Two new federal actions highlight growing pressure on access to medication abortion

Two recent federal developments are drawing new attention to medication abortion, which is now used in more than half of all abortions in the United States.

On May 1, a federal appeals court temporarily blocked access to abortion pills by mail, a major way patients receive care today. The ruling reinstates a requirement that patients see a provider in person to obtain mifepristone prescriptions. The next day, mifepristone manufacturers asked the Supreme Court to step in and restore access, setting up a fast-moving legal fight over what happens next.

And in April, the Environmental Protection Agency (EPA) recommended that states begin testing drinking water for hundreds of pharmaceuticals—including medications used in abortion care and birth control pills. This is the first time pharmaceuticals have been included in federal water testing guidance.

Neither action, on its own, determines what happens next. But together, they reflect continued activity across different areas of law and policy that could meaningfully shape how medication abortion is accessed and regulated going forward.

Note: This is an evolving legal situation. On May 14, the Supreme Court blocked the federal appeals court ruling, allowing access to mifepristone via telehealth providers while the case moves forward.

Why it Matters

There are several possible real-life outcomes from these two decisions, affecting both medication abortion and birth control pills:

• Abortion access could shift from remote to in-person—everywhere. If telehealth and mail options are limited, patients may need to visit clinics or navigate more complex, state-specific pathways to care.
• Decisions about access could evolve beyond healthcare. The EPA guidance introduces a new way to evaluate these medications—through environmental policy. This could lead to state agencies, regulators, and attorneys general playing a larger role in how these medications are managed.
• The impact could extend beyond abortion care. Some of these medications are also used for conditions like autoimmune diseases, ectopic pregnancies, and gastrointestinal issues, so changes could affect how they are prescribed or accessed more broadly.
• New requirements or restrictions could emerge over time. Monitoring these medications in water systems could lead to additional rules around how they are dispensed, handled, or tracked, even though none are currently in place.

Background

These developments reflect two different but connected pathways shaping access to medication abortion: court rulings that directly affect how care is delivered, and federal guidance that could influence how medications are regulated over time.

The EPA regularly publishes guidance to help states decide what substances to monitor in drinking water. In its latest update, the agency included a list of hundreds of pharmaceuticals recommended for testing—among them, medications used in abortion care and hormonal contraceptives, including birth control pills.

The guidance is advisory and does not require states to take action. It also does not mean the EPA has determined these medications are unsafe. Current research shows that pharmaceutical levels in water systems are extremely low and not considered a risk to human health.

At the same time, medication abortion has become a central focus of federal and state policy activity. In addition to the latest appeals court ruling, here are the other efforts at play:

• Federal legislation has been introduced to revoke FDA approval of mifepristone
• The FDA has launched a new safety review of the drug
• Several states have introduced “catch kit” legislation based on environmental claims (none have passed)
• A federal bill (HR 7983) was introduced in March using a similar "Clean Water for All Life" approach

Taken together, these developments reflect a broader shift in how medication abortion and birth control pills are being approached—through multiple areas of law and regulation, not just healthcare policy.

Related WRDI Reporting

Reproductive Rights Coverage
Congress and federal agencies turn attention to medication abortion
The shrinking reality of "legal" abortion
National Women's Rights Summary

Sources

NBC News - Appeals court blocks access to abortion pills via telehealth and mail nationwide
Guttmacher Institute - The War on Mifepristone: How Junk Science and False Narratives Threaten US Abortion Access
Abortion, Every Day - The Biggest Attack on Abortion Since the End of Roe