More than a hundred reproductive health physicians were gathered in Washington, D.C., on Friday afternoon, listening to an update on the shifting legal landscape of reproductive health care.

The presentation by Molly Meegan, the chief legal officer of the American College of Obstetricians and Gynecologists, covered past federal court rulings on the abortion pill mifepristone. Ms. Meegan had no idea that another ruling on mifepristone had arrived as she spoke, temporarily blocking the prescription of the pill by telemedicine and delivery of the drug by mail.

Ms. Meegan learned about the ruling when a reporter broke the news to her immediately after the session and a colleague pulled up the full text.

“This is not a ruling based in evidence, science or best interests of women,” she said.

The order, by a panel of the U.S. Court of Appeals for the Fifth Circuit in a case filed by Louisiana which is seeking to stop distribution of the drug by mail, pauses a major avenue for abortion access in the United States. The court said that while that lawsuit proceeded, the Food and Drug Administration needed to reinstate a requirement that patients visit medical providers in person to obtain mifepristone.

On Saturday afternoon, a mifepristone manufacturer filed an emergency appeal to the Supreme Court asking the high court to restore full access to mifepristone.

If the Supreme Court lets the Fifth Circuit’s order stand, it would upend access to a means of abortion that has been steadily growing in recent years. And as the midterm elections approach, abortion has once again been thrust into the national spotlight, as organizations that provide and support abortion services and those that oppose abortions unleased a flurry of responses.

“This decision represents the most sweeping threat to abortion since the overturning of Roe v. Wade,” said Kelly Baden, vice president for public policy at the Guttmacher Institute, a research organization that supports abortion rights. “If allowed to stand, it would severely restrict access to mifepristone in every state, including those where abortion is broadly legal and where voters have acted to protect abortion rights.”

Anti-abortion groups celebrated the ruling. Marjorie Dannenfelser, president of Susan B. Anthony Pro-Life America, called the court’s decision “a huge victory for victims and survivors of Biden’s reckless mail-order abortion drug regime.”

Carol Tobias, president of National Right to Life, said in a news release that the ruling “recognizes that the FDA cannot simply sweep legitimate safety concerns aside in favor of politics.”

Abortion opponents have argued that the F.D.A.’s decision to allow abortion pills to be available by mail posed safety risks to women and violated the sovereignty of states that had banned abortion. Major medical organizations and supporters of reproductive rights have pointed out that more than 100 studies have found the pills to be safe and effective, with serious side effects being rare.

Medication is now the method used in nearly two-thirds of abortions in the United States, and is typically delivered in the form of a two-drug regimen through the first 12 weeks of pregnancy.

The first of those drugs is mifepristone, which was approved in 2000, and blocks a hormone needed for a pregnancy to develop. The second drug, misoprostol, has many other medical uses and was not affected by the Fifth Circuit ruling.

Typically, misoprostol, which causes contractions similar to a miscarriage, is taken 24 to 48 hours after mifepristone. But several providers said they were prepared to continue telemedicine services prescribing only misoprostol, which can be used on its own for abortion, although it is considered somewhat less effective and more likely to have side effects.

Earlier on the day of the ruling, Planned Parenthood of Greater New York had announced an expansion of its telemedicine abortion service. After the Fifth Circuit decision, the organization said it would continue to provide telehealth abortion with misoprostol.

“In the wake of yesterday’s harmful decision by the Fifth Circuit, Planned Parenthood Direct is mailing misoprostol-only prescription kits,” said Jacquelyn Marrero, a spokesperson for Planned Parenthood of Greater New York.

Telemedicine abortion has steadily increased since the F.D.A. began allowing it in 2021. As of the first six months of 2025, more than one-fourth of abortions in the country were provided via telemedicine, according to a report from a reproductive rights research group.

Although abortion is currently banned or restricted in 20 states, over 100,000 patients per year in those states have been receiving pills through the mail. Those pills are prescribed and shipped by medical practitioners in states that have abortion shield laws. Officials in those shield-law states are prevented from obeying subpoenas, extradition requests and other legal actions that states with bans take against abortion providers.

The laws are being tested by several cases that are expected to lead to a constitutional showdown over whether states must honor one another’s abortion laws.

Dr. Angel Foster, co-founder of The Massachusetts Medication Abortion Access Project, which operates under that state’s shield law, said in a statement that her organization was consulting legal experts about the ruling’s implications and that the group would “do everything in our power to continue providing care to people in all 50 states.”

Dr. Jodi Abbott, a specialist in high-risk pregnancies who is a consultant to the Massachusetts project, said it would continue to prescribe and mail misoprostol for abortion use. “We have no concerns about its safety or efficacy,” Dr. Abbott, who is also a clinical professor at Boston University, said of using misoprostol alone. “But we also know it’s not optimal.”

This is a developing story. Please check back soon for updates.

Kate Zernike contributed reporting.