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What the Supreme Court decision means for abortion pill access
The Supreme Court unanimously rejected an attempt to significantly restrict access to mifepristone, a key abortion medication.
By Sabrina Malhi for the Washington Post
June 13, 2024 at 2:07 p.m. EDT
The Supreme Court unanimously rejected an attempt to significantly restrict access to a key abortion medication, mifepristone, on Thursday. The conservative majority ruled that the antiabortion physicians who filed the case did not have standing to challenge the Food and Drug Administration’s approval of the drug.
In a written opinion for the court, Justice Brett M. Kavanaugh said that because the plaintiffs don’t prescribe, sell or manufacture mifepristone, they suffer no direct monetary injuries related to the FDA’s loosening regulations for obtaining the drug in 2016 and 2021.
Medical profession organizations lauded the court’s decision, saying the science supporting the safety and efficacy of the drug has long been established.
“We now know that patients and clinicians across the country will continue to have access to mifepristone for medication abortion and miscarriage management,” Stella Dantas, president of the American College of Obstetricians and Gynecologists, said in a statement. “Decades of clinical research have proven mifepristone to be safe and effective, and its strong track record of millions of patient uses confirms that data.”
Here’s what you need to know.
WHAT TO KNOW
- What was the Supreme Court decision?
- Where can people get the abortion pill?
- How is mifepristone used and what are the side effects?
- Can you order mifepristone by mail?
- If I’m in a state where abortion is banned, is it legal to take mifepristone?
What was the Supreme Court decision?
The 9-0 decision reversed a lower-court ruling that would have made it harder to obtain mifepristone, part of a two-drug regimen used in more than 60 percent of U.S. abortions. The opinion was based on a procedural ruling that the plaintiffs did not have legal grounds to bring the case.
The court said that the antiabortion doctors who brought the case and the Alliance for Hippocratic Medicine did not provide any evidence to suggest that the FDA’s deregulatory actions have affected how they treat patients because they do not prescribe or use mifepristone.
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Even though the court’s decision was unanimous, it is unlikely to be the end of efforts to restrict access to the pill. The ruling leaves an opening for three states — Missouri, Kansas and Idaho — to quickly try to revive the challenge before a federal judge in Texas who is well known for his antiabortion views.
Where can people get the abortion pill?
In March, retailers Walgreens and CVS said they would start filling prescriptions for mifepristone “in states where it is legally allowed.”
It some states, it can be purchased via mail. In 2021, the FDA lifted a long-standing restriction, allowing patients to receive the medication by mail instead of requiring them to obtain the pills in person.
Some states have moved to block the use of telehealth for medication abortions.Fifteen states require that medication abortion be provided by a physician, and five of these states require an in-person visit with a doctor, according to the Guttmacher Institute.
How is mifepristone used and what are the side effects?
Mifepristone is used in combination with another drug, misoprostol, for terminating pregnancy through the first 10 weeks of gestation. The pill works by blocking progesterone, a hormone necessary for a pregnancy to continue. About 24 to 48 hours after taking mifepristone, a patient takes a four-pill dose of misoprostol, which induces contractions and expels the contents of the uterus.
Mifepristone was developed in the 1980s by French researchers and was initially banned in the United States. But in 2000, the FDA approved it for terminating pregnancies up to seven weeks’ gestation, and in 2016 the agency extended the approval to 10 weeks.
A 2015 study in the journal Contraception found that the two-drug regimen was 95 to 98 percent effective at terminating pregnancy, depending on when it was taken within those first 10 weeks. Mifepristone is not used to terminate pregnancies in certain circumstances, including an ectopic pregnancy or if a person has an intrauterine device.
Side effects of mifepristone are incredibly rare, according to Jessica Lee, an associate professor of obstetrics, gynecology and reproductive sciences at the University of Maryland School of Medicine.
“It’s safer than penicillin. It’s safer than Tylenol. It’s safer than probably eating peanut butter, given the rate of allergies or anaphylaxis,” Lee said. “A majority of people experience nothing. … The most common side effect, if [you] have any side effects at all, are very light vaginal bleeding, also known as spotting.”
Can you order mifepristone by mail?
This depends on your location. A few telemedicine clinics have started allowing U.S.-based doctors to prescribe and mail pills into restricted states, relying on new “shield laws” that have recently passed in several Democratic-led states to protect them from prosecution.
If I’m in a state where abortion is banned, is it legal to take mifepristone?
While mifepristone is most commonly used as a part of the regimen for abortion, the drug can also be prescribed off-label for circumstances such as miscarriage management because it can soften and dilate the cervix. That makes the legal situation murky in states where abortion is banned.
State restrictions primarily target providers rather than patients. However, there have been several instances in which local authorities have attempted to prosecute women under other state laws, such as those prohibiting drug consumption during pregnancy or desecration of a corpse.
“We’re kind of living in a world where there’s no zero-risk activity,” said Greer Donley, an associate professor at the University of Pittsburgh School of Law who specializes in abortion. “But given how many people are buying pills and using telehealth to get access to medication abortion, the number of prosecutions has been remarkably low.”
One factor that might help patients taking mifepristone in antiabortion states is that complications arising from the drug closely mimic those of a natural miscarriage, according to Lee Roosevelt, a clinical associate professor at the University of Michigan’s School of Nursing and a practicing nurse-midwife. The medication also doesn’t show up in the bloodstream, making it challenging for doctors to prove whether patients have taken it unless they disclose it themselves, she added.
Ann E. Marimow and McKenzie Beard contributed to this report.
U.S. abortion access, reproductive rights
Tracking abortion access in the United States: Since the Supreme Court struck down Roe v. Wade, the legality of abortion has been left to individual states. The Washington Post is tracking states where abortion is legal, banned or under threat.
Abortion pills: The Supreme Court refused to limit access to the abortion pill mifepristone. Here’s how mifepristone is used and where you can legally access the abortion pill.
Abortion and the election: Voters in about a dozen states could decide the fate of abortion rights with constitutional amendments on the ballot in a pivotal election year. Biden supports legal access to abortion, and he has encouraged Congress to pass a law that would codify abortion rights nationwide. After months of mixed signals about his position, Trump said the issue should be left to states. Here’s how Biden and Trump’s abortion stances have shifted over the years.
Reproductive rights: The Senate voted to block a bill to create a federal right to contraception access. Since Roe v. Wade was overturned, far-right conservatives have been trying to curtail birth-control accessby sowing misinformation about how various methods work to prevent pregnancy. See how every senator voted on the Right to Contraception Act.
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