The U.S. Supreme Court has ruled to maintain access to the abortion pill mifepristone, which is used in the majority of pregnancy terminations nationwide.

“The plaintiffs do not prescribe or use mifepristone,” Justice Brett M. Kavanaugh wrote in the unanimous decision. “And FDA is not requiring them to do or refrain from doing anything. Rather, the plaintiffs want FDA to make mifepristone more difficult for other doctors to prescribe and for pregnant women to obtain.”

Because the plaintiffs had no need to use mifepristone, they had no legal grounds to sue over its FDA approval, according to the decision. Federal laws already allow doctors to refuse abortion care on moral grounds. “The plaintiffs have not identified any instances where a doctor was required, notwithstanding conscience objections, to perform an abortion or to provide other abortion-related treatment that violated the doctor’s conscience since mifepristone’s 2000 approval,” Kavanaugh wrote.

Medication Abortion Is a 2-Pill Regimen

People seeking medication abortions are typically prescribed a two-drug regimen of mifepristone, which stops production of a hormone needed for pregnancy to continue, followed by misoprostol, which causes cramping and bleeding to remove tissue from the uterus, similar to what happens with a miscarriage.

For more than two decades in the United States, abortion pills have been a legal option for ending pregnancies up to about 10 weeks of gestation. For most of this time, the FDA required women to get these pills prescribed at in-person visits, effectively limiting access.

But when the COVID-19 pandemic hit, the FDA lifted this requirement, allowing women to get abortion pill prescriptions from telemedicine visits and receive the medications by mail instead of going to a pharmacy. The move was initially temporary, but the FDA made it permanent in December 2021.

Reliance on medication abortions has surged since June 2022, when the Supreme Court overturned the landmark Roe v. Wade decision that had protected abortion rights nationwide — thereby allowing individual states to ban or restrict pregnancy terminations.

Majority of Abortions Use Medication

“We know that that medication abortion via telehealth has been pivotal to preserving the abortion access landscape in the wake of the Dobbs decision, with care provided via telehealth accounting for 19 percent of all abortions nationwide,” says Ushma Upadhyay, PhD, MPH, a public health scientist with Advancing New Standards in Reproductive Health (ANSIRH) at the University of California in San Francisco.

If the plaintiffs had prevailed at the Supreme Court, the case had the potential to revoke FDA approval for mifepristone and restrict access to medication abortion even in states where abortion remains widely available.

Bans in 14 States Continue to Block Access to Abortion

While the ruling cut off one avenue for limiting access to abortion pills, it does nothing to stop individual states from enacting additional laws that aim to block access to these medications, Dr. Upadhyay says. “With total abortion bans in 14 states across the country and additional states that significantly restrict abortion, people will continue to struggle to obtain abortion care in this country.”

Another high-stakes abortion case over abortion restrictions in Idaho is also pending right now before the Supreme Court. The case turns on whether a federal law guaranteeing patients emergency medical treatment at hospitals should allow pregnant patients with severe or life-threatening complications to receive abortions even when state laws ban these procedures.

“A ruling in favor of Idaho certainly would empower states to pass ever more restrictive limitations on abortion,” says Alan Trammell, an associate professor at Washington and Lee University School of Law in Lexington, Virginia. “Having said that, Congress arguably still has latitude to pass a federal statute that would directly countermand a state statute like Idaho’s.”