In a significant ruling on Thursday, the Supreme Court decided to maintain access to a widely-used abortion pill, mifepristone, keeping existing provisions intact while ongoing litigation continues. This decision counters earlier lower-court rulings that sought to impose new restrictions.
With this order, women can continue to procure mifepristone from pharmacies or receive it by mail, eliminating the necessity for an in-person medical consultation. This access is expected to persist at least through the upcoming year as the legal battle unfolds, potentially reaching the Supreme Court once more.
The Supreme Court’s intervention came in response to emergency appeals from mifepristone manufacturers. These companies challenged a federal appeals court’s decision that would have reinstated the requirement for women to visit a doctor in person and prohibited mail delivery of the drug. Notably, the Food and Drug Administration (FDA), which originally approved mifepristone for abortion use in 2000, ceased mandating in-person consultations five years ago.
Meanwhile, anti-abortion advocates, discontented with the pace of the review process during President Donald Trump’s administration, are lobbying for stricter regulations on mifepristone. They aim to prevent its prescription through telehealth services. However, the administration has maintained that thorough reviews require time.
Amidst this controversy, FDA Commissioner Marty Makary stepped down earlier this week following sustained criticism from Trump’s political allies and anti-abortion groups.
Organizations like Susan B. Anthony Pro-Life America had previously urged President Trump to dismiss Makary, citing dissatisfaction with the sluggish progression of the FDA’s review of mifepristone.
The court is dealing with its latest abortion controversy four years after its conservative majority overturned Roe v. Wade and allowed more than a dozen states to effectively ban abortion outright.
The case before the court stems from a lawsuit Louisiana filed to roll back the Food and Drug Administration’s rules on how mifepristone can be prescribed. The state claims that the policy undermines the ban there, and it questions the safety of the drug, which has repeatedly been deemed safe and effective by FDA scientists.
Lower courts concluded that Louisiana is likely to prevail, and a three-judge panel of the 5th U.S. Circuit Court of Appeals ruled that mail access and telehealth visits should be suspended while the case plays out.
The drug is most often used for abortion in combination with another drug, misoprostol. Medication abortions accounted for nearly two-thirds of all abortions in the U.S. in 2023, the last year for which statistics are available.
The current dispute is similar to one that reached the court three years ago.
Lower courts then also sought to restrict access to mifepristone, in a case brought by physicians who oppose abortion. They filed suit in the months after the court overturned Roe.
The Supreme Court blocked the 5th Circuit ruling from taking effect over the dissenting votes of Justices Samuel Alito and Clarence Thomas. Then, in 2024, the high court unanimously dismissed the doctors’ suit, reasoning they did not have the legal right, or standing, to sue.
In the current dispute, mainstream medical groups, the pharmaceutical industry and Democratic members of Congress have weighed in cautioning the court against limiting access to the drug. Pharmaceutical companies said a ruling for abortion opponents would upend the drug approval process.
Debate over the safety of mifepristone has churned for more than 25 years. The FDA has eased a number of restrictions initially placed on the drug, including who can prescribe it, how it is dispensed and what kinds of safety complications must be reported.
Despite those determinations, anti-abortion groups have filed a series of petitions and lawsuits against the agency, generally alleging that it violated federal law by overlooking safety issues with the pill.
Trump’s administration has been unusually quiet at the Supreme Court. It declined to file a written brief recommending what the court should do, even though federal regulations are at issue.
The case puts the administration in a difficult place. Trump has relied on the political support of anti-abortion groups but has also seen ballot question and poll results that show Americans generally support abortion rights.
Both sides took the administration’s silence as an implicit endorsement of the appellate ruling.
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Mulvihill reported from Haddonfield, N.J.
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