WASHINGTON (AP) — Access to the abortion pill mifepristone will not change after the U.S. Supreme Court on Thursday unanimously rejected an attempt by anti-abortion groups to restrict the pill’s availability, a victory for abortion rights advocates and millions of women in states where abortion is legal.
Despite the ruling, women’s access to mifepristone still depends largely on the varying laws of each state, with only about half of states granting women full access under federally approved conditions.
“It doesn’t change anything,” said David S. Cohen, a law professor at Drexel University. “Tomorrow is the same as today, which is the same as yesterday, which is the same as before this case was filed.”
Here’s a look at what Thursday’s decision means and doesn’t mean for abortion access.
What did the Supreme Court decide?
Essentially, the justices said the anti-abortion activists who brought the case did not have the legal standing to sue the Food and Drug Administration over the drug’s safety or over changes that would make it more widely available. The FDA approved the drug more than 20 years ago and has repeatedly upheld its safety and effectiveness.
The anti-abortion group, known as the Alliance for Hippocratic Medicine, argued that they might have to treat emergency room patients who had suffered earnest injuries after taking mifepristone.
Although the decision keeps mifepristone available, legal experts say other groups or individuals who believe they can demonstrate a stronger legal connection to the drug may try to sue in a similar manner.
“Maintaining the status quo is a success, but it does not mean that these arguments are no longer valid and others will not pursue them,” said Rachel Rebouche, a law professor at Temple University.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 needed to maintain a pregnancy. It is usually taken with a second drug, misprostol, which causes cramping and contractions of 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 current FDA regulations that allow telemedicine prescribing and mail delivery to patients. The FDA has also expanded availability to vast pharmacy chains and allowed prescribing by nurses and other healthcare professionals.
These measures led to an raise in the prescription of mifepristone, which accounted for nearly two-thirds of all abortions in the United States last year.
Access to the pill is constrained in much of the country because state laws prohibit abortion (including medication abortion) entirely or impose specific restrictions on the apply of the drug.
How do state laws affect access to mifepristone?
Access depends largely on the laws of the state in which the patient lives and, in the case of states where mifepristone is banned or restricted, what steps the patient is willing to take to circumvent those laws.
About half of the U.S. states allow online prescribing and mail-in delivery of mifepristone under FDA drug approval.
Currently, 14 states prohibit abortions at all stages of pregnancy, including mifepristone. More than a dozen other states have laws that specifically restrict the drug’s prescription, such as requiring an in-person visit to a doctor or separate counseling about the drug’s potential risks and harms.
These steps are not supported by major medical societies, including the American Medical Association.
How protected and effective is mifepristone?
The FDA and the Biden administration have filed several lawsuits, affirming the drug’s safety and effectiveness.
According to FDA labeling, mifepristone produces a complete abortion in 97.4% of cases. Like all medications, the abortion pill is not 100% effective and in 2.6% of cases, surgical intervention was required to complete the abortion. In less than 1% of cases, the pregnancy continued.
In sporadic cases, mifepristone can cause earnest complications such as excessive bleeding, infections, and other emergency problems. These occur in far less than a fraction of 1% of all patients who take the drug, according to FDA labeling.
Why is there an raise in medical abortions despite restrictions?
Despite state laws against mifepristone, statistics show that women in these states continue to receive the drug through the mail because state authorities have little insight into U.S. Postal Service delivery methods.
According to the Society of Family Planning, a survey earlier this year found that in states where abortion is restricted or prescription drugs are constrained, about 8,000 women per month would receive the pills in the mail by the end of 2023.
What’s next for the legal challenges to mifepristone?
Legal experts warn that other parties could file modern lawsuits.
Idaho, Kansas and Missouri wanted to join the lawsuit against the FDA, but the Supreme Court rejected that request – although a conservative judge in Texas who originally ruled against the FDA allowed them to intervene in his district. The three states, all led by Republican attorneys general, could try to reopen the case in a lower court, legal experts say.
“They are not doctors who have to prove that they actually have anything to do with abortion care,” Rebouche said. “They are claiming that the state has an interest in regulating medicine, and I think that is the vehicle by which a lawsuit could be filed.”
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Geoff Mulvihill contributed to this story from Cherry Hill, NJ
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The Associated Press Health and Science Department receives support from the Science and Educational Media Group of the Howard Hughes Medical Institute. All content is the responsibility of the AP.
