On October 1, 2025, a significant legal battle over the abortion medication mifepristone took a new turn, as a Texas federal judge transferred the case to Missouri. The move, prompted by jurisdictional questions, shifts the center of a closely watched fight over abortion access and federal drug policy to the Eastern District of Missouri in St. Louis. The implications stretch far beyond legal technicalities, touching on public health, state politics, and the ongoing national debate over reproductive rights.
The lawsuit at the heart of this dispute challenges the U.S. Food and Drug Administration’s (FDA) policies regarding mifepristone, a medication used both to treat miscarriages and to induce abortions in early pregnancy. According to the Missouri Independent, the plaintiffs are demanding a return to stricter federal regulations: three required in-person doctor visits, a reduction in the gestational limit for mifepristone from 10 weeks to 7 weeks, and a rollback of recent changes that allowed the medication to be mailed and prescribed online or through pharmacies.
But how did this case end up in Missouri? The saga began in Texas, where a group of anti-abortion doctors and medical organizations filed the original lawsuit. The case quickly attracted national attention, as it questioned the very foundation of FDA approval for a drug that has been in use for nearly three decades. However, in June 2024, the U.S. Supreme Court rejected the lawsuit, concluding that the original plaintiffs lacked standing—they could not show they had been directly harmed by the FDA’s policy changes. Erin Morrow Hawley, who argued the case before the Supreme Court, is notably the wife of U.S. Senator Josh Hawley of Missouri.
Undeterred, attorneys general from Missouri, Kansas, and Idaho refiled the litigation, this time focusing on alleged harms to their states. When the case returned to Texas federal court, Judge Matthew Kacsmaryk ultimately found that he had no jurisdiction over the remaining plaintiffs. In his ruling, Kacsmaryk wrote, “Instead of returning this years-long case to square one,” it made sense to transfer the case to Missouri “to avoid the costs and delay” that would come from dismissing the lawsuit only for it to be refiled elsewhere. He emphasized that “the Eastern District of Missouri is an accessible district with a major city.”
The Missouri Attorney General’s Office welcomed the transfer, stating, “This order ensures Missouri’s case will be heard where it belongs: in Missouri. We will continue protecting the health and safety of women and children in our state and continue fighting to hold the Biden Administration and its allies accountable for unlawfully loosening safeguards on chemical abortion drugs.”
Yet the move has not quieted the controversy. Abortion rights advocates and medical professionals quickly responded. Emily Wales, president and CEO of Planned Parenthood Great Plains, said, “This case has always been about ideology, not patient safety. It’s no surprise it has now been transferred to a district where nearly half the bench was elevated to the judiciary after undermining abortion rights at the Missouri attorney general’s office.” Four of the nine judges in the Eastern District of Missouri were appointed in May by President Donald Trump, and two—Josh Divine and Maria Lanahan—worked on the mifepristone case before joining the bench.
Missouri’s legal and political landscape around abortion is complex. Last November, voters codified the right to abortion in the state constitution. However, medication abortion remains inaccessible through Planned Parenthood clinics in Missouri, as a Jackson County judge weighs whether to keep in place two state regulations that Planned Parenthood says are preventing its providers from performing medication abortions. Margot Riphagen, president and CEO of Planned Parenthood Great Rivers, commented, “In Missouri, we are all too familiar with the attacks on medication abortion not grounded in science, and continue to witness the detrimental public health outcomes as a result of politically motivated lawsuits, misinformation, and restrictions.”
The lawsuit’s arguments center on claims that the FDA’s loosening of restrictions—particularly policies allowing for online prescriptions and mailing of mifepristone—has led to unsafe conditions. The attorneys general wrote in their amended lawsuit, “The FDA has enabled online abortion providers to mail FDA-approved abortion drugs to women in states that regulate abortion—dispensing abortion drugs with no doctor care, no exam and no in-person follow-up care. These dangerous drugs are now flooding states like Missouri and Idaho and sending women in these states to the emergency room.” They argue that such policies make it difficult for state law enforcement to detect and deter violations of state abortion laws.
On the other side, the FDA maintains that mifepristone is safe when used as directed. According to their data, cramping and bleeding are common side effects, and patients are advised to contact their doctor if they experience heavy bleeding, abdominal pain, or fever—guidance that also applies to those who have had surgical abortions, miscarriages, or delivered a baby. Since mifepristone was approved 28 years ago, 32 deaths have been reported among 5.9 million women who took the medication between 2000 and 2022. Of these, 11 were due to sepsis, 20 were homicides, and two were suicides.
Former Missouri Attorney General Andrew Bailey added another layer to the debate, arguing in court filings that access to mifepristone lowered “birth rates for teenaged mothers,” which he claimed contributed to population loss, diminished political representation, and loss of federal funds. He wrote, “Younger women are more likely to navigate online abortion finders or websites ordering mail-order medication to self-manage abortions.”
The transfer of the case to Missouri has sparked renewed debate among legal observers, public health experts, and activists on both sides of the abortion divide. Supporters of the lawsuit see it as a necessary step to restore what they describe as “long-standing safety requirements” and to reinstate state control over abortion regulations. Critics, however, view the litigation as a politically motivated effort to restrict access to a safe and widely used medication, despite evidence and endorsements from major medical organizations.
As the case moves forward in the Eastern District of Missouri, all eyes will be on how the court navigates these competing claims—balancing concerns about patient safety, state sovereignty, and federal authority. The outcome could have sweeping consequences, not only for Missouri but for abortion access across the United States, as it tests the limits of state attempts to regulate or restrict medications approved by federal authorities.
For now, the legal and political wrangling continues, with the fate of mifepristone’s accessibility—and the broader fight over reproductive rights—hanging in the balance.
