Supreme Court rejects limits on abortion pill mifepristone

The US Supreme Court has unanimously rejected an effort to sharply restrict access to the abortion pill mifepristone.

The decision is a major win for pro-choice activists and comes two years after the court rescinded the nationwide guarantee to an abortion.

The justices decided the plaintiffs, a group of anti-abortion doctors and activists, did not have a legal right to sue.

Mifepristone is one of two drugs used in a medication abortion, now the most common method of terminating pregnancies in the US.

The plaintiffs, known as the Alliance for Hippocratic Medicine, had argued that approval for the drug from US Food and Drug Administration (FDA) should be withdrawn.

But during arguments on the case in March, several of the court’s seven justices sounded sceptical that any of the plaintiffs had suffered harm from the availability of mifepristone – which is necessary to have the legal standing to sue.

“The plaintiffs have sincere legal, moral, ideological objections to elective abortion and to FDA’s relaxed regulation,” wrote Justice Brett Kavanaugh for the court, “but they failed to demonstrate” any actual injury.

“A plaintiff’s desire to make a drug less available for others does not establish standing to sue,” he also wrote.

The top court overturned Roe v Wade, effectively rescinding a federal right to abortion, in June 2022. Since then, 21 states have moved to restrict abortion earlier in pregnancy than the standard it set. Seventeen of those have barred the procedure at six weeks or earlier.

Thursday’s ruling has no bearing on these laws – medication abortion remains illegal in states that prohibit abortion. But abortion pills have acted as an effective workaround to these bans, with thousands of pills flowing into restrictive states through the mail.

Pro-choice activists welcomed the continued access to abortion pills, but warned the Supreme Court’s decision was a qualified victory.

At least three states – Missouri, Kansas and Idaho – have also opposed the FDA’s approval for the drug. The Supreme Court’s decision on Thursday does not rule out these future challenges.

“This ruling is not a ‘win’ for abortion, it just maintains the status quo,” said Nancy Northup, president of the pro-choice Center for Reproductive Rights in a statement.

“The attacks on abortion pills will not stop here – the anti-abortion movement sees how critical abortion pills are in this post-Roe world.”

Anti-abortion groups criticised the decision. But these groups, too, indicated the fight would continue.

“It is a sad day for all who value women’s health and unborn children’s lives,” said Katie Daniel, state policy director for Susan B Anthony Pro-Life America. “But the fight to stop dangerous mail-order abortion drugs is not over.”

The two-drug regimen was approved for use up to 10 weeks of pregnancy by the Food and Drug Administration (FDA) in 2000. A patient is first given mifepristone to induce an abortion and then misoprostol to empty the uterus.

Since 2016, the FDA has eased access to the drug and has allowed doctors to hold virtual appointments with patients and for prescriptions to be sent by mail. Those more recent approvals were at question in this case.

Nearly two-thirds of all abortions in the US now are medication abortions, according to the Guttmacher Institute.

Throughout two decades of use, the FDA, the American College of Obstetrics and Gynaecologists (ACOG) and other mainstream medical organisations have maintained that both mifepristone and misoprostol are safe for use.

US studies say medication abortion is about 95% effective in ending pregnancy and requires further medical follow-up less than 1% of the time.