As the United States barrels toward the 2026 midterm elections, the battle over abortion rights is shifting away from the ballot box and into the nation’s courtrooms and federal agencies. While voters in states like Nevada and Virginia will face pivotal ballot measures on abortion, the most consequential fights are unfolding in legal briefs, regulatory offices, and the sometimes murky intersection of state and federal law.
At the heart of these disputes is mifepristone, a medication that, when used in combination with misoprostol, accounts for roughly two-thirds of all abortions in the U.S., according to the American Civil Liberties Union (ACLU). Approved by the Food and Drug Administration (FDA) in 2000, mifepristone’s regulatory journey has been anything but straightforward. Restrictions were eased in 2016 and 2021, allowing for expanded gestational limits and the ability for patients to receive the drug by mail, bypassing the need for in-person pick-up. These changes, hailed by reproductive rights advocates as a lifeline for patients—especially in states with abortion bans—have become the latest flashpoint in the national debate.
On December 9, 2025, the attorneys general of Florida and Texas filed a sweeping, 120-page lawsuit in federal court in Wichita Falls, Texas, challenging every major FDA decision on abortion drugs since 2000. The suit alleges that the FDA’s approval and subsequent deregulation of mifepristone and misoprostol were “arbitrary, capricious” and constituted an “abuse of discretion,” as reported by the Associated Press. The complaint further argues that the FDA’s actions violated the Administrative Procedure Act and ignored the constraints of the 1873 Comstock Act, which plaintiffs say prohibits mailing abortion drugs.
“The United States Food and Drug Administration is responsible for ‘protect(ing) the public health by ensuring that … drugs are safe and effective. Yet the FDA's approval and deregulation of abortion drugs have placed women and girls in harm's way,” the lawsuit claims, echoing a refrain that has become familiar in recent years among anti-abortion activists.
But reproductive rights advocates and medical experts have pushed back hard. Julia Kaye, senior staff attorney with the ACLU’s Reproductive Freedom Project, stated, “These lawsuits have nothing to do with the safety of this medication and everything to do with making it harder for people to get an abortion. Politicians in Texas and Florida are asking for a nationwide ban on a safe and effective medication that millions of Americans have used since the FDA first approved it 25 years ago.” The ACLU’s position is buttressed by decades of peer-reviewed research indicating that medication abortion is highly effective—about 98% when begun before ten weeks’ gestation—and complications such as infection or hemorrhage are exceedingly rare.
The stakes are especially high in states like Florida, where a law that took effect in May 2024 bans most abortions, bars telehealth abortions, and requires in-person dispensing of abortion drugs. Texas, meanwhile, has enacted HB 7, a law allowing private citizens to sue anyone attempting to mail abortion pills into the state. These state-level restrictions are now colliding head-on with shield laws in eight states that protect providers who offer reproductive health care—including medication abortion—to out-of-state patients, regardless of where the patient resides.
This legal tug-of-war has already produced dramatic courtroom showdowns. In late 2024, Texas sued a New York doctor for violating Texas abortion and licensure laws, and Louisiana indicted the same physician in early 2025. New York, citing its shield law, refused to enforce Texas’s fines and denied Louisiana’s extradition request. According to reporting from Rewire News Group, these state-to-state legal battles are only heating up, with Texas’s HB 7 representing the first law in the country to explicitly target shield laws.
On the federal stage, the fight over mifepristone is just as fierce. In 2022, the Alliance for Hippocratic Medicine—a coalition of anti-abortion physicians—sued the FDA over its approval and deregulation of mifepristone. The U.S. Supreme Court ruled in 2024 that the Alliance lacked standing to sue, but the case lives on in lower courts, with Kansas, Missouri, and Idaho joining the fray in 2023 and Louisiana filing a separate challenge. The focus, in many of these cases, is on the FDA’s 2021 decision to lift in-person pick-up requirements, which opened the door for mailed abortion pills.
In October 2025, a federal court in Hawaii reached a different conclusion, finding that mifepristone’s safety record required the FDA to reconsider whether any restrictions were necessary at all. Meanwhile, 51 Republican senators and 22 Republican attorneys general have called on the FDA to reinstate in-person restrictions, while 47 Democratic senators and 20 attorneys general have urged the agency to remove all remaining barriers. According to Bloomberg, the FDA in early December 2025 quietly postponed its planned review of mifepristone regulations until after the 2026 midterm elections, a move seen by many as a bid to avoid political fallout.
The political ramifications are already being felt. In November 2025, Democrats secured significant victories in New Jersey, Virginia, and Pennsylvania—states where abortion was not on the ballot but where the issue loomed large. Virginia’s newly elected governor, Abigail Spanberger, pledged to protect abortion access, while her opponent supported a ban. In Pennsylvania, voters opted to maintain a liberal majority on the state supreme court, which previously struck down a prohibition on Medicaid-funded abortions.
Ballot initiatives remain a potent tool for both sides. Nevada will once again ask residents in 2026 to approve constitutional protections for abortion rights, after a similar measure passed with just over 64% of the vote in 2024. Virginia is expected to follow suit, while anti-abortion activists in Missouri are working to reverse a 2024 amendment that enshrined abortion rights in the state constitution. In 2024 alone, fourteen states put abortion rights on the ballot, with eleven measures passing—a testament to the enduring salience of the issue for American voters.
Yet, as legal scholar Rachel Rebouché noted in an analysis for Rewire News Group, “With little political support to pass a nationwide abortion ban, making it illegal to mail abortion pills is the most immediate way to obstruct reproductive health care in states with abortion bans.” The question, she says, is whether courts or federal agencies will do what democratic processes have not: restrict access to medication abortion for millions of Americans.
For now, the nation’s courthouses and federal offices are the frontlines in America’s abortion wars, with the outcome likely to shape not only the 2026 elections but the future of reproductive rights for years to come.
