Earlier this year, the Fifth Circuit Court of Appeals ruled in Louisiana v. FDA to reinstate medically unnecessary in-person dispensing requirements for the medication abortion drug mifepristone. For the short time it was in effect, the ruling brought chaos to clinics and patients across the country. Who could still prescribe? Who could still get care? What was legal this week and what wasn’t?
Rigor in Real Time
Inside the Guttmacher Institute, research, policy and communications staff had tracked the case for months and anticipated the moment. “It looks chaotic to the outside world, and it is,” says Amy Friedrich-Karnik, Guttmacher’s director of federal policy. “But internally, we had been preparing for it.”
Medication abortion now accounts for 64% of all clinician-provided abortions in the United States, and one in every four US abortions is provided via telehealth. That is why the anti-abortion movement is targeting medication abortion with a playbook of recurrent and deeply flawed pseudo-scientific claims. Countering this playbook has become one of Guttmacher’s central functions. The Institute’s rapid response operation is built to expose those studies and champion science in the policymaking process and in public discourse.
“It’s critical that voices like Guttmacher, as a nonpartisan expert organization, can put our analysis into the official record.” — Amy Friedrich-Karnik
“The original goal of the anti-abortion activists was to try to take mifepristone completely off the shelves,” Friedrich-Karnik says. But even the notoriously anti-abortion Fifth Circuit understood that approach was going too far, given the drug has been FDA-approved since 2000. So the anti-abortion movement’s immediate focus shifted to the telehealth medication abortion provision that became a major lifeline for patients since the Dobbs decision. In 2025 alone, Guttmacher data show that 91,000 abortions were provided via telehealth in states with total bans, more than 9,300 of them in Louisiana, the state driving the lawsuit. “A big part of the reason medication abortion has become the most common method,” Friedrich-Karnik says, “is because people can get it via telehealth.”
Attacks on telehealth depend on making bad science look credible. “The anti-abortion movement is good at doing things that sound reasonable, but are egregiously harmful in how they play out,” says Joerg Dreweke, Guttmacher’s director of US communications, who has spent two decades in the field.
The clearest recent example is a widely cited paper self-published by an anti-abortion organization. It claimed serious complications from mifepristone were far more common than decades of research have found, by counting routine in-person visits during or after a medication abortion as serious adverse events. In many or most cases, Dreweke explains, these visits are not emergencies.
Medication abortion typically involves heavy cramping and bleeding, and many patients go to emergency departments or other care facilities simply to confirm their symptoms are normal or that they’re no longer pregnant. (A home pregnancy test can come back positive for up to several weeks after a successful abortion.)
“The anti-abortion movement presents these facts like there’s an ambulance coming in with sirens blaring and people bleeding out,” Dreweke says. “And that is just not the case.” In reality, far fewer than 1% of medication abortions result in a serious adverse event requiring a transfusion or hospitalization. By redefining ordinary patient concerns as something far more serious, the paper reached an inflated complication rate “20 times higher than a huge body of literature had previously found.”