Josh Hawley puts Missouri at center of national fight over abortion pill

U.S. Sen. Josh Hawley has opened a new front in the fight over medication abortion, pushing legislation to revoke federal approval of mifepristone, urging the Justice Department to investigate its manufacturer and helping launch a national political group aimed at reshaping abortion debates after a string of losses on the ballot.

The push has made Missouri a central arena in the national fight over mifepristone.

It’s not just focused on Hawley’s efforts. A major federal lawsuit looking to limit access to the drug is currently playing out in St. Louis after Missouri became the lead plaintiff. The state’s attorney general is pursuing a separate case against Planned Parenthood, testing the ability to wield consumer-protection laws as a means to limit mifepristone.

Later this year, voters will decide the fate of a proposed abortion ban placed on the ballot by Missouri lawmakers.

Nearly 18 months ago, Missouri voters approved a constitutional right to abortion, becoming the first state to overturn an abortion ban through the people’s vote. But medication abortion — which now accounts for about two-thirds of abortions in the United States — remains unavailable through Missouri providers as a state court weighs which regulations on the medication and its providers are now unconstitutional under the new amendment.

In April, Hawley called on acting Attorney General Todd Blanche to open an investigation into Danco Laboratories, the manufacturer of brand-name mifepristone, the first medication taken during a medical abortion that causes the embryo or fetus to stop growing and detach from the uterine wall. If Blanche follows through, it, could disrupt the supply of the drug nationwide. A few weeks earlier, Hawley announced legislation aimed at ending the use of mifepristone for abortion.

“It is time for Congress to do something about this racket, and it is a racket,” Hawley said during a March press conference, calling on his colleagues to withdraw the Food and Drug Administration’s approval of mifepristone, which is also used to treat miscarriages. “It is time for Congress to ban the use of Mifepristone for abortion.”

Few Republicans in Washington have made mifepristone as central to their work as Hawley. He has introduced or co-sponsored multiple measures targeting the drug, pressed the FDA and DOJ in letters and floor speeches, and made the medication a recurring theme of his public appearances. Abortion-rights advocates say his focus reflects a broader strategy to restrict abortion nationally, even in states where voters have backed legal access.

That strategy, they argue, is being built in Missouri.

“A lot of what we see happening across the country and at the federal level against reproductive freedom has its roots in Missouri,” said Emily Steinert McDowell, associate director of federal policy with Reproductive Freedom for All. “A lot of that does have to do with the leadership from Senator Hawley.”

The Missouri connection extends beyond the senator.

U.S. Solicitor General D. John Sauer, a former Missouri solicitor general, was among the lead donors to the campaign against Missouri’s 2024 abortion-rights amendment. Two federal judges nominated by President Donald Trump — Joshua Divine and Maria Lanahan — worked in the Missouri Attorney General’s Office on litigation challenging the FDA’s approval of mifepristone.

That case reached the U.S. Supreme Court, where Erin Hawley, wife to Josh Hawley, argued against the medication before the court, which ruled that the anti-abortion doctors and organizations challenging the drug lacked standing. The case has since returned to the lower courts and was relocated to Missouri where the attorneys general of Kansas and Idaho joined Missouri in trying to give the challenge new life.

The Hawleys also recently launched the Love Life Initiative. The group, organized as a nonprofit that does not disclose its donors, says it will invest in anti-abortion and pro-family messaging around the country.

“This is more a story about the nature of Missouri politics than it is about the nature of Missourians,” said Mary Ziegler, a law professor at the University of California-Davis and a leading expert on abortion in America. “So this is partly about the efficacy of the anti-abortion movement in Missouri, and the fact that a lot of politicians with national ambitions have made Missouri home, like Senator Hawley.”

Hawley was not available for comment.

The shift in access to medication abortion came under the Biden administration, when the FDA allowed for the mailing of mifepristone and for prescriptions to be made online or through pharmacies without seeing a doctor in-person.

During the March press conference, Hawley decried decisions by the Obama and Biden administrations to expand access to the medication.

“They did it because they wanted to turn mifepristone into the driver of abortion on demand, and we have to admit today they largely succeeded,” he said. “There are more abortions now in the United States than there were when Roe versus Wade was the law of the land.”

In the first six months of 2025, an estimated 15,000 abortions occurred each month using telehealth, according to the Society of Family Planning. 

While an estimate is not available specifically for Missouri, it’s widely known that getting abortion medication through the mail is possible.

To test how easy it was to access abortion medication, Sam Lee, a longtime anti-abortion lobbyist in Jefferson City, says he ordered mifepristone and misoprostol for “dirt cheap” off eBay in early 2022. He said the medication arrived at his Missouri home from India within about 26 days. At the time, doctors in Missouri could not legally prescribe the medication.

In the time since, Lee said it’s become more clear to him that without limiting mifepristone on the federal level, abortions will continue in large numbers.

“For years you could say, ‘okay, well, abortions are done at this local abortion clinic. If we just shut down the abortion clinic, if we just shut down Planned Parenthood’s clinic where they’re doing abortions, that will take care of it,’” Lee said. “That’s just not the case anymore.”

Missouri leaders began paying closer attention to medication abortion about a decade ago, Lee said.

In 2017, Republicans passed abortion regulations requiring mifepristone to be administered by a doctor, and only if the provider has a complication plan approved by the state that includes a contract with an OB-GYN who can be on call 24/7 to treat any complications.

That change effectively halted Missouri doctors’ ability to prescribe abortion medication.

The FDA states that mifepristone is safe to use if taken as directed in the first trimester of pregnancy. That conclusion has become a focal point in anti-abortion challenges to the drug.

Hawley has called the medication “inherently dangerous” and “inherently prone to abuse,” noting a dozen instances in the past year where he said men were criminally charged with giving a woman mifepristone without her consent.

He also points to a 2025 study from the Ethics and Public Policy Center, a right-leaning think tank, which concludes that serious complications from mifepristone are much more common than the FDA reports.

That study has been widely criticized by medical professionals as flawed and politically-motivated. The paper concluded that 1 in 10 people who take mifepristone experience a serious adverse event.  The FDA data cites serious adverse reactions in less than 0.5% of women who take the medication. Critics of the latest study said the decision to include visits to the emergency room when the patient doesn’t require admission as well as follow-up appointments as adverse outcomes was misleading.

Since the medication was approved for use nearly three decades ago, the FDA has reported only 32 deaths associated with mifepristone. The report evaluates data from 5.9 million women who took mifepristone between 2000 and 2022. Of the three dozen deaths, 11 were the result of sepsis, 20 were homicides and two were suicides.

Bleeding and cramping are expected side effects. More rarely, there can be hemorrhaging and infection. Those prescribed mifepristone are urged to call their doctor if they experience heavy bleeding, abdominal pain or a fever. This guidance also applies to those who recently underwent surgical abortions, experienced miscarriages or delivered a baby.

“Missouri is leading the way in restoring commonsense limits on abortion that reflect the state’s longstanding priorities, including health and safety standards for women and clarifying parental consent,” Sue Liebel, director of state affairs with Susan B. Anthony Pro-Life America, said in a statement.

She pointed to the proposed constitutional amendment on the ballot in Missouri this year that will ask voters if they want to reinstate a ban with limited exceptions for medical emergencies and survivors of rape and incest. It would also ban gender-affirming care for minors, which is already illegal in Missouri.

The ballot measure is among the recent strategies Ziegler has seen emerge from Missouri. She said she’ll be watching closely to see whether the decision by the Missouri legislature to tie the amendment to transgender issues may prove to be a reliable “Trojan Horse” strategy that could be copied by other anti-abortion legislatures.

A recent SLU/YouGov poll found that while almost 60% of Missourians support abortion access until at least the eight week of pregnancy, even more Missourians — 67% — oppose puberty blockers, cross-sex hormones and gender transition surgeries for minors.

“For the national anti-abortion movement,” Ziegler said, “Missouri is sort of a laboratory for other strategies that could be exported elsewhere to shut down access to abortion.”

She said this includes the “vanguard” consumer protection lawsuit against Planned Parenthood challenging its portrayal of mifepristone’s safety.

Last July, then-Missouri Attorney General Andrew Bailey sued Planned Parenthood Federation of America for $1.8 million in damages, claiming the nonprofit violated the Missouri Merchandising Practices Act for stating on its website that mifepristone is “safer than many other medicines like penicillin, Tylenol, and Viagra.”

In November, current Missouri Attorney General Catherine Hanaway asked a federal court to roll back the FDA’s decision to approve a new generic brand of mifepristone. 

“For Missouri and other states with strong protections for unborn life and maternal health, the widespread mail-order distribution of mifepristone directly undermines state law and burdens state hospitals, emergency rooms, and taxpayers,” Hanaway said at the time.

Hanaway in a statement Wednesday said she will continue advocating for additional regulations around mifepristone use, including in-person appointments.

“As Missouri Attorney General,” she wrote, “I am proud to lead the fight to protect women’s health and safety, ensure every unborn child has a voice, and defend the rule of law.”

A majority of Americans support at least some access to abortion, including medication abortion, polling by the Pew Research Centers shows.

It could be why some Republicans on the national level have been quieter on the subject, especially ahead of the midterms. Many anti-abortion activists have expressed frustration with the second Trump administration’s reluctance to talk about abortion. But Missouri’s leaders haven’t shied away from the issue.

“Folks who are being rewarded,” Steinert McDowell said, “Despite doing this advocacy — or perhaps because of doing this advocacy — to undermine access to abortion care.”

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: info@missouriindependent.com.