Science Weekly
Stateside with Kai and Carter: why the fight over abortion pills is only just beginning
23 May 2026
Chapter 1: What is the current status of mail-order abortion pills in the U.S.?
This is The Guardian.
Hey, it's Carter Sherman here, host of The Guardian's new podcast Stateside with Kyan Carter. Today we're bringing you one of our latest episodes. It looks at why the political and legal fight over abortion pills in the U.S. is really just at the beginning.
Listen on to hear the episode in full and find all of our shows every Monday, Wednesday, and Friday on Apple Video Podcasts, YouTube, or wherever you are hearing this.
What I see in terms of anti-abortion movement rhetoric is that I fear that there is going to be a continued push to criminalize the abortion patient. Ten years ago, this was almost unthinkable that the anti-abortion rights movement would say out loud that a strategy for reducing the number of abortions was to put abortion seekers or abortion patients in jail.
But now we're seeing more and more of this conversation in the press, and we're also seeing state legislatures taking this up.
From The Guardian, this is Stateside. I'm Carter Sherman. I'm Kai Wright. Today, the fight over abortion pills is just beginning. Kai, as you know, before I entered the glorious world of podcasting with this show, I covered gender and sexuality for 10 years. So I wanted to bring you a fact you might not know. In the years since the U.S. Supreme Court overturned Roe v. Wade, abortions in the U.S.
have actually gone up, not down. In 2024, for example, there were more than 1.1 million abortions in the United States, which is the highest number on record in recent years.
So I had heard they'd gone up, but I didn't realize by quite that much. Is that considered a surprising victory in the abortion rights movement?
Well, I think it speaks to the breadth and the depth of the organizing that advocates have undertaken in the years since Roe fell. In particular, advocates have worked very hard on expanding access to abortion pills, and they have started mailing pills into states with abortion bans so that even people who live under those bans can still end their pregnancies.
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Chapter 2: How has the anti-abortion movement changed its rhetoric?
So it's mifepristone and misoprostol, right? Which one of them is at stake now in the court fight?
OK, so that is mifepristone. Mifepristone is the drug that is at stake right now. Last year, Louisiana sued the FDA over the fact that it allows abortion providers to mail mifepristone. And on May 1st, the Fifth Circuit Court of Appeals ruled to pause mail order access to Mifepristone while litigation in Louisiana's case plays out.
Easily the most conservative court in the appeals circuit.
Absolutely. So what that means is that under the Fifth Circuit's ruling, no one can get access to mail order Mifepristone, including people who live in states that don't ban abortion, people who live in blue states who might think that their abortion rights are protected.
And are they arguing in court that they're doing this because mifepristone is unsafe? Is it a safety debate we're having here?
That argument has entered the chat, shall we say, but it's not really a good faith argument. Mifepristone and misoprostol are incredibly well-researched. More than 100 studies conducted across more than a dozen countries have found that when you use these two drugs to end a pregnancy, it is a safe and effective abortion method in the first trimester of pregnancy.
Now, the thing to understand here is that it is possible to have a misoprostol-only abortion and just use that second drug in the regimen. But it tends to be less safe and less effective. But abortion providers have said that if they're not allowed to mail mifepristone anymore, they'll send people misoprostol-only.
So I did follow this court case. Many people will have seen the news that the Supreme Court has decided to allow, in that Louisiana case, to allow continued access to Mifepristone, right? Right. Again, this seems like a victory. And is that the end of it? That we continue to have access to abortion pills now?
Well, no. Basically what the Supreme Court did is they just punted. They just kicked the can down the road. And presumably they might want to avoid having this argument in open court until after the midterms. Yeah. Yeah. Yeah. And I think a lot about this woman I spoke to in the summer of 2021. I was working on a story then called The Last Summer of Roe v. Wade.
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Chapter 3: What are the two main drugs used in medication abortion?
Abortion is legal in my state. Or how does this affect me? Just having no idea why something that a Fifth Circuit court would decide on a Friday afternoon would impact their ability to have an abortion or get pills sent to them on Monday.
It sounds like you had to mitigate all this confusion. There was a lot of damage control you were trying to get done. But I feel like folks might hear what had happened and think, okay, why don't people just take misoprostol? Why is it a big deal to switch from a mifepristone plus misoprostol regimen to the misoprostol-only protocol?
So from the medical side, mesoprostol only or mesoprostol as a single abortifacient regimen is highly safe and effective. We have evidence-based regimens that we use. We have a lot of experience using this regimen internationally in places where mifepristone is not available. So we have this very good alternative regimen.
The regimen does have more side effects that are associated with it because there's more mesoprostol and mesoprostol is the drug that really has the side effects. And so we want patients... The side effects that people associate with abortion? With medication abortion. And there's ongoing research to really look at the efficacy or the completion rate with mesoprostol.
It sounds like if you're saying that a misoprostol-only abortion is associated with more side effects, more nausea, more cramping, more bleeding, it does sound like those are abortions that cause individuals more suffering.
Right. I mean, I think of it as being less comfortable. We do know that people who use misoprostol alone all over the world are very satisfied with the regimen and have good outcomes. But it, you know... But we have a gold standard, and that gold standard involves Mifepristone, and there's a reason for that. It makes for a more comfortable and shorter process.
You know, this decision that the Fifth Circuit issued was in addition to being fair. a travesty and not grounded in science was also cruel. It was cruel because it didn't take into consideration that there were real people who were in the process of getting abortion care and that this would wreak havoc on their ability to do that and cause a lot of stress and anxiety.
And it's cruel because we can pivot to another regimen, but it's a regimen that is potentially less comfortable for patients. And it's really... Feels like it's a way of trying to punish people for getting the abortion care they want, need, and deserve.
It feels like a punishment for people. From the court. It feels like the court is trying to punish people.
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Chapter 4: Why is mifepristone currently at stake in legal battles?
And 8% of our patients reported experiencing one or more forms of violence either in becoming pregnant or during the pregnancy. So not over the course of their lives, not in the last 12 months, but during the current pregnancy. And for these patients, being able to get pills by mail is sometimes a lifeline. It's a way for them to extricate themselves from abusive relationships.
It's a way for them to sever ties with an abusive partner. And for some of these patients who are in these violent relationships, they don't have the option of being able to travel across state lines. We also know that violence kind of co-occurs with financial precarity. I have a couple of stories from patients that I think are really telling.
This one is from a 23-year-old patient from Oklahoma, and she wrote to us to say, the man I'm impregnated by had assaulted me by strangulation and is being charged with domestic abuse. I found out I was pregnant when I got rushed to the emergency department. I want nothing to do with this man being a part of my life to be able to hurt me again.
I would really greatly appreciate the help from y'all. Thank you. A 29-year-old patient from South Carolina wrote to us to say, "...just left a domestic violence situation with the father of all the kids. It's only been three weeks of him being in jail and I just found out.
I was a stay-at-home mom for seven years and have literally just started getting all of the balls caught up and figuring out life. I have no idea how to even afford this right now, but I cannot have another." I've had extremely difficult pregnancies and end up hospitalized almost every time, and I don't have a support system to help.
And so I fear that if we are unable to provide care through our telemedicine service to patients in states with near total bans or with severe gestational duration restrictions, it's patients like these that are not going to get the care that they need.
One of the things that was most interesting to me about the ruling from the Supreme Court was actually the dissent that Justice Samuel Alito wrote. And he says that at the heart of this case over Mifepristone is really, quote, the perpetration of a scheme to undermine our decision in Dobbs v. Jackson Women's Health Organization, which is, of course, the case that overturned Roe v. Wade.
And what Alito is talking about is the existence of shield laws, which are these laws, as you know, that have been passed in states like New York and California and Massachusetts that seek to protect abortion providers from out-of-state prosecutions, even in cases where the providers are mailing pills across state lines into states that ban abortion.
The Massachusetts shield law is, of course, what makes the map possible. When you saw Alito's dissent, when you saw that he is so skeptical of shield laws, what did you think? What did you make of that decision?
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Chapter 5: What impact did the Supreme Court's recent ruling have on abortion access?
So it's upsetting that I think this is the direction. And I think part of the reason that this is the direction that at least some part of the anti-abortion rights movement is going in is because the number of abortions have actually increased since Dobbs.
Even if Shilba providers all went away tomorrow, even if mifepristone by telemedicine was no longer available, people will still be able to get mifepristone and mesoprostol. They'll be able to get that through community networks. They'll be able to get medication abortion pills through international clinics. That's not going to go away.
Yeah, I mean, I can say as... someone who covered abortion rights for 10 years, I was really struck by how in the last year, I think it was about a dozen states introduced laws that would have criminalized, that would have treated abortion as homicide, which is to say women who got abortions would be treated as murderers and faced criminal consequences accordingly.
And the thing is, you know, these proposals get introduced every year and, But they usually, I feel like, draw more outrage and controversy. And then in the last year, it was just sort of like, oh, this is maybe an increasingly normal thing to propose. Maybe it's not something that people need to get eyes up and arms about.
And I was really struck by, it seems like, the normalization of this idea, which is incredibly politically unpopular, even among most of the anti-abortion movement.
I agree with you. I mean, I think we're seeing some slight shifts in the Overton window. And I think this is a good example of that, where, you know, I think back to when Donald Trump was running the first time and was asked in an interview about whether or not a woman who has an abortion should go to jail if abortion is illegal. And he said yes.
And it felt like the entire anti-abortion rights community at that point was like, no, that's not the message. You can't say that. That's not the right thing we're pushing for. That is not what we're doing and had to do this whole backtracking of that. And, you know, that was a little, that was 10 years ago. And now I agree with you.
It's not that these, not that fetal personhood bills have never been introduced or no one's thought about this before, but the way that they're being discussed, the fact that they're actually being debated, the fact that organizations are, you know,
anti-abortion rights movement organizations are issuing statements about them it really does feel like there's a a bit of a shifted time dr angel foster thank you so much for your time thank you
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Chapter 6: How are abortion providers adapting to legal restrictions?
I'm not a huge fan of shield laws. Bring me something that will allow me to say that in writing from the highest court in the nation.
Which is what a lot of people were concerned about in Clarence Thomas's concurring opinion in getting rid of Roe in the first place, that he was inviting cases to get rid of same-sex marriage under the same kind of case law.
So thank you so much for bringing up Clarence Thomas. He is actually very critical to the third threat. Remember, this is a list of four possible threats. This is, I would say, the biggest threat to abortion access. And specifically, Clarence Thomas brings up something called the Comstock Act.
I can see what you're, I can see the sigh you've just brought up, but I would like you to read what Clarence Thomas said about it.
I'm going to have to read Clarence Thomas on Anthony Comstock.
Exactly. And if you're listening, we're going to explain this. You're going to hear why Kai has so much consternation already in his voice.
This is a low point in my professional life. Okay. Clarence Thomas's opinion reads, quote, It is a criminal offense to ship Mifepristone for use in abortions. The Comstock Act bans using, quote, the males to ship, quote, any drug for producing abortion. Applicants are not entitled to a stay of an adverse court order based on lost profits from their criminal enterprise. Criminal enterprises.
Okay. So he is saying that the applicants, which to be clear, are pharmaceutical companies that manufacture Mifepristone. He is saying that they are committing a criminal enterprise because of the Comstock Act. Kai, you know what the Comstock Act is. Do you want to do a little spiel on it? I'll do my best. I'll do my best.
I'll fill in the blanks. This is an anti-imsinity law going back to the 1870s in which Anthony Comstock, one of the most despicable people in the history of the United States.
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