It’s been more than a year since Louisiana passed Act 246, locking up life-saving maternal medications that were also prescribed for medical abortions here, before the state banned abortion in 2022.
After 2022, state doctors could no longer prescribe the drugs for abortions. But the drugs’ very presence in Louisiana seemed to make legislators nervous.
So, on October 1, 2024, in a national first, Louisiana reclassified misoprostol and mifepristone as Schedule IV drugs — a categorization typically reserved for medicine with addictive qualities.
By law, Louisiana pharmacies and hospitals must now keep the medications under lock and key.
Legislators say that the law was necessary to prevent “coerced abortions” and cite the example of a lawmaker’s brother-in-law who slipped a pill into his pregnant wife’s drink. Critics say that the restrictions are detrimental to women’s health and that the husband’s actions already violated laws.
Soon after the bill became law, reproductive-rights advocates Lift Louisiana filed suit against the state, arguing that pregnant women weren’t being given equal rights and that legislators had overstepped their boundaries by dictating medical policy without valid medical reasons.
Even for those who oppose abortion, the medications have important, common uses that are now in jeopardy, said Louisiana doctors, pharmacists and patients, who now work and live under increasing fears that they won’t be able to access the critical drugs in an emergency, according to a report released in September 2025 by the New Orleans Health Department.
Then last month, Louisiana went a step further, asking a federal judge to tighten restrictions on misoprostol and mifepristone — this time for the entire nation, by undoing the 2021 authorization by the Food and Drug Administration that allowed doctors, including telehealth doctors, to ship mifepristone and misoprostol directly to patients by mail.
If the judge grants the state’s motion, people dealing with miscarriages or seeking abortions across the nation would no longer be able to pick up their prescription by mail or from a pharmacy. Instead, patients across the United States, even in states where abortion is legal, would have to pick up the pill in person from a hospital or clinic, according to the ACLU Reproductive Freedom Project, whose lawyers are opposing the state’s ruling in court.
Two other pending federal lawsuits, in Missouri and Florida, also are seeking nationwide restrictions on mifepristone.
Hemorrhaging without critical medicine
Last year, as the bill became law, the New Orleans City Council charged the Health Department with chronicling the effects of Act 246 on doctors, nurses, pharmacists, and people in all stages of pregnancy — including those considering pregnancy or managing miscarriages and those in the delivery room, where postpartum hemorrhage can quickly become life-threatening — if misoprostol isn’t close at hand.
“It is clear that the new requirements and restrictions for misoprostol have resulted in documented delays in access to care for women,” concludes the Health Department’s report, issued after the bill had been in place for a year.
When the New Orleans City Councilmembers officially received the report, they issued a resolution that started with the recommendation that the state repeal Act 246.
The state of Louisiana did not follow the city’s directive.
The report also makes clear that Louisiana conservatives apparently didn’t prioritize the everyday uses of misoprostol and mifepristone that have nothing to do with elective abortion.
Misoprostol is the go-to drug for postpartum hemorrhages, doctors and midwives said. “Every day this law is in effect, it’s harming health and welfare in the state,” Lift Louisiana attorney Allison Zimmer said. “It jeopardizes access to necessary treatments.”
In the Health Department report, a woman recounted her emergency caesarian section in December 2024, two months after the law went into effect. She was losing too much blood.
Misoprostol is routinely used to stop hemorrhaging. Her doctor had requested that someone go to the locked pharmacy cabinet, enter a code, and retrieve the medication – which had previously been kept close at hand, on delivery-room trays.
With the bleeding at an urgent level, the doctor turned to staff to again ask for an update on the medication. The nurse responded, “It should have been here by now.”
The woman, understanding the gravity of her situation, turned to her doctor. “Is this how I’m going to die?” she asked.
In the Health Department report, a local doctor described a similarly critical situation. “One patient had an unexpected postpartum hemorrhage and it took literally just under 10 minutes to get the medication in the room.”
It was also difficult to dispatch the nurse down the hall at a life-threatening time when they needed help in the delivery room, said the physician, who found it “very stressful and frustrating as a doctor.”
Some doctor’s offices and small community and rural hospitals in Louisiana are unable to stock any controlled substances. There, mifepristone and misoprostol will not be available at all.
Meandering intent
In March 2024, Louisiana lawmakers who claimed to be targeting coerced abortion introduced the bill that would become Act 246.
Thomas Pressley, a Republican state senator, was motivated to sponsor the bill because of a personal tragedy: the husband of his sister, Catherine Herring, put misoprostol into her drink in Houston, causing her to cramp and deliver prematurely; her husband, Mason Herring, an attorney, pleaded guilty in a Texas court, spent 180 days in jail and is on 10 years of probation.
At first the proposed Louisiana law dealt with that specific situation, providing penalties to any third party who gave the two drugs to a pregnant person. But after the bill cleared the initial committee, lawmakers expanded its scope, to reclassify misoprostol and mifepristone as Schedule IV drugs.
To accommodate the new 2024 requirements, hospitals scrambled to adjust labor and delivery floors.
The effects are not confined to delivery rooms. Misoprostol and mifepristone are used to treat a range of conditions, including gastric ulcers and Cushing’s disease. The drugs also aid with fertility treatments and diagnostic care such as endometrial scopes. Those seeking birth control also often need prescriptions, to soften the cervix so that a woman can be fitted with an intrauterine device, best known as an IUD.
Denying the drugs could even lead to a delay in cancer diagnosis and certain treatments, Zimmer said. “People are impacted across the life cycle and across demographics,” she said.
The new law created barriers that may be necessary for true Schedule IV drugs that carry legitimate risks of misuse or dependence. But the heightened cautions are unnecessary for these particular drugs, which are both “safe and non-addictive,” she said.
Important for miscarriages
After a miscarriage, misoprostol and mifepristone help ensure the contents of the uterus are fully expelled. If tissue remains, it can cause infection, and in severe cases, sepsis and death.
Roughly 1 in 4 desired pregnancies end in miscarriage — and that is a key reason that doctors prescribe misoprostol and mifepristone, to guard against infection. But at Louisiana pharmacies, women who have suffered a miscarriage may face additional hurdles — those prescriptions now require more information from the doctor and more paperwork from the pharmacist.
“The people who suffer the most aren’t people looking for elective terminations, they are women in dangerous and devastating situations,” the Department of Health report concluded.
Cristina Perez Edmunds, a New Orleans mother of two, knows that desperate and scary feeling.
In 2018, Edmunds learned she was pregnant — despite having an IUD. The news was a whirlwind. It was unexpected. But she and her husband decided to carry the pregnancy. “Okay, we’re gonna do this,” we decided. They got excited about the prospect.
Then, at her first exam, they received devastating news. “The ultrasound showed an empty sac,” she said. Still, driven by hormones, her body was acting as though she was pregnant. “So even though there was not a fetus, my belly was growing.”
Edmunds needed medical intervention to end the pregnancy. She had three options: Have surgery, induce labor with medication, or risk spontaneously going into labor.
Fresh off a C-section from her now-eldest child, she did not want to have another surgery. She chose to get a prescription, so that she could induce a miscarriage at home while her son was at daycare.
Already feeling miserable from the doctor’s news, Edmunds headed to the pharmacy to pick up her prescription for misoprostol and mifepristone.
Now those drugs are classified as Schedule IV. But even then, patients with misoprostol prescriptions often faced extra questions and even refusals to dispense, at certain drug stores.
“When I went to go pick it up the pharmacist goes, ‘I have to ask if you’re pregnant?’” Edmunds recalled. “So I was like ‘Yes, but it’s not viable.’”
It felt uncomfortable to answer that question in a public setting, with people within earshot in the line behind her, she said. She drove home and took the pills to self-induce a miscarriage, which spurred strong cramps and bleeding. “It was horrible and really unpleasant — you’re basically putting yourself into labor,” she said. “It’s not something I would want anyone to go through.”
But in their situation, she and her husband decided that it was the “least bad option,” she said.
Political interference in medicine, doctors say
Both gunshot-wound victims and women bleeding out during delivery need critical medical care that includes medication. But Act 246 makes it harder for women miscarrying or in labor to receive necessary, lifesaving medication than people who face other medical conditions, contends Lift Louisiana in its December 2024 lawsuit.
Women are denied the equal protection that is their constitutional right, the Lift suit argues.
That’s consistent with the difficult history of women’s healthcare in Louisiana, some say.
Since abortion became legal in the nation with the Roe v. Wade decision in 1973, Louisiana legislators have attempted to limit the procedure within the state. Every year, there was a new state bill, instituting new hurdles to abortion that most often were struck down by courts.
In 2006, Louisiana passed a “trigger ban,” designed to outlaw abortion if states were ever allowed to do so. The ban took effect immediately in 2022, after the U.S. Supreme Court ruled that states could decide about abortion for themselves, in its Dobbs v. Jackson Women’s Health Organization decision.
But it seems that anti-abortion legislators in the 13 states that quickly implemented bans hadn’t anticipated the rise in medication abortions, which now make up two-thirds of all abortions in the United States, according to KFF, which tracks health policy.
So, though there was an immediate post-Dobbs decline in abortions, it was not as drastic as it would have been if the ban had been implemented even a few decades ago, when nearly all abortions were done in brick-and-mortar clinics and doctor’s offices. In recent years, the number of total abortions has risen, partly because of the lower cost and access provided by pills, which are still provided by mail to states like Louisiana with abortion bans in place and received by women who choose to self-manage their abortions at home.
Given those realities, it’s clear why anti-abortion officials focused on medications that could be used to induce abortions.
But Louisiana’s legislature reclassified misoprostol and mifepristone as Schedule IV substances based on a false, non-medical premise, the Department of Health report argues. “Act 246 established a precedent of classifying drugs as controlled substances based not on their potential for abuse or addiction, but as a means to decrease access,” the report concludes.
There is no “need or real purpose rooted in medicine,” Zimmer said. “There is no basis for this law.”
“It has no impact on abortion even if that is a motivation for the law,” she said.
Ten other states attempted to introduce similar legislation in the last year, according to the city’s report. None made it to a hearing. That in itself shows that Louisiana’s law is “a huge outlier,” Zimmer said.
