It is well established that mifepristone, the popular abortion drug, is deadly to unborn babies and dangerous to women — especially those who take it without medical oversight. Confidence that the Trump administration will do anything to curb the harms wrought by the Biden administration’s radical expansion of mail-order abortion drugs, however, is dwindling.
New polling from Cygnal suggests that 32 percent of Republican voters are unmotivated to show up for the midterms “if Republican leaders weaken or abandon pro-life policies.” Trump, who fears impeachment if the GOP loses control of Congress come November, can’t afford to be shunned by the pro-life base that played a pivotal role in electing and reelecting him. Yet, he has deliberately avoided addressing mifepristone and the Biden-era mail-order scheme that has contributed to the deadly drug’s popularity.
Trump’s silence is unsurprising given his history of blaming pro-life issues for Republicans’ political losses. What is surprising to the pro-life organizations and GOP legislators is that their demands that the U.S. Food and Drug Administration at least restore the mifepristone safeguards present during the first Trump administration have yet to manifest in any measurable action.
Pro-lifers believe this stalling is deliberate. SBA List Pro-Life America and Live Action’s Lila Rose used an anonymously-sourced article claiming the FDA head was “Slow Walking a Long-Awaited Abortion Pill Safety Study” to call for FDA Commissioner Marty Makary’s firing. The FDA called the accusation “baseless.”
Sen. Josh Hawley, R-Mo., told The Federalist in a phone call that he also believes, after conversations with Makary, that the FDA’s “safety study thing is just a dead end.”
“Women are being lied to, babies are being killed, and we need to do something about it. I’ve concluded that the safety study, which the FDA promised they would initiate a year ago, it just doesn’t seem to be going anywhere to me,” Hawley said.
Empty Promises?
Both U.S. Health and Human Services Secretary Robert F. Kennedy Jr. and Makary pledged throughout 2025 to review the data suggesting the popular abortion pill drug regimen linked to hemorrhage, “fast, weak pulse,” “trouble breathing,” diarrhea, dizziness, headache, vomiting, and “pain” across the back, arms, neck, and abdomen.
The real push for the FDA to act didn’t heat up after the Ethics and Public Policy Center’s April 2025 examination of private medical insurance data determined that more than one in 10 women who take mifepristone suffer a serious adverse event such as hemorrhage or infection. The risk of contracting a life-threatening side effect linked to pill-induced abortion, according to EPPC’s findings, is at least 22 times higher than what the FDA and mifepristone manufacturer Danco Laboratories boast.
New polling suggesting a majority of likely voters also want the FDA to protect women from the dangers of abortion pills also made a debut as Congress and pro-life organizations teamed up to pressure the FDA to at least roll back Biden-era expansions that make it easier for people to obtain and take mifepristone without medical oversight.
HHS and the FDA appeared receptive to these calls to action, but ultimately failed to respond to The Federalist’s repeated questions about who is leading the review, what process the review will follow, whether it had formally commenced, and how long it is estimated to take.
Hawley said that the FDA, despite previously confirming that the mifepristone review is in “data acquisition phase” and will continue “under [Makary’s] auspices,” is “not even reviewing any data yet.”
The only mifepristone-related activity out of the FDA thus far occurred in October when the agency approved a generic version of the abortion pill for sale and distribution. The FDA claimed at the time to The Federalist that the HHS secretary was required “by law” to “approve an application if it demonstrates that the generic drug is identical to the brand-name drug.” The off-brand abortion pill, however, went unapproved for 1,207 days under the Biden administration and another 253 days under Trump until the FDA ultimately greenlit it.
Waiting on the FDA to do anything to limit mifepristone in a timely manner, Hawley added, “doesn’t seem to be remotely on the horizon.”
“The FDA could reinstate the safety protocols that President Trump had in his first term, and that would be certainly a step in the right direction. So I continue to believe that that’s what the FDA should do. I just — the safety study was supposed to be a precursor to that and they don’t even seem to be doing the study. So I just don’t have a lot of confidence that they’re going to act,” Hawley said.
No review is required for the FDA to reinstate some of the common-sense abortion pill safeguards, such as an in-person doctor visit, that were stripped from the FDA’s Risk Evaluation and Mitigation Strategy (REMS) at President Joe Biden’s behest. Doing so would bring the second Trump administration’s mifepristone policy up to speed with the first Trump administration’s parameters. Yet, the FDA recently declared it does not plan to act on those REMs until it concludes its official abortion drug evaluation.
States’ Hands Are Tied
Women and babies aren’t the only ones suffering the consequences of the FDA’s delay. Despite the promises of the Supreme Court’s Dobbs v. Jackson ruling, states are also struggling to enforce their laws limiting or outright banning mail-order mifepristone.
“Voters in the states? It doesn’t matter what they pass. Right now, that does not matter at all because these drugs are gonna get mailed in,” Hawley concluded.
There’s no better example of this than the case of Rosalie Markezich, who was coerced into chemical abortion by her boyfriend who mail-ordered abortion pills against her consent.
Louisiana prohibits both surgical and chemical abortions, classifies mifepristone as a controlled dangerous substance, and levies punishments against abortion pill poisoners, but none of those laws prevented the loss of Markezich’s baby. As a result, Louisiana, led by Attorney General Liz Murrill, and Markezich filed a lawsuit against the FDA demanding an end to the agency’s “mail-order abortion scheme” ushered in by the Biden administration.
A majority of abortions, 70 percent, are believed to be unwanted, coerced, or inconsistent with the mother’s values and desires. Even those abortions that aren’t forced, leave women with physical, mental, and emotional scars.
“These are women who have no medical oversight and are exposed to coercion and abuse, right? So I think that if the [Trump administration] isn’t helping, I do think that their position is hurting,” Murrill told The Federalist over the phone.
The case received support from 21 states, 60 members of Congress including Hawley, and 58 pro-life organizations who all filed friend-of-the-court briefs noting that women and babies hang in the balance and states’ sovereignty is threatened as long as the interstate illegal drug trafficking system is allowed to stand.
“I think it’s unfortunate that we are adverse to the Trump administration’s HHS leadership on this,” Murrill continued. “We should all be on the same page.”
Murrill noted that Louisiana believed HHS and FDA would withdraw the Biden rule after Kennedy acknowledged under oath that the Biden administration “twisted the data to bury one of the safety signals.” Instead, the FDA asked a federal court in January to halt litigation on the landmark Pelican State abortion pill case over claims that legal challenges to the radical mail-order mifepristone expansions are “disruptive” and possibly “unnecessary” in light of the agency’s ongoing abortion pill review.
Murrill wasn’t convinced by the FDA then, calling the memo “an affront to our sovereignty and the dignity of women and the unborn,” and isn’t convinced now.
“We can’t wait forever for them to do it,” Murrill said. “People are suffering
severe consequences from this. The system is suffering too.”
Not only did Murrill say women are hurt and babies’ lives are lost due to mail-order mifepristone, “but it is also a real attack on the entire constitutional structure that presumes that states are going to give full faith and credit to other states’ laws.”
States such as California and New York have weaponized so-called “shield laws” to repeatedly stymie states like Louisiana and Texas from holding doctors accountable for illegally trafficking mifepristone.
“Those shield laws and the governors who are blocking our extradition are essentially facilitating criminal conduct in our state and they are nullifying our laws in our state simply because they disagree with our policy,” Murrill noted.
Murrill added that this new “sanctuary state” model designed to protect abortion pill prescribers from punishment will require judicial intervention sooner rather than later.
“You’ve now found a sanctuary state where you can nullify the laws of other states and not face consequences for that. That’s a huge problem. It’s a commerce clause problem, it’s a full faith and credit clause problem, and it’s an extradition clause problem, and we’re going to need the federal courts to clarify that they can’t do that because right now, they’re getting away with it,” Murrill said.
“If it was fentanyl or Xanax or Adderall or guns, I mean, if I was sending guns into their state, they would charge me,” she added.
The U.S. Supreme Court previously refused to rule on the merits of the Biden-era expansion after determining the pro-life plaintiffs lacked adequate legal standing. The majority opinion, penned by Justice Brett Kavanaugh, however, left the door open for the court to evaluate a stronger challenge.
Murrill’s hope, much like Hawley’s, is for the Trump administration to do “the right thing” and “withdraw the rule.” Both Hawley and Murrill cited the climbing number of U.S. abortions as evidence that allowing Biden’s mail-order abortion scheme to continue puts women and babies at risk and effectively handicaps states from protecting them.
“If they want to conduct a study, they can do that. But, for the health and safety of women and the unborn, they should do it now,” Murrill said.
Congress Isn’t Off The Hook
Vice President JD Vance pledged at the 2026 March For Life in January that pro-lifers have “an ally in the White House.” But that’s not enough. Hawley believes that as long as the FDA refuses to act swiftly and states’ ability to intervene is tied up in courts, the mifepristone mantle falls squarely on the shoulders of Congress.
“I think Congress needs to ask itself and pro-life members of Congress need to say ‘What can we do legislatively that will really make a difference on this?’ I think that that’s where we’re getting to,” Hawley said.
Republicans can claim to be pro-life, but Hawley said if they aren’t doing anything about mifepristone, “we’re really not engaging on where the real battle is to protect life.”
“Congress shouldn’t be off the hook anyway. Congress should quit being a spectator. Congress should take up their role and say, ‘Okay, what can we do by policy to protect women and to protect babies?’” Hawley said.
