For a brief stretch, she allowed herself to imagine motherhood. Then came a car ride she still struggles to talk about. Her boyfriend, who had a history of volatile behavior, began shouting that the pregnancy would “ruin” his life. Rosalie said she felt cornered. She swallowed chemical abortion pills that had arrived by mail days earlier, and hoped it wouldn’t be too late to vomit them in the bathroom when she arrived home.
Rosalie maintains that she did not order the pills and that it was her boyfriend who used her name and information to obtain the drugs online. There was no in-person medical visit or physical exam. Nor was there any screening for coercion or abuse. The pills were simply delivered to her home address.
What happened next unfolded the way chemical abortions typically do: cramping, heavy bleeding, and isolated suffering.
One day, Rosalie was dreaming about her baby; the next, her child was gone.
Rosalie’s story raises an uncomfortable question that has received little attention in the heated post-Dobbs debate: What happens when abortion moves almost entirely through the mail and into the hands of whoever controls the mailbox?
Many medical professionals and “women’s rights activists” are silent about a medical crisis when women need them the most. Blatant examples of domestic abuse and coercion involving chemical abortion drugs are met by many in leadership positions with apathy rather than outrage. Many pro-abortion activists within the medical community and beyond ignore or attack studies showing that the chemical abortion drugs themselves are inherently dangerous and can cause hemorrhaging, infection, and worse. They don’t seem to care that 70% of Americans support doctors screening for potential coercion before prescribing abortion medication.
A Louisiana court recently heard arguments in Louisiana v. U.S. Food and Drug Administration, a case brought on behalf of Rosalie and the state of Louisiana, which asks that the FDA restore the in-person dispensing requirement for dangerous abortion pills. The lawsuit highlights how mail-order abortion is causing direct harm to young women. Its necessity damningly indicates the failure of our nation’s highest institutions to protect women from mail-order-abortion related abuse and complications.
What happened to Rosalie — and many other women in recent years — ought to have sparked national outrage. Yet an FDA review of the abortion pill, mifepristone, drags on, and the Department of Justice asked the court to delay the proceedings, noting a lack of “immediate harm.”
In 2021, the U.S. Food and Drug Administration (FDA) removed the in-person visit required before chemical abortion drugs could be prescribed, allowing abortion drugs to be ordered online and delivered by mail for any reason, in any state, by any person. Two years later, 63 percent of all abortions in the U.S. relied on pills mailed from a prescribing clinician. Given the ease of access, it is safe to say that number is growing.
For Rosalie and hundreds of thousands of other women across the country, this removal of the in-person doctor’s visit destroyed any chance of catching a possible ectopic pregnancy. It also eliminated the possibility that her doctor could detect signs of abuse or coercion.
As a board-certified OB/GYN with over 20 years of experience caring for women, I have always believed that healthcare should never promote or intentionally harm patients. Before 2021, most of the medical community agreed that women’s health and safety must be prioritized. However, the rise of mail-order chemical abortion has completely transformed the medical landscape.
Rather than voicing caution and concern, pro-abortion advocates instead promote the lie that chemical abortion is “safe as Tylenol,” and that tele-abortions are “healthcare.”
Rosalie disagrees. The FDA’s rollbacks allowed her abusive boyfriend to use her name, email, and address to order chemical abortion drugs online without her or her doctor’s knowledge or input. This stripped Rosalie of her consent, as well as medical guidance for follow-up appointments, where a doctor could have detected domestic abuse and helped. Most importantly, it stole her motherhood.
Like Rosalie, women across America are suffering from mail-order abortions. Last summer, an Illinois man was accused of drugging his girlfriend, causing her to experience a severe medical emergency. Just months before that, a Texas man was charged with murder after drugging his girlfriend’s drink, causing her to be rushed to the emergency room with severe bleeding. In the fall of 2025, another Texas man was convicted of drugging his wife seven separate times, leaving the woman with subsequent mental and physical trauma. In November 2025, a Florida man killed his preborn child and his pregnant girlfriend because she refused to have an abortion.
In a cruel and ironic twist, states across the country have prioritized the protection of chemical abortion drugs over women with new laws aiding and abetting traffickers and abusers. So far, 19 states plus the District of Columbia have passed “shield laws,” protecting abortionists and abortion “facilitators” from criminal, civil, and professional consequences when they violate other states’ abortion laws. The most extreme shield laws explicitly protect abortionists who send abortion drugs to women and girls in states where the abortionists do not have licenses to practice medicine. In short, these laws protect anyone providing an abortion, regardless of whether they are qualified to do so and regardless of whether a woman is being coerced or forcibly drugged.
My heart breaks for the women who have been victimized by abortion drugs, as well as the lives lost because of them. Like Rosalie, they deserve better than forced abortions and complications at the hands of abusers. They deserve better than propaganda or silence from medical professionals who swore an oath to do no harm.
The court can right this wrong by requiring the FDA to reinstate basic safeguards on medication abortion drugs.
If we truly care about women like Rosalie, we must rise above partisan objectives and demand better of women’s healthcare.
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Dr. Christina Francis is an OBGYN and CEO of the American Association of Pro-Life Obstetricians and Gynecologists.
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