Abortion Pill Legal Fight Moves to Trump-Packed Missouri Court

The legal fight over abortion pill access now rests in the hands of a court featuring judges appointed by President Donald Trump, including jurists who had previously participated in litigation to limit access to the mifepristone medication.

Texas federal Judge Matthew Kacsmaryk, who for years presided over major litigation on abortion pills, surprised many case watchers on Tuesday by transferring a battle over the abortion pill from his court to the US District Court for the Eastern District of Missouri.

Reproductive rights advocates have long considered Kacsmaryk hostile to medication abortion, the use of which accounted for over 60% of US abortions in 2023. His selection of venue sparked more concern this week because seven of the nine active judges on that Missouri court were appointed by Trump, according to data from the Federal Judicial Center.

“The goal is crystal clear: anti-abortion leaders like Judge Kacsmaryk want to ban abortion nationwide and will deploy every trick in the book to do so,” said Jennifer Driver, senior director of reproductive rights at the State Innovation Exchange, in a statement.

Kacsmaryk’s decision comes as the courts, lawmakers, and Trump administration focus on mifepristone use in the US, with all three branches taking actions that may ultimately limit access to reproductive services.

States’ Case

Missouri, Idaho, and Kansas are waging the legal battle against the Food and Drug Administration over loosened restrictions that eased access to mifepristone.

In January, the Trump administration said the states lacked venue to bring their claims in Texas, and asked Kacsmaryk to toss the case or transfer it to venues in “the Federal courts in the States’ capital cities or where Defendants are headquartered.”

The Department of Justice in the brief didn’t request a specific court, but included the Western District of Missouri among its examples.

Kacsmaryk chose Missouri’s Eastern District, calling it “an accessible district with a major city where at least one party resides.”

“I’m not aware of any party asking for transfer to the Eastern District of Missouri, but that is what Kacsmaryk chose to do anyway,” said Katie Keith, who was deputy director of the Biden White House’s Gender Policy Council. “He could have dismissed this case outright, and chose not to do so.”

Some attorneys agree with Kacsmaryk acknowledging the jurisdictional issue in Texas and transferring the case.

Kacsmaryk “deserves some credit here,” said Josh Blackman, professor at South Texas College of Law Houston. “If he wanted to keep this case, he could have.”

Thomas Jipping, a senior legal fellow at the Heritage Foundation, said someone arguing “Kacsmaryk didnt have appropriate jurisdiction” couldn’t “also say that he should exercise jurisdiction and dismiss the case.”

The Heritage Foundation is the conservative group behind Project 2025, a policy proposal Trump has followed closely that targets mifepristone directly.

Missouri Courts

It remains to be seen which Eastern District of Missouri judge will take over the case, but several Trump appointees with experience challenging the FDA over its approval of mifepristone now sit on the court.

Former Missouri solicitor general Joshua Divine and the state’s former principal deputy solicitor general, Maria Ann Lanahan, are both Trump-appointed judges at the Eastern District of Missouri and previously represented the state in its mifepristone litigation.

Judges Zachary M. Bluestone and Christian M. Stevens, both nominated to the court this year, previously worked in the Missouri attorney general’s office.

Blackman said that “any judge who participated in the litigation might have to recuse” themselves. He added that “there are plenty of judges in Missouri who can handle the case.”

“I think we should start with assuming that our US district judges will be fair and impartial,” Jipping said.

Beyond the Court

The Trump administration will need to grapple with Missouri’s legal challenge regardless, which so far has included an attempt to require the drug be dispensed in person and allowing the drug be taken later in pregnancy.

Yet Trump’s HHS may ultimately address mifepristone access outside of the court, and is already taking steps to reevaluate previous safety approvals of the medication.

In a recent letter to Republican attorneys general, FDA Commissioner Marty Makary and US Department of Health and Human Services Secretary Robert F. Kennedy Jr. said they would conduct a review of the drug regarding its safety and efficacy.

In doing so, they cite a controversial study from the faith-based Ethics and Public Policy Center, which found that one in 10 abortion pill users experience an adverse event.

The HHS letter responded to a request from the Republican attorneys general, among whom were those from Idaho, Kansas, and Missouri. The states in their letter cite the Ethics and Public Policy Center’s data in pushing for a review of mifepristone.

“That letter was a real escalation,” Keith said.