ALBANY, N.Y. — A federal appeals court on Monday temporarily blocked New York Attorney General Letitia James from enforcing state consumer-protection laws to stop two upstate crisis pregnancy centres from advertising that they offer a controversial abortion pill reversal treatment, in a closely watched test of the limits of anti-abortion speech. Since 2018, James has been battling with one national and one local anti-abortion group over whether their ads send a deceptive message about their services. The unanimous ruling leaves in place a lower court injunction. At the same time, the case moves forward and temporarily curbs how far the state can go in cracking down on assertions about the disputed protocol, Dec. 1, 2025.
The centres’ messaging regarding abortion pill reversal, the court said in a 3-0 opinion by Circuit Judge Joseph Bianco, joined by Circuit Judges Alison Nathan and Eunice Lee, constitutes noncommercial speech because the organisations do not administer the treatment or receive money for referring women to it. That ruling, as noted in a Bloomberg Law summary, makes it more difficult for New York to penalise the plaintiffs’ statements under the First Amendment.
How the abortion pill reversal fight wound up at the Second Circuit
A typical abortion pill reversal involves administering large doses of the hormone progesterone after a woman takes the first of two drugs that most people use to end a pregnancy, Mifepristone. The American College of Obstetricians and Gynaecologists, in a widely circulated fact sheet, warns that “claims regarding abortion ‘reversal’ treatment are not based on science and do not meet clinical standards.” At the same time, researchers who have reviewed the literature say the small studies thus far are too flawed to determine whether the protocol is safe or effective.
In May 2024, James escalated the conflict by filing a lawsuit in state court against Heartbeat International and 11 crisis pregnancy centres, accusing them of defrauding and endangering women with false claims that they could reverse medication abortions through an unproven approach known as abortion pill reversal, according to a complaint filed in court and summarised by Reuters. “Abortions cannot be reversed,” she said at the time, adding that “claims of medical treatments that can reverse the effects of a medication abortion are not supported by evidence.”
Weeks later, the National Institute of Family and Life Advocates — an association of anti-abortion centres — as well as two New York clinics, Gianna’s House and Options Care Centre, filed their own lawsuit in federal court against James, claiming his threats to enforce had a chilling effect on their ability to talk about abortion pill reversal as a moral and religious issue. Judge John Sinatra of the U.S. District Court agreed, in an Aug. 22, 2024 ruling, that shackled the attorney general from enforcing New York’s consumer-protection and false-advertising laws against the plaintiffs while their lawsuit is pending.
At arguments in June, lawyers for James asked the appeals court to consider the centres’ messaging as commercial advertising, seeking to direct patients toward doctors who would offer a controversial service. The panel asked whether that theory wouldn’t open the door for states to also categorise referrals by nonprofits, such as in immigration or environmental advocacy, as low-value commercial speech subject to more regulation, Courthouse News Service reported.
Monday’s decision leaves Sinatra’s injunction in place. It suggests that federal courts in the 2nd Circuit are not eager, at this stage, to let officials recast political advocacy as consumer marketing merely because it mentions health care. The ruling comes as other courts address similar disputes on the West Coast, and while the United States Supreme Court is considering a separate case involving a New Jersey crisis pregnancy centre’s attempt to avoid an investigation by that state into its counselling practices.
Anti-abortion advocates hailed the outcome. “The court is right to affirm that women in New York have the right to know about safe and effective supplemental progesterone,” said Caroline Lindsay, of the conservative Christian law firm Alliance Defending Freedom, which is representing the plaintiffs. James’ office did not immediately respond to whether she was planning to seek further review, and the underlying lawsuit she brought against other centres and Heartbeat International proceeds in state court — the scientific and legal fights over abortion pill reversal show no sign of winding down any time soon.
