Since the federal right to an abortion was overturned last year, 24 states have banned or severely restricted the right to terminate a pregnancy. Except in extremely rare circumstances, doctors are not able to perform or prescribe abortions to patients needing or requesting one. 

These restrictions have left women like Cassie, who requested she not be fully named for privacy reasons, without many options. Traveling outside of her home state of Louisiana could cost thousands of dollars in missed work and travel expenses, but Cassie needed a way to end her unwanted pregnancy.

She turned to Plan C Pills, a website that provides a one-stop-shop for people looking to access abortion pills anywhere in the country. She just had to enter her state to access a list of resources, including online clinics, independent clinics, and European and Australian clinics. 

She said the pills were delivered just a few weeks after her first search, in discreet packaging. 

“If you’re thinking about doing it, you won’t have regrets about it,” she said.

Cassie may be one of the last people in abortion-banned states able to easily access pills through websites like Plan C. These sites are facing an increasing number of legal challenges as courts across the country take up abortion-related cases. 

Dr. Jennifer Lincoln, an OB-GYN practicing in Oregon, runs Mayday Health, a site that helps people in restrictive states access abortion pills by mail. The site went up the day Roe vs. Wade was overturned. 

“With the fall of Roe, we knew with worse restrictions coming that people still were going to get abortions and still needed abortion access,” Lincoln said. “So we wanted to make sure that they knew that they could still access abortion pills in all 50 states, even if abortion is banned.” 

Mayday is currently navigating a series of lawsuits that threaten its entire operation. A Texas judge appointed by former President Donald Trump is considering a petition that questions the approval of mifepristone, the first of two abortion pills, in the United States. 

As soon as Wednesday, the judge could decide to halt all sales of the drug –– even in states where abortion remains legal –– until a lawsuit seeking to ban it plays out in court. 

“The plaintiffs are asking the judge to decide that there is a sufficient likelihood that the FDA acted incorrectly in the way that they went about approving medication abortion,” Alyssa Morrison, a reproductive staff attorney at Lawyers for Good Government, said. “If he sides with them, providers and prescribers and pharmacies are going to be extraordinarily hesitant to prescribe abortion pills until litigation is finished.”

Right now, Mayday Health sources some of its pills from American clinics, who send pills to addresses in states where abortion is permitted. Mail-forwarding then allows that package to be sent into restricted states. 

Wednesday’s case could end that method for Mayday completely. 

“For providers in states where abortion is legal who are turning a blind eye to whether or not abortion medications are being forwarded via mail forwarding services, it will force them to take a more risk averse approach,” Morrison said. “Abortion opponents have shown themselves to be nothing if not extraordinarily proactive in their desire to impose liability and to really aggressively pursue lawsuits.”

Morrison said that the judge’s halt on abortion medication could last a year or longer. She added that she thinks an outcome banning abortion medication is likely, given the judge’s track record on abortion-related issues.  

Reproductive health lawyers say cases like this are extremely unprecedented. The FDA’s approval process is not frequently called into question by a federal judge, even with regard to drugs that are far more controversial. 

Though the judge’s ruling could put a stop to the mail-forwarding of abortion pills, international shipping could remain an option for people seeking medication abortions. 

Aid Access, which services both Plan C Pills and Mayday Health by shipping pills from overseas manufacturers, has long been operating in a legal gray area, according to Morrison. But, the group utilizes European prescribers and has said that they will not stop servicing clients in the United States.

“It (the judge’s ruling) would strongly strengthen the argument that it is illegal for these providers to just ship medications into the US,” Morrison said. “But Aid Access has sort of indicated over their many, many years of operating that they will continue to operate until they’re forced not to.”

Still, Lincoln says limiting access to abortion medication within the US poses a significant challenge for many people regardless –– especially those who discover they are pregnant later in their term. 

“International pharmacies are not bound by US law so they’re able to ship those medications directly to your house,” Lincoln said. “But, this (international shipping) can take longer –– it can take a few weeks longer –– and that can be really hard for people to wait.”

Plus, delayed access to medication abortion can pose serious health risks for people having a miscarriage. Pills are a non-invasive, safe process to evacuate a fetus when the child is not likely to survive or the mother is at risk.

Wednesday’s case means people experiencing a miscarriage may be unable to access that medication under most circumstances. 

“I had multiple miscarriages before my first child, who was very much wanted,” Lawyers for Good Government staff attorney Khadijah M. Silver said. “I had to use mifepristone. It makes rejection of an unviable fetus safer and it saves lives.”  

Despite these legal challenges, pro-abortion networks are continuing to file counter lawsuits. GenBioPro, a mifepristone producer, has filed a lawsuit arguing that the FDA’s federal approval of the medication means it should override state bans. 

Attorney generals from several abortion-safe states have also filed a lawsuit in federal court, arguing people seeking abortions have been subject to overly strict regulations in its use from the FDA. According to Silver, the two opposing cases could kick Wednesday’s case up to the Supreme Court.  

“You have two federal judges coming to exact opposite conclusions around the same point in time around the same legal issue,” Silver said. “That could then usher that case up before the Supreme Court. Either way, the hearing will create a great deal of ambiguity surrounding the availability of medication abortion that will likely last for the duration of the litigation, which could be years.”

Still, Lincoln said Mayday Health will continue to do what they can to ensure access to abortion medication during the litigation period –– in ban and non-ban states alike. She advised that Americans stock up on what is available to them, using websites like Mayday Health or turning to their local pharmacies. 

She said people can order medication abortion in advance without being pregnant, and can access other methods, like the morning after pill, over the counter. 

“Lawsuits like these will just keep on coming,” Lincoln said. “We’ll just fight some more. It’s a great day to get subpoenaed if it means you’re doing the right thing.”