Abortion provider Carafem’s phones were ringing off the hook over the weekend after a US appeals court reinstated a nationwide requirement that the drug mifepristone, one of two pills used for medical abortions, be available in person. The decision, issued on Friday, left patients unsure whether they would be able to receive their treatment over the phone. “People are scared, and they’re angry,” said Carafem’s chief operating officer, Melissa Grant. “I was contacted by people saying, This cannot be true. Do you still have medication available? Can’t you just give it to me? They were negotiating.”
With the limitation in place, Carafem quickly turned to a backup method. Instead of prescribing a protocol for two common medical abortion drugs—mifepristone, which blocks progesterone and prevents the pregnancy from progressing, and then misoprostol, which causes the uterus to contract—the agency began recommending misoprostol alone. Although less effective than the two-pill option, it has been widely used in the past. “We feel free to explain it,” Grant said.
Some Planned Parenthood clinics also used misoprostol-only medications this weekend. “Planned Parenthood providers are doing everything they can to make sure patients know that medical abortion is still safe, legal, and available,” said Danika Severino, vice president of care and outreach at Planned Parenthood Federation of America.
On Monday, the Supreme Court granted interim relief, putting the appeals court’s decision on hold for a week. The measure allows patients to resume receiving mifepristone at physical clinics at least until May 11, when SCOTUS will hear the case again. Carafem and Planned Parenthood say they are prepared to switch back to misoprostol only if necessary. Some providers, including digital abortion clinic HeyJane, have confirmed they will take that option if necessary.
Mifepristone was developed in the 1980s in France and has been widely studied for its safety and efficacy. It was approved by the Food and Drug Administration in 2000. Under President Joseph Biden, the FDA first allowed the drug to be obtained by mail instead of in person in April 2021, during the Covid-19 crisis. The agency permanently lifted the manual distribution requirement in 2023.
After the Supreme Court reversed Roe v. Wade in 2022, which ends the constitutional right to abortion, telehealth medical abortion has become a popular option, especially for patients in states that accept abortion restrictions. About one in three abortions that took place in the first quarter of 2025 used abortion pills obtained via telehealth, according to the public health nonprofit Plan C.
Access to mifepristone has become the next big battleground in reproductive health, with anti-abortion politicians and lobbyists seeking to restore personal dispensing requirements to the drug and, in doing so, make medical abortions harder to obtain.
After conflicting legislative decisions in 2023 caused confusion over whether mifepristone would be available in virtual clinics, some of them planned to switch to providing abortions only with misoprostol. Some virtual clinics offered single-pill options even before that. Carafem has offered misoprostol-only medical abortions since 2020, in an effort to provide patients with virtual care options during the early days of Covid.
Originally developed to treat stomach ulcers, misoprostol has been used in abortion since the late 1980s. It remains the primary method of abortion in many parts of the world where access to mifepristone is limited.
“Mifepristone and misoprostol are both very safe medications, and in general, having mifepristone increases the effectiveness and reduces the complication rates of medical abortions,” said Rachel Jensen, a fellow of the American College of Obstetricians and Gynecologists, which allows the protocol of misoprostol only when mifepristone is not available. The single-drug regimen is also endorsed by the World Health Organization, the Family Planning Association, and the National Abortion Federation.
