other pocketbook concerns.
Timmaraju said in the wake of 2024, her group has been working to make voters understand abortion is an economic issue.
“You don’t want to segregate issues around health care and reproductive freedom from the economy, when you know having a child is the single most significant financial decision most families will ever make,” Timmaraju said.
“I do think cases like this and instances like this are important illustrative moments for us to explain to voters directly … that this is not settled law, that we are still under attack, and that the 5th Circuit [Court of Appeals] can make a decision that impacts care nationwide, including in blue states that have protected access,” Timmaraju added.
Democrats are taking notice, and some are ramping up their messaging.
A majority of Democratic lawmakers in Congress filed an amicus brief with the Supreme Court on Tuesday, urging the justices to overturn the lower court’s ruling.
At the state level, the Democratic Governors Association (DGA) said it was ready to “go on offense and hold Republicans accountable.”
“With 36 critical governor’s races this year and extreme Republican candidates for governor wholeheartedly embracing this dangerous and deeply unpopular agenda, electing Democratic governors who will protect fundamental freedoms has never been more important,” DGA Executive Director Meghan Meehan-Draper said in a statement.
Medication abortion is the most common pregnancy termination method. Mail-order pharmacies, combined with blue state “shield laws” protecting clinicians from prosecution, have helped women maintain access even as conservative states ban or severely limit access to abortion clinics.
As a result, abortions have increased despite the end of Roe.
Medication abortion accounted for roughly two-thirds of all abortions in the U.S. in 2023, according to the Guttmacher Institute, which tracks abortion policy. In 2025, online-only clinics accounted for about a quarter of clinician-provided abortions in the United States.
After Roe was overturned, the Biden administration in 2023 permanently ended the in-person dispensing requirement for mifepristone.
The Trump administration has left those Biden-era regulations in place, keeping the issue out of the political spotlight but angering anti-abortion lawmakers and advocates, who have been demanding the White House stop the widespread proliferation of mifepristone.
The White House has not commented publicly about the case and has tried to thread the needle in lower courts. The administration has not outright defended mifepristone’s safety, but it has argued lawsuits should be thrown out for procedural reasons.
The Department of Justice last year asked a court to throw out a challenge from conservative states to the mifepristone regulations, arguing they did not have standing to sue.
The Food and Drug Administration (FDA) is undertaking a review of the safety of mifepristone, but there’s been no public indication when that will be complete.
When prominent anti-abortion groups demanded the ouster of FDA Commissioner Marty Makary over the lack of action, the White House dismissed those calls as “uninformed attacks” and denied that the review was being delayed.
On Monday, the anti-abortion group SBA Pro-Life America again called for Makary’s ouster.
“This is a five-alarm crisis for the pro-life movement and for the GOP,” the group’s president, Marjorie Dannenfelser, said in a statement. “The GOP cannot win without its base and simply will not get the enthusiasm that drives turnout without leadership from the top.”
