The U.S. Supreme Court has ruled to maintain access to the abortion pill mifepristone, a decision that secures that availability of one of the most widely used drugs for terminating pregnancies in the United States.
Mifepristone, a key component in medication abortions, is currently used in the majority of pregnancy’s terminations across the country.
The case in question revolved around anti-abortion groups attempting to revoke the U.S. Food and Drug Administration’s (FDA) approval of mifepristone, but the justices determined that the plaintiffs lacked the legal standing to bring the case forward.
Legal Standing of Plaintiffs
In their ruling, the Supreme Court justices highlighted that the organizations and individuals challenging mifepristone’s FDA approval did not have a legitimate legal right to do so because they were not required to prescribe or provide the drug to patients. The plaintiffs argued that the FDA should make it more difficult for doctors to prescribe mifepristone and for pregnant women to obtain it, but the justices found this argument insufficient.
Justice Brett M. Kavanaugh, writing for the unanimous decision, stated, “The plaintiffs do not prescribe or use mifepristone. And FDA is not requiring them to do or refrain from doing anything. Rather, the plaintiffs want FDA to make mifepristone more difficult for other doctors to prescribe and for pregnant women to obtain.” Kavanaugh’s opinion made it clear that the plaintiff’s lack of direct involvement with the medication undermined their ability to sue over its FDA approval.
Furthermore, federal law already allows healthcare providers to refuse to offer abortion services on moral or ethical grounds. The court’s ruling emphasized that there had been no documented cases where doctors were forced to perform abortions against their conscience, especially since the FDA approved mifepristone in 2000.
As Kavanaugh wrote, “The plaintiffs have not identified any instances where a doctor was required, notwithstanding conscience objections, to perform an abortion or to provide other abortion-related treatment that violated the doctor’s conscience since mifepristone’s 2000 approval.”
Understanding Medication Abortion
Medication abortions involve a two-step process, typically using mifepristone followed by another drug, misoprostol. Mifepristone works by blocking the hormone progesterone, which is essential for pregnancy to continue.
Once the progesterone is blocked, the pregnancy stops developing, and misoprostol is taken to induce cramping and bleeding that removes the pregnancy tissue from the uterus. This process mimics the natural miscarriage process.
For over 20 years, this medication regimen has been a legal option in the U.S. for terminating pregnancies, usually up to 10 weeks of gestation. Initially, FDA regulations required that mifepristone by prescribed in person, which created barriers to access.
However, during the COVID-19 pandemic, the FDA lifted this restriction and allowed for telemedicine consultations, enabling patients to receive the medication through the mail. This change, initially temporary, became permanent in December 2021, further expanding access to medication abortion across the country.
The Rise of Medication Abortion Post-Dobbs Decision
The Supreme Court’s June 2022 ruling in Dobbs v. Jackson Women’s Health Organization overturned Roe v. Wade, removing federal protection for abortion rights and allowing states to implement their own abortion bans or restrictions. Following this decision, the reliance on medication abortions has increased significantly. According to a report published by the Guttmacher Institute in March 2024, about two-thirds of all abortions in the U.S. are now performed using medications rather than surgery.
Public health experts have highlighted the importance of telehealth in maintaining abortion access after the Dobbs ruling.
“We know that that medication abortion via telehealth has been pivotal to preserving the abortion access landscape in the wake of the Dobbs decision, with care provided via telehealth accounting for 19 percent of all abortions nationwide,” says Ushma Upadhyay, PhD, MPH, a public health scientist with Advancing New Standards in Reproductive Health (ANSIRH) at the University of California in San Francisco (UCSF).
Had the plaintiffs succeeded in their efforts to revoke mifepristone’s FDA approval, access to medication abortions could have been restricted even in states where abortion remains legal. This would have created significant barriers for individuals seeking abortion care, particularly in states that had enacted few or no restrictions on abortion.
State-Level Restrictions on Abortion Continue
While the Supreme Court’s decision ensures continued access to mifepristone on a federal level, it does not prevent individual states from passing laws that limit or block access to abortion medication.
As Dr. Upadhyay noted, “With total abortion bans in 14 states across the country and additional states that significantly restrict abortion, people will continue to struggle to obtain abortion care in this country.”
States with strict abortion laws are expected to continue their efforts to restrict access to both surgical and medication abortions. Currently, 14 states have enacted total bans on abortion, and several others have imposed significant restrictions that make it difficult for patients to access the care they need. Despite the federal ruling, patients in these states may find it increasingly challenging to obtain abortion services.
Upcoming Supreme Court Abortion Case
The fight over abortion access is far from over, as another high-profile case regarding abortion restrictions is pending before the Supreme Court. This case, based in Idaho, centers on whether federal law mandates that hospitals provide abortions in emergency situations, even in states where the procedure is banned. The federal Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals to provide emergency care to patients, and the plaintiffs argue that this should extend to pregnant individuals facing life-threatening complications.
“A ruling in favor of Idaho certainly would empower states to pass ever more restrictive limitations on abortion,” says Alan Trammell, an associate professor at Washington and Lee University School of Law in Lexington, Virginia. “Having said that, Congress arguably still has latitude to pass a federal statute that would directly countermand a state statute like Idaho’s.”
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