Mifepristone is indisputably the single biggest driver of abortion in America today.
R obert F. Kennedy Jr.’s nomination to lead the Department of Health and Human Services raised concerns among many pro-life Republicans, given his past support of legal abortion. However, in his confirmation hearings, Kennedy stated, “We cannot be a moral nation if we have 1.2 million abortions a year.” He also affirmed that he and President Trump had not decided on precisely how to regulate mifepristone, “the abortion pill,” and that Trump wanted the question examined further before acting. If Trump and Kennedy are serious about lessening the tragedy of abortion, safeguarding women, and reducing abortion numbers by tens of thousands, they must restrict the abortion pill, the chief driver of American abortion.
Mifepristone is responsible for 63 percent of approximately 1 million annual American abortions. The drug inhibits hormones necessary for the embryo or fetus to remain adhered to the uterine wall, killing the child by cutting him or her off from nutrition and oxygen. Mifepristone is now the dominant method of abortion provision in America because of a long history of Democrat-directed FDA decisions.
President Clinton’s FDA first approved the abortion pill in 2000 with an expedited process designed for drugs that treat “serious or life-threatening illness” — even though pregnancy is not an illness. The FDA limited mifepristone’s use to the first seven weeks of pregnancy and mandated three in-person clinical visits.
In 2016, President Obama’s FDA reduced these requirements to one in-person appointment, eliminating the requirement for follow-up care. He also allowed the drug to be prescribed through ten weeks of pregnancy, even though complications from mifepristone increase later into pregnancy. On top of this, as he was lessening these safety standards, Obama also eliminated all reporting requirements for adverse outcomes short of death.
The Biden FDA in 2021 eliminated the need for any in-person visit, allowing mifepristone to be prescribed with only a telemedicine appointment. Simultaneously, Biden allowed mifepristone to be shipped to patients directly through the mail, or to be picked up at major pharmacies, rather than be provided in a clinical setting.
The elimination of safety restrictions makes the abortion pill dangerous. Over 6 percent of women who have pill abortions experience “incomplete abortions,” a dangerous outcome that requires follow-up surgery at the risk of serious infection. Thousands of women have been hospitalized from the abortion pill for serious hemorrhaging, extreme pain, passing significant blood clots, and other adverse outcomes. At least 36 women have died from the abortion pill. These and other health risks have been downplayed because of the abortion industry’s desire for universal abortion “access,” a goal hampered by requirements for in-person visits and follow-up appointments.
Within four years of Obama’s 2016 regulations, the percentage of abortions performed via mifepristone jumped from 39 percent to 53 percent. By 2023, following the Biden changes, it was 63 percent.
Mifepristone deregulation also contributed to a spike in total abortions during the Biden years. The total number of American abortions jumped from approximately 900,000 per year to more than 1 million by 2023. This additional 100,000 annual abortions track almost perfectly with the 10 percent increased rate of mifepristone abortions.
So what should Trump and Kennedy do? The FDA could start with reviewing and rescinding its original approval of mifepristone in 2000, or its subsequent 2016 and 2021 deregulations. In 2023, the Fifth Circuit Court of Appeals held that the 2016 and 2021 regulations violated the Administrative Procedures Act. While the Supreme Court overturned the Fifth Circuit, it only did so on standing grounds, leaving the Fifth Circuit’s substantive assessments untouched. Judge James Ho (in a concurrence to the Fifth Circuit’s decision) and others have convincingly argued that the 2000 FDA approval of mifepristone was plainly unlawful, since it does not treat a “serious or life-threatening illness,” as FDA regulations required. These findings could give the FDA ample ground for rescinding its prior policies, reinstating robust safety requirements, or eliminating mifepristone’s FDA approval altogether.
The Trump administration, alone or with Congress, could crack down on American companies in blue states shipping the abortion pill to states where abortion is illegal. It could pursue punitive funding restrictions against states such as California and New York that shield such companies and doctors from civil or criminal penalties for their violations of pro-life states’ laws. The DOJ could enforce the Comstock Act (a Ulysses Grant–era law prohibiting the shipment of abortifacient drugs through the mail) to shut down such activity. These practices endanger women who are “self-managing” their abortions, getting mifepristone without a doctor visit or an ultrasound.
Presuming that RFK is confirmed as health secretary, conservatives must get the best pro-life scholars and researchers into his office, if not the Oval Office, to make the case against mifepristone. Physician organizations such as the American Association of Pro-Life OB/GYNs, think tanks such as the Charlotte Lozier Institute, and scholars including Melanie Israel from the Heritage Foundation have done extraordinary work highlighting the safety risks of the abortion pill and its shameful regulatory history.
Mifepristone is indisputably the single biggest driver of abortion in America today. To be a moral nation, and to make an appreciable impact on abortion, Trump and RFK must stop it.