Access to the abortion pill mifepristone will not change. After this Thursday the United States Supreme Court unanimously rejected an effort by anti-abortion groups to reduce its availability, the widely used drug will continue to be sold. The high court's action represents a victory for abortion rights supporters and millions of women in states where termination of pregnancy is illegal.
Despite the ruling, women's access to mifepristone will still largely depend on a patchwork of state laws, with only about half of states allowing full access to the drug under terms approved by the federal government.
We explain what Thursday's decision means for access to abortion.
What did the Supreme Court decide?
Essentially, the judges said that the anti-abortion doctors who brought the case did not have the legal basis to sue the Food and Drug Administration (FDA) over the drug's safety or changes that have made it more accessible to the public. The FDA approved the drug more than 20 years ago and has reiterated its safety and effectiveness.
Anti-abortion doctors, under the name the Alliance for Hippocratic Medicine, argued that they might have to treat emergency patients who suffered serious injuries after taking mifepristone.
While the decision keeps mifepristone available, legal experts warn that other groups or individuals, who believe they can demonstrate a stronger legal connection to the drug, could try to file a lawsuit on similar terms.
“It is a victory that the status quobut this does not indicate that they are dead arguments that others will not try to use,” said Rachel Rebouche, a law professor at Temple University.
What is mifepristone?
Mifepristone is prescribed to terminate pregnancies by dilating the cervix and blocking the hormone progesterone, which is necessary to maintain the pregnancy. It is usually taken with a second medication, misprostol, which causes cramps and contractions in the uterus. The two-drug regimen is used to terminate a pregnancy up to 10 weeks.
What does the ruling mean for the status of mifepristone?
Mifepristone remains fully approved and available under the current FDA framework, which allows prescriptions to be issued via telehealth, a service that uses video calls to consult with a medical professional, and delivery of the drugs by mail to patients. The FDA has also expanded availability to large pharmacy chains and allowed nurses and other health care professionals to prescribe it.
These policies have led to a rise in mifepristone prescriptions, accounting for nearly two-thirds of all abortions in the United States last year.
Access to the pill is restricted in large areas of the country due to state laws that either ban abortion entirely (including medication abortion) or impose separate restrictions on the drug's use.
How do state laws affect access to mifepristone?
Access depends largely on the laws in the state where the patient lives and, in the case of states that ban or restrict mifepristone, the measures each person is willing to take to circumvent them.
About half of the states in the country allow online prescribing and mail-order delivery of mifepristone, in accordance with the FDA's labeling for the drug.
Currently, 14 states are imposing abortion bans at all stages of pregnancy. About a dozen other states have laws that specifically limit how mifepristone can be prescribed, in some cases requiring an in-person visit with a doctor or separate counseling about the drug's possible risks and drawbacks.
Those measures are not supported by major medical societies, including the American Medical Association.
How safe and effective is mifepristone?
The FDA and the administration of Democratic President Joe Biden filed multiple legal challenges that reiterated the safety and effectiveness of the drug.
Mifepristone produces a complete abortion 97.4% of the time, according to the FDA label. Like all medications, the abortion pill is not 100% effective and in 2.6% of cases a surgical intervention was necessary to complete the abortion. Less than 1% of the time the pregnancy continued.
In rare cases, mifepristone can cause serious complications, such as excessive bleeding, infections, and other emergency problems. This occurs in much less than a fraction of 1% of all patients who use the drug, according to the FDA label.
How are medical abortions increasing despite restrictions?
Despite state laws targeting mifepristone, statistics show that women in those states continue to receive the drug by mail because state authorities have little visibility into deliveries made by the United States Postal Service.
A survey earlier this year found that about 8,000 women a month in states that severely restrict abortion or impose limits on telehealth prescriptions were receiving the pills in the mail by the end of 2023, according to the Planned Parenthood Society.
Additionally, some patients order the medication through international pharmacies outside of United States jurisdiction.
What's next for legal challenges against mifepristone?
Legal experts say other parties could file new lawsuits.
Idaho, Kansas and Missouri attempted to join the case against the FDA and the Biden Administration, a move the Supreme Court rejected, although a conservative Texas judge who initially ruled against the FDA allowed them to join the case in his district. The three states, all led by Republican attorneys general, could try to revive the case in a lower court, arguing they have state interests in blocking the use of mifepristone.
“They are not doctors who have to prove that they really have any relationship with abortion care,” Rebouche said. “They are alleging a state interest in the regulation of medicine, so I think that is the avenue through which a lawsuit could be seen.”
