The US Supreme Court is set to make a decision that could have significant implications for access to mifepristone, an abortion pill that is used in over half of all abortion procedures in the United States. Mifepristone was approved by the Food and Drug Administration (FDA) in 2000, but a conservative judge in Texas recently issued a ruling that would prevent its sale from April 7. The Biden administration has appealed the decision, and the Supreme Court is expected to issue a ruling before midnight on Friday.
Mifepristone is commonly used as the first step in a two-part abortion procedure, which also involves taking a second pill called misoprostol. The pills can be used to terminate a pregnancy for up to 10 weeks. While misoprostol can be taken alone, taking it with mifepristone is considered more effective. The FDA approved mifepristone for use up to seven weeks of pregnancy in 2000, and extended its use to 10 weeks in 2016.
Pills have become the dominant form of abortion in the US, accounting for over half of all legal abortions in 2020. The Guttmacher Institute, a pro-abortion rights group, found that medication was used in 53% of all legal abortions in the US in 2020, up from 39% in 2017.
Mifepristone is considered safe for use in terminating pregnancies. It has been used by millions of people in the US and around the world for decades. While there can be side effects such as bleeding and brief abdominal pain, serious complications are rare. In January, the FDA expanded access to the pill by allowing it to be sold at US pharmacies and allowing people to receive it in the mail.
The use of mifepristone is being challenged due to the repeal of Roe v Wade, a 1973 case that had enshrined the constitutional right to an abortion. With the repeal of Roe, states gained the ability to ban abortion entirely, and more than a dozen states have enacted such bans in the time since. Anti-abortion rights advocates view pills like mifepristone as an important battleground in the ongoing battle to determine access to reproductive health services and have pushed for greater restrictions on their use.
In Texas, a coalition of anti-abortion medical providers called the Alliance for Hippocratic Medicine filed a lawsuit challenging the FDA’s approval of mifepristone, stating that the pill is unsafe and should never have been approved. The case went before District Judge Matthew Kacsmaryk, a Trump-appointed judge with a reputation for sympathy to conservative causes, who ruled in favour of the anti-abortion group’s request for an injunction on mifepristone on April 7.
If the injunction were allowed to stand, it would further restrict access to abortion services in the United States, where millions of people have already lost or experienced diminished access in the aftermath of the decision to overturn Roe. However, Kacsmaryk’s decision gave the Biden administration seven days to appeal before the order went into effect.
The Biden administration quickly appealed the decision, stating that it would undermine the authority of the FDA and diminish access to necessary healthcare. An appeals court in New Orleans rolled back some of the restrictions from Kacsmaryk’s ruling on April 13, but significant restrictions remained, including revoking the ability to receive the pill in the mail and requiring an in-person visit to the doctor.
The Biden administration appealed this ruling to the Supreme Court, which issued a temporary stay on the restrictions a week ago, extending the stay for a two-day period on Wednesday. The Supreme Court is expected to issue a ruling by Friday at midnight. The decision will have significant implications for access to reproductive healthcare in the United States.