A Louisiana Law Could Kill Women Giving Birth & Other States May Copy It

On October 1, a Louisiana law took effect that reclassifies medication abortion drugs mifepristone and misoprostol as controlled substances — alongside drugs like Xanax and Valium — that have the potential for addiction or abuse. It’s the first law in the country to target abortion pills in this way, representing a new front in the attack on abortion rights as lawmakers try to restrict access to the most common method of abortion. The passing of the law is part of a larger national effort by anti-abortion extremists to crack down on medication abortion, including an ongoing lawsuit against the FDA over expanded access to mifepristone, specifically. Nearly two-thirds of all reported abortions in 2023 were done with pills, and medication abortion by mail is helping people get care in the 21 states where abortion has been partially or fully banned after the 2022 fall of Roe v. Wade.

Both medications have other life-or-death uses besides abortion, like miscarriage management and labor induction, and misoprostol is a critical treatment for postpartum hemorrhage, a leading cause of maternal mortality. But according to the new law, that doesn’t matter: The drugs have to be stored in a locked cabinet with other controlled substances, even if healthcare providers need them in emergencies, adding unnecessary barriers to the prescription process.

Doctors found to violate the law face up to 10 years in prison and a fine of up to $15,000. The purported reason for the bill is that state Sen. Thomas Pressly’s sister was unknowingly given misoprostol in Texas by her abusive then-husband who didn't want her to have their baby. Pressly and his fellow lawmakers jumped at the chance to not only create the crime of “coerced criminal abortion,” but to tack on a provision that makes mere possession without a prescription a crime — though pregnant people are exempt. 

The state already bans nearly all abortions, whether by medication or done in a clinic. It’s illegal to prescribe the pill to terminate a pregnancy outside of the exceptions of life endangerment, medical emergencies, or a lethal fetal anomaly. This post-Roe trigger ban was already impacting medical care for pregnant patients: Rather than performing or inducing an abortion, some hospitals have been delaying care for miscarriages and even forcing women whose water breaks early to have C-sections, according to a joint report by reproductive rights organizations published in March. The pills were already being used sparingly, and now access in emergency situations will be even more limited. The new law adds restrictions for women coming to ERs with miscarriages, and can also complicate care for people delivering full-term babies.

It also impacts those who have been helping people self-manage their abortions amid state bans: While abortion bans are typically enforced by criminalizing doctors, Louisiana's new law could also lead to arrests of non-pregnant people who possess abortion pills without a valid prescription or who give the pills to anyone who needs help.

The new law may also worsen the already-high rates of maternal death in Louisiana, and could threaten the lives of Black women in particular, said Neelima Sukhavasi, MD, MPH, an OB/GYN who practices at an academic medical center in Baton Rouge and is a fellow with Physicians for Reproductive Health. “I definitely think that this will impact Black and brown women more than white women in the state,” Sukhavasi said. These patients already have different social determinants of health like proximity to care and the consequences of implicit bias.

Sukhavasi referred to recent reporting by ProPublica about two Georgia women, Amber Thurman and Candi Miller, who died after alleged delays in treatment and fear of seeking care under the state’s six-week ban; they were both Black. Thurman came to an ER with signs of infection after getting abortion pills from a clinic in another state and staff allegedly waited 20 hours to give her a dilatation and curettage (D&C) procedure. Miller ordered pills online and didn’t seek care after complications; her family said she was afraid of being arrested.

Anyone giving birth can experience postpartum hemorrhage (PPH) — life-threatening bleeding that can happen right after delivery or up to 12 weeks post-birth — but Black and brown patients are more likely to have risk factors, including multiple previous births and anemia, Sukhavasi said. “We take care of people all the time who have no risk factors and happen to have a postpartum hemorrhage that we have to treat,” Sukhavasi said. Any delays when people are bleeding too much after giving birth could endanger their lives, she added.

It’s no wonder, then, that hospitals often stock misoprostol on postpartum hemorrhage kits or carts that are in delivery rooms for quick access. But under the new law, which classifies mifepristone and misoprostol as Schedule IV drugs, some large Louisiana hospitals said the medications will be "stored in a passcode-protected dispensing system" alongside other controlled substances.

Doctors are now also required to put in a physician’s order before obtaining the drugs and specify the reason for the prescription, rather than documenting this information afterward, a change that wastes precious time. Some staff did timed drills in advance of October 1 to see how long it would take them to retrieve misoprostol and bring it back to a patient room. As the clock ticks, hemorrhaging patients lose more blood. As Jennifer Avegno, director of the New Orleans Health Department, told the Washington Post: "Most patients would likely make it. But I’ve seen myself what can happen when someone is bleeding out from a miscarriage. And a few minutes could mean life and death in some cases.” If the law does worsen death rates, it could be a while before the public knows because of how maternal mortality review committees work, Sukhavasi said. (Thurman and Miller died in 2022.)

The consequences will depend on details as minute as hospitals’ floor plans: The further away the secure storage area for controlled substances is, the worse it could be. Plus, providers now need a DEA registration and a state license in order to prescribe the drugs, which could affect access in so-called maternal health care deserts in more rural parts of the state where there aren’t OB/GYNs. Sukhavasi worries that nurse practitioners may not have the licenses and may need to transfer patients to other doctors — or potentially other hospitals — which would delay care even further. 

Louisiana is the only state with this law so far, but other legislatures may introduce copycat bills in 2025. Duplicating restrictions is a longtime strategy of the anti-abortion movement, said Jennifer Driver, senior director of reproductive rights at the State Innovation Exchange Reproductive Freedom Leadership Council. “It would be very naive of us to think that Louisiana is going to be the only state to introduce a law [criminalizing these drugs],” she said. She pointed to states like Florida and Oklahoma that moved to copy the 2021 Texas “bounty hunter law” that let private citizens sue each other over abortions. (A criminal ban now supersedes that law.)

Yes, Vice President Kamala Harris is campaigning heavily on abortion and has pledged to sign a law that would codify the protections of Roe v. Wade and overturn state bans. But she’d need Democrats to control both the House and Senate for that to have a chance of happening — a Harris win alone wouldn’t prevent states from copying the Louisiana bill.

Driver added that, while federal races are important, she’s worried they’re taking up so much oxygen that competitive down-ballot races get less attention and could result in losses. “I'm actually really concerned about the state legislature makeup following this election,” she said, adding that if Republicans make gains, they’ll feel “incredibly emboldened.” Even lawmakers who are pro-choice can get scared if the state house margins are tight. “That clouds your view and your willingness to really go bold in the session — and that's actually what we need to fight back against bills like what we see in Louisiana,” she said.

Laws that put criminal restrictions on healthcare create a climate of fear for both patients and their doctors. People with uteruses could be increasingly scared to get medical care, and history suggests that hospitals will be ever more cautious in treating them. Elizabeth Ling, senior helpline counsel at If/When/How, an organization that assists people with pregnancy-related legal issues, said the law is confusing by design and that abortion-seekers have already been calling the organization’s helpline with questions.

Despite the clear carveout, Ling said, “what the law says and what happens in reality can be very different.” Sukhavasi said providers' own fear of being thrown in jail seeps into patient care, which causes harmful delays. “It impacts what you say to patients, and the counseling you give them, maybe where you would refer them.”

Any delays in care can lead to a patient deteriorating, developing an infection, and possibly needing a blood transfusion or a hysterectomy, she said. Louisiana’s law could also make pharmacists less likely to fill misoprostol prescriptions for people miscarrying at home, or even for non-pregnant patients taking the drug before IUD insertions or diagnostic procedures called hysteroscopies. That’s the thing about restrictions on reproductive healthcare — they can affect anyone with a uterus, even people who think they’d never have an abortion.

Miscarriage treatment is “more or less abortion care,” Sukhavasi said. The treatments are mifepristone and misoprostol (or miso only) to help the body expel pregnancy tissue, or a procedure to clear the uterus. “People, until recently, have never thought of those things coinciding,” she said. “Laws that are regulating or potentially restricting the use of mifepristone and misoprostol are affecting your options as someone coming in with a very desired pregnancy and having some sort of complication.”

Ultimately, Sukhavasi said, “it's a problem when there are constraints placed on medications that are safe and that we use every day.” And it’s a problem that’s unlikely to stay in Louisiana.