Abortion pill access is unchanged after the Supreme Court’s decision. Here’s what you need to know

WASHINGTON — Access to the Abortion pill mifepristone does not change after the U.S. Supreme Court on Thursday unanimously rejected an effort by anti-abortion groups to roll back its availability, a victory for abortion rights advocates and millions of women in states where abortion is legal.

Despite the ruling, women’s access to mifepristone is still largely dependent on a patchwork of state laws, with only about half of states allowing full access under terms approved by the federal government.

Here’s a look at what Thursday’s decision does and doesn’t mean for abortion access.

Essentially, the justices said the anti-abortion doctors who brought the case did not have the legal standing to sue the Food and Drug Administration over the drug’s safety or the FDA’s policy to make it more widely available. The FDA approved the drug more than two decades ago and has repeated its approval its safety and effectiveness.

The anti-abortion doctors, under the name Alliance for Hippocratic Medicine, argued that they might have to treat emergency room patients who suffer serious injuries after taking mifepristone. They had asked the court to strike down several FDA policies that have made it easier to obtain the drug, claiming the agency overlooked the drug’s safety risks.

While the decision keeps mifepristone available, legal experts say other groups or individuals who believe they can demonstrate a stronger legal tie to the drug could try to file a lawsuit along similar lines.

“It’s a victory that the status quo is preserved, but it doesn’t mean these are now dead arguments that others won’t try to pursue,” said Rachel Rebouche, a law professor at Temple University.

Mifepristone is a prescription drug that helps end pregnancies by dilating the cervix and blocking the effects of the hormone progesterone, which is needed to maintain a pregnancy. It is usually taken with a second medication, misprostol, which causes the uterus to cramp and contract. The two-drug regimen is used to terminate a pregnancy up to 10 weeks of gestation.

Mifepristone remains fully approved and available under the latest FDA framework, which includes prescribing telehealth and mail delivery to patients. The FDA has also expanded availability to major pharmacy chains and allowed prescribing by nurses and other health care professionals, not just doctors.

This policy has increased the prescription of mifepristone, which accounted for nearly two-thirds of all abortions in the US last year.

Access to the pills is limited in many parts of the country due to state laws that outright ban abortion (including medication abortion) or place separate restrictions on the drug’s use.

Access largely depends on the laws in the state where a patient lives and—in the case of states that ban or restrict mifepristone—what steps they are willing to take to circumvent those laws.

About half of U.S. states allow online prescribing and delivery of mifepristone by mail, in accordance with FDA-approved labeling for the drug.

Currently, Fourteen states maintain bans on abortion at all stages of pregnancy. Another dozen states have laws that specifically limit how mifepristone can be prescribed and distributed, such as requiring an in-person visit to a doctor or separate counseling about the drug’s potential risks and harms.

These steps are not supported by major medical associations, including the American Medical Association, which have reiterated that mifepristone can be safely prescribed remotely and is highly effective for terminating a pregnancy.

The anti-abortion group that brought the case to the Supreme Court alleged that FDA regulators overlooked serious safety issues in approving mifepristone and in subsequent moves to relax prescribing.

The FDA and the Biden administration have filed multiple legal challenges, reiterating the drug’s track record.

American studies have shown that mifepristone led to a completed abortion in 97.4% of cases according to the FDA label. Like all medications, the abortion pill is not 100% effective and in 2.6% of cases surgical intervention was required to complete the abortion. In less than 1% of cases the pregnancy continued.

In rare cases, mifepristone can cause serious complications, including excessive bleeding, infections, and other problems that require emergency care. According to the FDA label, these problems occur in far less than a fraction of 1% of all patients taking the drug.

Despite state laws targeting mifepristone, statistics show that women in those states still receive the drug through the mail because state authorities have little visibility into the deliveries handled by the US Postal Service.

A study earlier this year found that about 8,000 women per month in states that severely restrict abortion or place limits on telehealth prescribing received abortion pills in the mail by the end of 2023, according to the Society of Family Planning.

In addition, some patients order the drug through international pharmacies, which are outside the jurisdiction of US authorities.

Drug makers and patient groups had warned that a ruling against mifepristone could undermine the FDA’s century-plus regulatory authority by increasing challenges to drugs the agency considers safe and effective.

The decision could help discourage legal challenges against other medical products that have sparked political controversy, such as vaccines, HIV treatments and emergency contraceptives.

Legal experts say other parties could file new lawsuits.

Idaho, Kansas and Missouri tried to join the case against the FDA and the Biden administration, which the Supreme Court rejected — although a conservative Texas judge who initially ruled against the FDA allowed them to join the case in his district to connect. The three states, all led by Republican attorneys general, could try to revive the case in the lower court, arguing that they have state interests in blocking the use of mifepristone.

“It is not physicians who have to demonstrate that they actually have a relationship with abortion care,” says Rebouche of Temple University. see there will be a lawsuit.”

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.