Supreme Court Upholds Access to Abortion Pill

The Supreme Court on Thursday unanimously rejected a lawsuit that questioned the Food and Drug Administration’s process in approving mifepristone. The ruling ensures that Americans can continue to access the abortion medication without an in-person visit with a healthcare provider.

The Court’s decision in FDA v. Alliance for Hippocratic Medicine reverses a Texas appeals court order that blocked the FDA approval of mifepristone and required in-person prescribing of medication abortion.

The decision also maintains the Food and Drug Administration’s authority to regulate medicines through its approval process.

This was the Supreme Court’s first case on reproductive rights since the conservative-majority court overturned the right to access abortion care under Roe v. Wade.

The doctors and anti-abortion groups who brought forth the lawsuit, represented by the Alliance Defending Freedom, said they had a right to sue because the use of mifepristone goes against their beliefs and they could experience “harm” by having to care for people who experience complications from the medication, even if they are not the ones to prescribe or use it.

In the Supreme Court opinion, Justice Brett Kavanaugh said the plaintiffs did not have the standing to sue because there are already federal laws stating doctors are not required to provide abortions or other medical care that goes against their religious beliefs or moral convictions. The plaintiffs, he said, had to prove that they were directly harmed by the government’s under-regulation of other people.

“In short, given the broad and comprehensive conscience protections guaranteed by federal law, the plaintiffs have not shown – and cannot show – that FDA’s actions will cause them to suffer any conscience injury,” Kavanaugh wrote. “Federal law fully protects doctors against being required to provide abortions or other medical treatment against their consciences—and therefore breaks any chain of causation between FDA’s relaxed regulation of mifepristone and any asserted conscience injuries to the doctors.”

What This Means for Drug Regulation

Mifepristone has been available in the U.S. since 2000 for medication abortion and miscarriage management. The drug has been available through telehealth and mail order since 2021.

Medications like mifepristone go through a rigorous approval process, and the FDA has tracked the safety of the medication in real-world use since it became available.

If the ruling had stood, it would have been the first time that the use of a drug was limited based on a court order.

The pharmaceutical industry warned that upholding a ruling that challenges regulations for mifepristone could open the door to more legal challenges against other medications.

Danco Laboratories, the manufacturer of Mifeprex, applauded the court’s decision.

“[The judges] maintained the stability of the FDA drug approval process, which is based on the agency’s expertise and on which patients, healthcare providers and the US pharmaceutical industry rely,” Abby Long, Vice President of Marketing & Public Affairs at Danco, said in a statement.

Meanwhile, the Alliance Defending Freedom, a conservative legal group that brought the lawsuit on behalf of the anti-abortion doctors, said it was “disappointed that the Supreme Court did not reach the merits of the FDA’s lawless removal of commonsense safety standards for abortion drug.”

Upholding the Safety of Mifepristone

Mifepristone is the first pill taken in the two-drug medication abortion regimen. It is approved by the FDA for use through 10 weeks of pregnancy. Abortion providers in the U.S. can legally prescribe it through 12 weeks of pregnancy because the World Health Organization says the drug can be safely given up to that point.

Major medical organizations, including the American Medical Association and the American College of Obstetricians and Gynecologists, filed an amicus brief discussing the safety of mifepristone. They said that less than 0.32% of patients experience adverse events related to the drug and that the risk of death “is almost non-existent.”

“Few drugs have been so extensively studied after their approval by FDA and can boast such a clear and compelling record of safe use,” the authors wrote.

Unnecessarily restricting mifepristone would “exacerbate existing inequities in maternal health for women of color, low-income women, and those living in rural areas,” they wrote. “Restricting access to mifepristone will not only jeopardize health, but worsen racial and economic inequities and deprive women of the choices that are at the very core of individual autonomy and wellbeing.”

In February, the medical publisher Sage Perspectives retracted three studies that found safety issues related to mifepristone use. The Texas judge who initially ruled in favor of Alliance for Hippocratic Medicine case cited two of those studies in his decision. The publisher said the studies were detracted due to possible “defects” in the data selection and potential conflicts of interest—some of the authors didn’t disclose their affiliations with anti-abortion advocacy organizations.

How You Can Get the Pill Now

Since the overturn of Roe v. Wadethe use of medication abortion has grown. By some estimates, it accounts for nearly two-thirds of all abortions.

“When this litigation began in 2022, only 1 in 4 adults knew abortion pills existed—today, that number has doubled,” Kiki Freedman, CEO of Hey Jane, a telehealth clinic that offers medication abortion, said in a statement.

“If there is one silver lining to this politically motivated effort to curtail access to mifepristone, it’s that even more people are now aware that medication abortion is a safe, effective, discreet, and common option for accessing abortion care,” she added.

Since the fall of Roe v. Wade21 states have imposed abortion bans. The use of telehealth services to prescribe and mail abortion pills has improved abortion care access, even for some people living in states with abortion bans. Shield laws in seven states that support abortion allow providers to mail the pills out of state.

Despite today’s ruling, the challenge to mifepristone access may not yet be over. Three states—Idaho, Kansas, and Missouri—tried to intervene in the case against the FDA, but the court didn’t allow them to do so. Those states may attempt to challenge the mifepristone approval through other cases.

The Supreme Court is also hearing another major case about whether emergency rooms in hospitals are required to provide abortions if a woman’s life is in jeopardy and in other urgent situations.