Supreme Court Upholds Access To the Abortion Pill, Mifepristone

The Supreme Court is upholding access to a widely-used abortion pill, mifepristone, in a case that could have had a massive impact on how patients seek abortion care in the US.

In a unanimous decision, the justices ruled that the plaintiffs — a group of anti-abortion organizations — ultimately lacked the standing to legally challenge the actions of the Food and Drug Administration, which oversaw expanded access to mifepristone over the last several years. The plaintiffs “have sincere legal, moral, ideological, and policy objections to mifepristone being prescribed and used by others,” wrote Justice Brett Kavanaugh in the majority opinion. Because the plaintiffs don’t prescribe or use the drug themselves, they sought “to challenge FDA’s regulation of others.” The court found that the plaintiffs’ arguments failed to establish that they themselves had been injured by the FDA’s regulation of others, and that they therefore had no legal standing to sue.

“The federal courts are the wrong forum for addressing the plaintiffs’ concerns about FDA’s actions,” Kavanaugh concluded, noting that they could instead take their concerns to the president, the FDA, Congress, or other citizens.

By using this reasoning, the Court didn’t actually rule on whether the FDA was legally able to lift the restrictions it did when expanding access to mifepristone — just that this particular lawsuit couldn’t stand. That means another lawsuit on those matters could potentially reach the Court in future.

For now, though, mifepristone will continue to be available by mail and used for up to 10 weeks into pregnancy, among other regulatory decisions the Court left in place.

Why was the Supreme Court reviewing the abortion pill, mifepristone?

The legal challenge to mifepristone came from the Alliance Defending Freedom, an organization that the Southern Poverty Law Center calls a “designated hate group,” on behalf of four anti-abortion organizations in Texas. Originally, their goal was to invalidate the FDA’s original approval of mifepristone, a decision that dates back to 2000.

A Texas district judge ruled in their favor in April 2023, which would have removed mifepristone’s FDA approval, but the Supreme Court put that decision on hold while appeals took place. And sure enough, in August, an appeals court ruled against the anti-abortion groups’ call to overturn the drug’s original approval. The appeals court also upheld the FDA’s 2019 decision to approve a generic form of mifepristone.

So why didn’t the case end there? Well, the appeals court left a few doors open for the anti-abortion groups. Specifically, that court ruled that a few FDA decisions in 2016 and afterward, which increased access to mifepristone, should be put on hold because the actions “were taken without sufficient consideration of the effects those changes would have on patients.”

What the Supreme Court ultimately ruled on were a series of FDA actions that made the medication more accessible. The actions under review (and now upheld) included:

The Biden administration and drugmaker Danco, which makes the brand version of mifepristone, both defended the FDA decisions to the Supreme Court.

What is the abortion pill, mifepristone?

Mifepristone is one of two pills typically taken for a medication abortion. Mifepristone works to block progesterone, which stops the pregnancy from continuing; the second pill, misoprostol, causes cramping and bleeding to empty the uterus, per Planned Parenthood. (Misoprostol alone can also be used to end a pregnancy.) Medication abortions account for more than half of all US abortions, according to the Guttmacher Institute.

What’s next?

Access to mifepristone remains the same — you can get it by mail, for up to 10 weeks into pregnancy, after one doctor’s visit, and at a lower dose. But, unsurprisingly in this time of widespread attacks on abortion rights, the abortion still facing other legal threats. The Court is due to decide whether Idaho’s abortion ban prevents emergency room doctors from providing abortion care when a pregnant person is facing dangerous complications. The federal government is arguing that the abortion ban conflicts with the federal Emergency Medical Treatment and Labor Act, which requires that patients receive adequate emergency room care.

Before you go, read about these celebs who’ve spoken about their abortion experiences: