20 Republican AGs Concerned About Abortion Drug Safety

A coalition of over 20 Republican attorneys general demands the Trump administration restore critical safety protocols for the abortion drug mifepristone, citing significant risks to women’s health.

Story Highlights

Over 20 Republican AGs request reinstatement of 2011 safety protocols for mifepristone.
The Trump administration is reviewing mifepristone’s safety profile for possible policy changes.
REMS protocols were relaxed under the Obama and Biden administrations to improve access.

Republican AGs Advocate for Stricter Controls

A coalition of over 20 Republican attorneys general, led by Kansas Attorney General Kris Kobach, has formally requested that the Trump administration and the FDA reinstate safety protocols for the abortion drug mifepristone. These protocols, known as REMS (Risk Evaluation and Mitigation Strategy), were originally implemented in 2011 but were relaxed or removed under the Obama and Biden administrations. The attorneys general argue that the removal of these safeguards poses significant health risks to women and urge either the reinstatement of the 2011 protocols or the withdrawal of mifepristone from the market until a comprehensive safety review is completed.

The effort is notable not only for its scale—over 20 states represented—but also for its timing amid ongoing national debates over abortion access. This push comes as the Trump administration shows openness to reviewing mifepristone’s safety profile, despite previous statements indicating that no major changes to its availability were planned. The coalition demands either the reinstatement of strict protocols or the removal of mifepristone from the market entirely.

Background on Mifepristone and Regulatory Changes

Mifepristone, approved by the FDA in 2000, is used for medication abortion and miscarriage management. The FDA imposed REMS in 2011, requiring in-person dispensing and provider certification due to concerns about potential complications. Over the past decade, these restrictions have been relaxed, especially during the COVID-19 pandemic, to improve access. In 2016, the Obama administration relaxed some REMS requirements, and in 2023, the Biden administration further eased restrictions, including allowing mail-order dispensing.

The current push for reinstating these protocols comes amid a polarized national landscape on abortion. Republican-led states are seeking to restrict access, while Democratic-led states work to expand it. The Trump administration’s approach to mifepristone is under intense scrutiny, with both sides mobilizing legal and political resources. Legal challenges to mifepristone’s FDA approval and REMS requirements have been ongoing, including high-profile cases such as Missouri v. FDA.

Potential Impacts of Policy Changes

If the REMS protocols are reinstated, access to mifepristone could be restricted, especially in states with existing abortion bans or restrictions. This would increase healthcare costs, force more women to seek surgical abortions or travel out of state, and intensify political polarization. It could also impact pharmaceutical companies and the broader healthcare sector. Experts argue that if mifepristone is withdrawn or heavily restricted, medication abortion access could be severely curtailed nationwide, affecting millions of women and potentially setting a precedent for further restrictions on reproductive healthcare.

Medical and public health experts overwhelmingly support the safety and efficacy of mifepristone, citing decades of data and international experience. The American College of Obstetricians and Gynecologists and other professional bodies oppose additional restrictions. Recent academic reviews have found that mifepristone is safer than many common medications, including Tylenol, and that REMS restrictions are not scientifically justified.