PROFILE: RFK Jr.'s FDA turns against the abortion pill it approved 25 years ago

A drug on the market for a quarter century, suddenly called into question

Mifepristone has been on the American market since 2000. For 25 years, the Food and Drug Administration approved it, evaluated it, re-evaluated it, and consistently upheld its verdict: this drug is safe when used as directed. More than 7.5 million women have used it over the past two decades, according to data from the University of California, San Francisco. The rate of serious adverse effects is below 0.5 percent according to the American Medical Women's Association — safer, it notes, than ibuprofen, penicillin, or Viagra.

And yet, in June 2026, the FDA overseen by Robert F. Kennedy Jr. announced the opening of a safety inquiry into mifepristone. According to Trump administration officials who spoke to the Wall Street Journal on a Thursday evening in early June, this study will take approximately six months. It will be conducted using existing drug safety surveillance systems and may involve a subcontractor's analysis. No new scientific data was presented to justify this re-evaluation. No new clinical warning signal was cited.

The agency that re-examines its own decision after a quarter century

The FDA is an institution that approves drugs after years of rigorous testing, clinical review, and large-scale data evaluation. When it withdraws or re-evaluates a drug, it is normally because a new, documented safety signal has emerged since the initial approval. In the case of mifepristone in 2026, no such signal was publicly cited. The stated motivation is political: anti-abortion groups had been pressuring the administration, and a Louisiana judge had set an October deadline for an evaluation to be conducted.

Marty Makary, the former FDA commissioner removed the month before the announcement, had himself promised to launch this study at Kennedy's request — before being pushed out. He had said he needed new data systems to conduct the study properly. His successor ultimately decided to use existing systems. The FDA now finds itself in the uncomfortable position of studying the safety of a drug it deemed safe for a quarter century, under pressure from an administration and interest groups seeking to restrict its access.

There is an honest way to request a drug re-evaluation: present new data, clinical warning signals, proof that something has changed in its safety profile. That is not what Kennedy is doing. He is requesting a study because his political allies are demanding it. That is a fundamentally different thing.

25 years of surveillance, hundreds of studies, one consistent conclusion

Mifepristone's safety is not an open scientific question. The Guttmacher Institute was direct: more than 100 studies and decades of real-world data show that mifepristone is safe and effective, both in-person and through telehealth services. The institute's director of federal policy, Amy Friedrich-Karnik, called the FDA review a "politically motivated safety review" of mifepristone. That is not a partisan position. It is a reading of the available data.

Mifepristone is approved for use up to 10 weeks of pregnancy. It is used not only for elective abortions but also for incomplete miscarriages and other pregnancy complications. Restricting its availability would therefore affect far more than women seeking elective abortion — it would reach women experiencing often traumatic medical complications who need rapid access to safe medical treatment.

The 2016 decision that anti-abortion groups want to undo

In 2016, the FDA made an important decision: it informed physicians, hospitals, and emergency services that they would no longer need to report complications or adverse events resulting from mifepristone use — a decision that reflected the conclusion that the drug had a sufficiently established safety profile to no longer require that level of monitoring. Carol Tobias, president of National Right to Life, explicitly cited this 2016 decision as one reason her organization is satisfied with the current re-evaluation. She stated that after ten years, she is pleased to see the agency re-examine "the so-called safety" of the drug.

That phrase — "so-called safety" — encapsulates the political stakes of this case. For the anti-abortion groups backing Kennedy, the 25 years of data accumulated by the FDA on mifepristone do not constitute evidence of safety. They constitute a problem to be dismantled. And the 2026 FDA re-evaluation is the instrument chosen to attempt that dismantling.

When anti-abortion groups speak of "so-called safety" for a drug used by 7.5 million women with a serious-complication rate below 0.5 percent, we need to name things plainly: that is not science. That is medical politics.

Two years of lobbying since the second inauguration

Anti-abortion groups have been pressuring the Trump administration since the start of its second term to act against mifepristone. After the overturning of Roe v. Wade in 2022, more than a dozen states effectively banned abortion in most circumstances. But mifepristone remained accessible at the federal level — via medical prescriptions and, following a Supreme Court decision, maintained accessible through telehealth services. For anti-abortion groups, this federal accessibility represented a major obstacle to their goal of entirely eliminating abortion access in the United States.

More than 100 bills have been introduced by states to restrict or completely prohibit abortion medications, according to available data. The FDA re-evaluation represents a complementary federal strategy: if the FDA concludes — after a six-month study — that mifepristone presents health risks requiring new restrictions, it would provide scientific cover for already-decided political decisions. That is precisely the kind of institutional manipulation that reproductive rights advocates are denouncing.

The role of the Louisiana judge as catalyst

A less-covered element of this case is the judicial pressure that helped precipitate the FDA's decision. A Louisiana judge had set an October deadline for a mifepristone safety evaluation to be conducted. This judicial pressure, combined with repeated demands from Kennedy and anti-abortion groups, ultimately led the administration to announce the study in early June 2026. The judicial agenda and the political agenda aligned to create a window of opportunity the administration did not miss.

This mechanism — using courts as levers to force re-evaluations of federal agencies — is a well-documented strategy of anti-abortion groups since the overturning of Roe v. Wade. The FDA thus finds itself in a delicate position: it must conduct a study under judicial pressure, with an administration that has already determined its political utility, on a drug whose own evaluation record has said for 25 years that it is safe. The agency's scientific independence in this context is, at minimum, seriously compromised.

An agency conducting a study under judicial and political pressure, on a drug it has always confirmed is safe, with a timeline set by anti-abortion stakeholders — can that agency still produce a scientifically independent evaluation? I ask the question honestly, because it deserves an honest answer.

Planned Parenthood and the Center for Reproductive Rights at the front lines

Alexis McGill Johnson, president and CEO of Planned Parenthood Action Fund, called the FDA review a "politically motivated farce." She restated the facts with the clarity the situation demands: "Mifepristone is safe and effective. We know it, the FDA knows it, and the more than 7.5 million people who've used mifepristone for abortion and miscarriage care over the past 25 years know it too." That statement is not merely emotional. It is factual. And the facts are not on the other side. They are on the side of the data.

Liz Wagner, senior federal policy counsel at the Center for Reproductive Rights, was more specific in her criticism. She stated that hundreds of high-quality studies had made mifepristone's safety and effectiveness "overwhelmingly clear." She also argued that the Trump administration had launched the review with the politically motivated goal of making abortion pills harder to obtain. That reading is consistent with all available facts.

Guttmacher Institute: resist the political pressure

The Guttmacher Institute published an explicit call to the FDA: resist political pressure from the White House and anti-abortion groups, and conduct a fair, science-based review. That appeal implicitly acknowledges that the agency's independence is under threat — that the FDA will need to actively resist pressure to maintain its scientific integrity, which is not a normal situation for a regulatory agency whose independence should be a structural given.

Amy Friedrich-Karnik also addressed the fate of former commissioner Makary: his resignation or removal is said to stem from his attempt to remain independent as agency head and to not follow the White House's political directives. If that reading is accurate, it confirms that the Trump administration is not merely pushing its agendas through persuasion. It removes officials who resist those agendas. In that context, who remains to defend the FDA's scientific independence on mifepristone?

When an FDA commissioner is removed for attempting to remain independent, the institution itself sends a signal to all its employees: scientific independence has career costs. That signal may be more devastating for the FDA than any specific decision about any particular drug.

Students for Life and Americans United for Life: concerns about methodology

It is worth noting that even within anti-abortion groups, the FDA re-evaluation did not generate unconditional enthusiasm. Kristi Hamrick, spokesperson for Students for Life of America, told the Wall Street Journal that her organization had "many unanswered questions" before it could be satisfied. She insisted: "This study needs to be thorough." Gavin Oxley, of Americans United for Life, called for a robust methodology, grounded in real-world data, with no shortcuts.

These precautions are revealing. Even the organizations most ardently seeking mifepristone's removal from the market know that a sloppy study will immediately be challenged in court and in the press. Oxley explicitly stated that the study should be prepared for the "close scrutiny" it will face upon publication. This awareness that the study will be closely examined forces even the most ardent supporters to demand rigor — not because they believe the data will confirm their positions, but because they know a weak study will be politically useless to them.

National Right to Life: settling scores with 2016

Beyond the nuances, Carol Tobias of National Right to Life did not conceal her organization's satisfaction. The FDA's 2016 decision to no longer require reporting of mifepristone complications remains in the anti-abortion movement's memory as a victory for the drug's defenders. The 2026 study represents an opportunity for institutional payback — reintroducing into the regulatory record a reporting requirement that would document complications otherwise invisible in current statistics.

This strategy is sophisticated: if new reporting requirements are introduced, the FDA will collect more data on mifepristone complications — data that, by definition, does not exist in current statistics because it has not been systematically collected since 2016. These new data points could then be used to justify further restrictions in a second phase. It is a long game that anti-abortion groups play very well.

I understand the strategy. It is not science. It is long-term regulatory politics: create the data that is missing to justify tomorrow the restrictions you want to impose today. It is clever. And that is precisely why it is alarming.

The structural limits of a study conducted under political pressure

A study's scientific value depends on its independence, its methodology, and the quality of its data. The 2026 FDA study on mifepristone raises problems on all three fronts. Independence is compromised by the political context of its commissioning. The methodology — using existing surveillance systems and possibly a subcontractor — has not yet been submitted for peer validation. And the data will be whatever existing surveillance systems, designed for other purposes, can provide.

A study conducted under these conditions could produce three types of results: confirm mifepristone's safety (which, politically, would be a useless result for those who ordered it), find marginal risk signals susceptible to amplification through regulatory changes, or produce conclusions ambiguous enough to justify whatever political decision was chosen beforehand. In the current context, independent observers have serious reasons to distrust a study whose conclusions may be shaped before the data is even analyzed.

The difference between a warning signal and a political decision

The FDA normally operates this way: clinical data flags a problem, the agency evaluates the signal, and if it is robust enough, it takes regulatory action. This process is slow, rigorous, and designed to resist external pressure. In the case of mifepristone in 2026, the direction is reversed: the political decision to investigate was made first, and the data is now being sought to justify it. This reversal of normal process is not a procedural nuance. It fundamentally compromises the value of any result the study might produce.

It is possible — and even probable, given the robustness of existing data — that even in this unfavorable political environment, the study confirms mifepristone's safety. But in that case, anti-abortion groups will demand another study, with different methods. And the cycle will begin again. The objective is not to learn something new about mifepristone. The objective is to maintain institutional uncertainty around a drug that science has judged safe.

Maintaining institutional uncertainty around a safe drug is itself a strategy. When people are no longer sure what they can take, some give up. That is the goal. And the FDA becomes, despite itself, the instrument of that strategy.

From Paris to Washington: 25 years of battle

Mifepristone did not arrive in the United States without a fight. Developed in France in the 1980s by the laboratory Roussel Uclaf and known as RU-486, it met virulent political opposition as soon as it reached the European market. Its FDA approval in 2000, after years of political pressure, represented a medical victory and a political defeat for American anti-abortion groups. These groups never abandoned their goal of having it removed from the American market — and every Republican administration since then has represented for them an opportunity to achieve it.

But the 2000 approval was not an arbitrary decision. It was the result of decades of clinical studies conducted in Europe and the United States, demonstrating a solid safety profile. Mifepristone works by blocking progesterone, the hormone necessary for pregnancy to continue. It is generally combined with misoprostol, a second drug that triggers expulsion. This combination protocol has proven itself on millions of women in dozens of countries. Questioning this protocol in 2026, without new scientific data, amounts to denying a quarter century of evidence-based medicine.

The Supreme Court decision that changed everything

A recent Supreme Court decision maintained mifepristone accessible via telehealth services — a victory for reproductive rights defenders in a post-Roe environment where abortion access is massively restricted across much of the country. This decision reinforced mifepristone's importance as the last federal safety net for millions of women in states that have banned surgical abortion. It is precisely this status as a last federal safety net that makes it the anti-abortion movement's priority target.

The 2026 FDA re-evaluation thus takes on particular significance in this context: it arrives precisely when mifepristone has become the primary avenue of abortion access for women in restrictive states. If the FDA were to impose new restrictions on its accessibility, the combined effect with state-level bans would create a situation where medication abortion becomes effectively inaccessible for millions of American women. That is not speculation. It is the scenario anti-abortion groups are explicitly seeking to create.

I think of women in states like Texas or Alabama, who already have almost no options left. Mifepristone via telehealth is often their last resort. What Kennedy is doing to the FDA is cutting that last thread. Not openly, not through a dramatic decision — but gradually, quietly, by casting doubt on a drug medicine has known for 25 years.

An agency under direct White House pressure

The Makary affair — the former FDA commissioner pushed out after attempting to preserve the agency's independence — illustrates an important structural shift in how the FDA operates under the Kennedy administration. Historically, the FDA commissioner enjoys relative independence from the White House, precisely because drug safety decisions must be grounded in scientific data rather than political considerations. Appointing and removing commissioners based on their ideological conformity destroys this independence at a structural level.

For every FDA employee who observes what happened to Makary, the message is clear: independence has a career cost. Scientists who might wish to resist political pressure now know they risk being sidelined or having their careers compromised. This systemic implicit pressure is more insidious than any direct instruction — it leads professionals to self-censor their conclusions before they are even formulated.

The future of the FDA as an independent scientific institution

The question raised by the mifepristone case goes well beyond the fate of one drug. It interrogates the viability of the FDA as an independent scientific institution in a political environment where its supervising secretary is ideologically opposed to the scientific conclusions his own agencies have produced for decades. The FDA has survived political pressure before. But rarely in a configuration where the health secretary himself is the primary vector of that pressure.

The outcome of the mifepristone study — expected in the coming months — will be a crucial test of the FDA's institutional resilience. If the agency confirms the drug's safety on the basis of available data, it will demonstrate it can still resist. If it produces ambiguous or restrictive conclusions without solid new scientific grounding, it will have signaled its capitulation to political pressure. And that signal will be heard by every pharmaceutical company, every clinical researcher, every patient who depends on its decisions for their health.

I have hope for the FDA. Its agents are scientists, physicians, professionals who chose this career to protect public health. They see what is happening. Some will resist. But resisting within an institution whose leadership is ideologically hostile to your mission — that is exhausting. And exhaustion, slowly, does its work.

The verdict on an unprecedented decision

The history of mifepristone in the United States is one of the most documented stories in modern pharmacology. Approved in 2000, evaluated for a quarter century, used by more than 7.5 million women, with a safety profile more favorable than common medications like ibuprofen. That history does not justify an urgent re-evaluation. It justifies exactly the opposite: medical confidence grounded in decades of real-world data. What the Kennedy administration is doing in 2026 is imposing an artificial doubt on a drug whose safety profile is among the best established in the American pharmacopoeia.

The FDA that emerges from these six months of study will be a changed agency. If it confirms mifepristone's safety, it will have proven it can withstand political pressure. If it produces ambiguous or restrictive conclusions, it will have demonstrated that its scientific independence can be compromised by an ideologically motivated health secretary. In either case, the mere fact of having been compelled into this study under these conditions represents a loss of institutional credibility that will be difficult to erase.

What American women have the right to expect

American women who depend on mifepristone — for abortions, for miscarriages, for other medical complications — have the right to know that the FDA's decisions about their reproductive health are grounded in science, not politics. They have the right to an agency that says what it knows, says only what the data supports, and resists political pressure seeking to transform its public health tools into instruments of an ideological agenda. That is what the FDA was built to be. And that is what it risks ceasing to be.

Organizations like Planned Parenthood, the Center for Reproductive Rights, and the Guttmacher Institute will continue to fight in courts and in the public sphere. But the real battle for the FDA's independence — and for the health of the millions of women who depend on its decisions — is being waged inside the agency itself, in every decision its scientists will make over the coming months. Let us hope they hold the line.

Mifepristone is not just a drug. It is a symbol — of what medicine can achieve when it is free from politics, and of what it risks losing when politics takes it hostage. Twenty-five years of data should be more than enough to reassure American women in 2026. The fact that it is not says something very dark about the state of our institutions.

By Maxime Marquette, columnist

Editorial stance

I am not a journalist but a columnist and analyst. My expertise lies in observing and analysing the geopolitical, economic and strategic dynamics that shape our world. My work is to take political strategies apart, to understand global economic movements, to put the decisions of international actors in context and to offer analytical perspectives on the changes that are redefining our societies.

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