Most pro-lifers are familiar with significant abortion-related legal cases, such as Roe v. Wade, Planned Parenthood v. Casey, and Dobbs v. Jackson Women’s Health Organization. But few have ever heard about Louisiana v. FDA. And yet, 20 years from now, we may look back and conclude that this little-noticed ruling—and whatever the Supreme Court does with it next—mattered more for the future of unborn life in America than any of the better-known headline cases.
The case is about whether abortion pills can be mailed directly into states where abortion is illegal—and in the span of 72 hours, two federal courts gave opposite answers.
In a unanimous opinion issued on May 1, the Fifth Circuit panel reinstated the FDA’s pre-2023 in-person dispensing requirement for mifepristone, the first drug in the two-drug medication abortion regimen. Until last week, the FDA’s 2023 rule allowed mifepristone to be prescribed via telemedicine and mailed directly to a patient’s home—no clinic visit, no pharmacist, no in-person evaluation needed. Then, on May 4, the Supreme Court issued an administrative stay allowing the practice to continue nationwide while the underlying litigation proceeds.
The case is about whether abortion pills can be mailed directly into states where abortion is illegal—and in the span of 72 hours, two federal courts gave opposite answers.
The numbers behind this rule explain why the stakes are so high. By the first half of 2025, more than one in four U.S. abortions were obtained via telemedicine. Medication abortion (using mifepristone) accounted for the majority of abortions in 2023 in nearly all U.S. states without a total ban, ranging from 44 percent in Washington, D.C. and 46 percent in Ohio to 84 percent in Montana and 95 percent in Wyoming. And in the most recent year for which we have full data, an estimated 91,000 abortions were provided by telehealth in states with total bans.
Many of us pro-lifers haven’t fully reckoned with the fact that, while Dobbs returned the question of abortion to the states, the FDA quietly took it back. It’s hard to fight for life when abortions are invisible. If mifepristone can be prescribed by a doctor in California and shipped to a teenager in Baton Rouge, then the laws in Baton Rouge are, in practical effect, unenforceable in the earliest state of pregnancy. The result is that the Dobbs decision becomes toothless and every mailbox becomes a potential abortion clinic.
Why It’ll Be Hard to Undo
The Fifth Circuit’s ruling is a genuine victory worth celebrating. But pro-lifers should also recognize that even if the Supreme Court ultimately upholds it, three deeper currents make the medication-abortion era difficult to roll back.
First, there’s no political will to restrict abortion in the first few weeks of conception. This is the hardest truth for pro-lifers to absorb. The 2024 Republican platform—the less pro-abortion of the two major parties—dropped its long-standing support for a national 20-week limit, declined to mention the Comstock Act (which prohibits mailing abortion drugs), and committed only to opposing “late term abortion” while affirming support for IVF.
The platform leaves abortion regulation entirely to the states. If even the GOP is unwilling to defend the unborn earlier than the third trimester, the political ceiling for restoring real protections is lower than many activists realize or concede.
Second, America has adopted a “don’t ask, don’t tell” posture toward private vice. From 1994 to 2011, the U.S. military operated under a policy in which gay and lesbian service members wouldn’t be asked about their sexual orientation and wouldn’t be expelled for it, but were also not permitted to disclose it. While the compromise pleased almost no one, it survived for nearly two decades because it allowed the government to avoid moral confrontation by keeping behavior private.
That same compromise has spread throughout American culture. Pornography is socially condemned in the abstract and consumed by tens of millions in private. Casual drug use, gambling, and marital infidelity are often publicly regretted while being quietly tolerated. As long as a behavior is conducted behind a closed door, our cultural instinct is to look away and “mind our own business.”
Mifepristone fits this pattern, since a pill that arrives in a plain envelope and is taken in a bathroom is the most “don’t ask, don’t tell” form of abortion ever devised. It lets a culture believe abortion has receded simply because abortion moved from clinics to our homes.
Third, America’s moral imagination still doesn’t extend to the embryo. The pro-life movement has always relied, whether it wanted to or not, on visual moral disgust. The horror of a 20-week abortion is something even many of our pro-choice neighbors feel in their stomachs. But an embryo at six or ten weeks—the gestational range in which most medication abortions occur—is morally invisible for most of our neighbors. It doesn’t look like a baby. It looks, to the uninstructed eye, like nothing at all.
An embryo at six or ten weeks is morally invisible for most of our neighbors. It doesn’t look like a baby. It looks, to the uninstructed eye, like nothing at all.
This is why evangelicals and other Christians—people who would march against late-term abortion—often celebrate IVF without flinching, despite the fact that the standard practice involves the routine destruction of human embryos. It’s why almost one-third of evangelicals supported embryonic stem-cell research in the early 2000s when proponents framed it as harvesting “clumps of cells” rather than killing the youngest humans.
We haven’t catechized our own people, let alone our culture, into recognizing the truth that a human embryo is a human being. Until we do, a pill like mifepristone that ends a life at seven weeks won’t feel like a technology being used to kill humans.
Reasons for Sober Hope
If I stopped there, this would be a counsel of despair, and despair is a posture Christians cannot adopt. As we often find in this life, the situation is serious but not hopeless.
The first sign of sober hope is in the legal realm. A federal court was willing to restore a rule that had previously protected unborn life for more than two decades. Although President Trump said during his 2024 campaign that he’d take no federal action to limit the availability of abortion pills, his administration is unlikely to oppose the court’s ruling.
The case is also now likely headed to the Supreme Court, which has already shown, in Dobbs, that it’s willing to take pro-life arguments seriously when they’re framed in the language of constitutional law. There’s a real chance of a permanent restoration of the requirement that the abortion pill not be delivered by mail.
But even the best legal outcome would only buy us more time. The harder work is cultural. A society that hasn’t viewed the embryo as human life worthy of protection can still be taught to see the truth. The pro-life movement spent 50 years teaching America to see the late-term fetus as a “baby,” and it succeeded well enough to bring down Roe. The same patient labor of teaching, arguing, and preaching about and for the protection of the unborn can be extended to the earliest weeks of life.
This work should begin in the church. Before we can convince our secular neighbors to see the embryo as a human being, we have to convince our fellow Christians to recognize that all human embryos—whether in the womb or in a petri dish—are people made in God’s image.
Keep Faithful Witness
Underneath all this is the deeper hope that no court ruling, no party platform, and no pharmaceutical technology can ever erase: God is sovereign over both wombs and consciences. He was sovereign in the dark years before Roe, sovereign through the long captivity of Roe, sovereign in the unexpected mercy of Dobbs—and he is sovereign now over a process that delivers death pills in plain packaging. Every child conceived, whether welcomed or aborted, is known, named, and loved by the One who knit him or her together.
Every child conceived, whether welcomed or aborted, is known, named, and loved by the One who knit him or her together.
Ultimately, the pro-life cause isn’t a political project that requires our optimism to survive. It’s a witness to a loving God who counts every sparrow and every embryo and who hasn’t, in any age, abandoned the smallest of his image-bearers.
That’s the reason to keep working and praying, no matter how the Court rules in the days ahead. Three judges in New Orleans briefly opened a door that the Supreme Court has now temporarily closed again. Whether it stays closed is for the justices to decide. Yet the larger question—whether the embryo is finally welcomed as our neighbor—is still ours to answer.
