NEJM Interview: Elizabeth Tobin-Tyler on the legal argument that permitting telehealth access to mifepristone can abet reproductive coercion.

In recent years, anti-abortion legal organizations and state attorneys general have brought several lawsuits challenging the safety of mifepristone, part of the medication abortion regimen. One of their arguments has involved the claim that mifepristone must be prescribed in person to prevent reproductive coercion. I'm Stephen Morrissey, managing editor of the New England Journal of Medicine, and I'm talking with Elizabeth Tobin Tyler, a professor of health services policy and practice at the Brown University School of Public Health and of family medicine and medical science at Warren Alpert Medical School of Brown University. Professor Tobin Tyler has co-authored a perspective article about telehealth and reproductive coercion. Professor Tobin-Tyler, how common is medication abortion in the United States and what proportion of those procedures involve telehealth?

One of the interesting things after the Dobbs decision in 2022 is that medication abortions have actually gone up. And I think one of the reasons that this is critical in the debate about abortion access across the country is that even as states, many states have banned abortion or have significantly restricted abortion, many people are still accessing abortion medication And many of them are doing that through telehealth access. So even in states where abortion is restricted or illegal, more people now after Dobbs are actually accessing medication.

And then what arguments have anti-abortion organizations and policymakers made to challenge the use of mifepristone in particular?

Yeah, this has really become an issue since the Dobbs opinion as anti-abortion policymakers and activists have been frustrated by the actual increase in medication abortion. So they're making a number of different arguments. They are arguing, one, that mifepristone is unsafe for women's health. They are arguing that the FDA, when it determined in 2023 through its REMS, which is the risk evaluation and mitigation strategy that is applied to medications in terms of dispensing, that their decision in 2023 to allow telehealth access to Mifepristone was wrongly decided, that it was an abuse of power, that it was arbitrary and capricious, which is legal language for describing a violation of the Administrative Procedures Act. And then another argument that they're making is that access through telehealth to Mifepristone is a violation of state sovereignty for states that have abortion bans. And then finally, what our paper is focused on is an argument that telehealth access to mifepristone supports and enables reproductive coercion that allows abusive partners to force their partner to take mifepristone against their will, causing an abortion. And if there is telehealth access to mifepristone, perpetrators of abuse are able to fraudulently access the medication themselves. and then force their partner to take it.

So I want to ask first about that case brought by the Louisiana Attorney General against the FDA. What are the facts of that case and what developments have we seen so far?

Yeah, so this case was filed in October of 2025 by Liz Merle, who's the Attorney General of Louisiana. And she alleges in that case, as I