A three-judge panel of the 4th U.S. Circuit Court of Appeals in Richmond, Virginia, affirmed a ruling by a U.S. district judge in 2023 despite federal regulators' approval of the abortion pill as a safe and effective medication.

We take no position on the wisdom or folly of West Virginia’s abortion law," Judge J. Harvie Wilkinson III wrote for the 2-1 majority. "As Dobbs makes clear, that judgment belongs with the people and their elected representatives.

After Roe v. Wade was overturned, West Virginia imposed limits on how physicians can prescribe and dispense abortion medications. The state’s law outlaws most abortions, with some exceptions for rape and incest victims and in cases of life-threatening medical emergencies and nonviable pregnancies.