WASHINGTON (AP) — In a landmark decision on Thursday, the Supreme Court unanimously preserved access to mifepristone, a medication used in nearly two-thirds of all abortions in the U.S. last year. This ruling marks the court's first major abortion decision since the conservative justices overturned Roe v. Wade two years ago.

The Court's Ruling

The nine justices ruled that abortion opponents lacked the legal standing to sue over the federal Food and Drug Administration’s (FDA) approval of mifepristone and its subsequent actions to ease access to the drug. This case had posed a significant threat to restrict access to mifepristone nationwide, even in states where abortion remains legal.

Justice Brett Kavanaugh, who was part of the majority to overturn Roe, wrote the opinion for the court. He stated that “federal courts are the wrong forum for addressing the plaintiffs’ concerns about FDA’s actions.” The opinion emphasized the technical legal issue of standing without making a judgment on the FDA’s actions.

Political Implications

The decision has significant political ramifications, particularly as the 2024 election approaches. The ruling highlights that an FDA commissioner appointed by a potential Republican president, such as Donald Trump, could consider tightening access to mifepristone, including prohibiting its distribution through the mail.

Reactions from Political Figures

President Joe Biden praised the decision but emphasized that the right to abortion is still under threat in many states. “It does not change the fact that the right for a woman to get the treatment she needs is imperiled if not impossible in many states,” Biden said. He signaled that Democrats will continue to campaign heavily on abortion rights leading up to the November elections.

Marjorie Dannenfelser, president of SBA Pro-Life America, expressed disappointment with the ruling but criticized Democrats for their stance on abortion. “Joe Biden and the Democrats are hell-bent on forcing abortion on demand any time for any reason, including DIY mail-order abortions, on every state in the country,” she said.

Public Opinion

A KFF poll conducted in February revealed that about two-thirds of U.S. adults oppose banning the use of mifepristone nationwide, while about one-third support a nationwide ban. The poll underscores the broad public support for maintaining access to medication abortion.

Current Legal Landscape

The Supreme Court is also considering another significant abortion-related case. This case questions whether a federal law on emergency treatment at hospitals overrides state abortion bans in rare emergency cases where a pregnant patient’s health is at serious risk.

Since 2000, more than 6 million people have used mifepristone. The medication works by blocking the hormone progesterone and preparing the uterus to respond to the contraction-causing effects of a second drug, misoprostol. This two-drug regimen is used to end pregnancies through 10 weeks of gestation.

Personal Stories

Jillian Phillips from North Brookfield, Massachusetts, took mifepristone after suffering a miscarriage eight years ago. She eventually passed the remains of her nine-week pregnancy, which she buried in a memorial garden. “It should have never been something we had to win,” Phillips said. “These are decisions that should be happening in a medical exam room, not courtrooms.”

Broader Impact on Healthcare

Healthcare providers have indicated that if mifepristone becomes unavailable or too difficult to obtain, they would switch to using only misoprostol, which is less effective in ending pregnancies. The potential shift underscores the critical role mifepristone plays in medication abortion.

Biden’s administration and drug manufacturers had warned that siding with abortion opponents in this case could undermine the FDA’s drug approval process beyond the abortion context by inviting judges to second-guess the agency’s scientific judgments. The Democratic administration and New York-based Danco Laboratories, which makes mifepristone, argued that the drug is among the safest the FDA has ever approved.

Danco spokeswoman Abigail Long stated that the decision “safeguards access to a drug that has decades of safe and effective use.”

Legal and Policy Challenges

The plaintiffs, anti-abortion doctors and their organizations, argued that the FDA’s decisions in 2016 and 2021 to relax restrictions on mifepristone were unreasonable and jeopardized women’s health nationwide. Kavanaugh acknowledged their “sincere legal, moral, ideological, and policy objections to elective abortion and to FDA’s relaxed regulation of mifepristone.”

Kavanaugh pointed out that federal laws already protect doctors from having to perform abortions or give other treatments that violate their beliefs. He noted that the plaintiffs had not identified any instances where a doctor was required to perform an abortion or provide abortion-related treatment against their conscience since mifepristone’s approval in 2000.

Ultimately, Kavanaugh stated that the anti-abortion doctors should direct their efforts toward persuading lawmakers and regulators to make changes rather than seeking judicial intervention.

Future Outlook

Abortion rights advocates welcomed the decision but emphasized the ongoing public health crisis. “This ruling is not a ‘win’ for abortion — it just maintains the status quo, which is a dire public health crisis in which 14 states have criminalized abortion,” said Nancy Northup, president and CEO of the Center for Reproductive Rights.

The mifepristone case began five months after the Supreme Court overturned Roe. Initially, U.S. District Judge Matthew Kacsmaryk, a Trump nominee in Texas, issued a ruling that would have revoked the drug’s approval entirely. The 5th U.S. Circuit Court of Appeals left intact the FDA’s initial approval but would have reversed changes made in 2016 and 2021 that eased some conditions for administering the drug.

The Supreme Court put the appeals court’s modified ruling on hold and agreed to hear the case. Justices Samuel Alito and Clarence Thomas, who authored the decision overturning Roe, joined the court’s opinion, despite initially favoring some restrictions while the case proceeded.

Ongoing Legal Battles

The effort to restrict abortion pills is expected to continue. Erin Hawley, an attorney for the anti-abortion group Alliance Defending Freedom, indicated that lawsuits from other parties, including states like Idaho, Kansas, and Missouri, could proceed. Kansas Attorney General Kris Kobach, a Republican, confirmed that his state would continue to pursue the case.

The Supreme Court’s unanimous decision to uphold access to mifepristone is a significant moment in the ongoing debate over abortion rights in the United States. As legal and political battles continue, the ruling underscores the complexities and high stakes surrounding reproductive health and access to care.