WASHINGTON — The Supreme Court will again delve into the vexed issue of abortion this week when it hears arguments over a drug most commonly used to end a pregnancy, a case with profound implications for millions of women wherever they live. living in America and, perhaps, for the race for the White House.
Two years after the Supreme Court overturned Roe v. Wade and cleared the way for bans or severe restrictions on abortion in many Republican-led states, abortion opponents will ask the Supreme Court on Tuesday to ratify a ruling by a conservative federal appeals court. restrict access to the drug mifepristone, which was used in nearly two-thirds of all abortions in the United States last year.
That decision to overturn Roe had immediate political consequences, with Democrats arguing that the court had taken away a right that women had held for half a century and won elections as a result. Even conservative-leaning states like Kansas and Ohio voted against abortion restrictions. If the court were to uphold restrictions on medication abortions, it could roil the electoral landscape in races for Congress and the presidency.
By reversing the Food and Drug Administration’s changes to the use of mifepristone, the ruling would cut off access to the drug through the mail and impose other restrictions even in states where abortion remains legal. The restrictions would shorten the time in which mifepristone can be used during pregnancy from the current 10 weeks to seven weeks.
Most U.S. adults, 55%, believe medication abortion pills are very or somewhat safe when taken as prescribed by a doctor, according to a May 2023 KFF survey, and 65% have “a lot” or “some” trust the FDA to ensure that medications sold in the US are safe and effective.
A decision should be made by the end of June. But regardless of the outcome, the Supreme Court has not seen its last abortion case. Legal battles are underway over state restrictions, and new federal boundaries are likely if former President Donald Trump, Republicans’ presumptive 2024 nominee, returns to the White House.
Next month, the justices will hear arguments on whether a federal law on emergency hospital treatment should include abortions, even in states that have otherwise banned them.
Mifepristone, made by New York-based Danco Laboratories, is one of two medications, along with misoprostol, used in medication abortions. Their numbers have been rising for years and were responsible for 63% of the more than 1 million abortions in the US last year, according to an estimate by the Guttmacher Institute, which supports abortion rights. Since 2000, more than 5 million people have used mifepristone.
Mifepristone is first taken to dilate the cervix and block the hormone progesterone, which is needed to maintain a pregnancy. Misoprostol is taken 24 to 48 hours later, which causes the uterus to contract and expel pregnancy tissue.
Healthcare providers have said that if mifepristone is no longer available or becomes too difficult to obtain, they would switch to using misoprostol alone, which is slightly less effective at terminating pregnancies.
What underlines the importance of the matter is that the number of medication abortions is increasing for several reasons. Taking pills at home to end a pregnancy is less invasive than surgery, more convenient than having to travel to an abortion clinic and more private, allowing women to avoid anti-abortion protesters knocking on clinic doors.
It’s becoming even easier to get the two drugs in some states now that CVS and Walgreens have announced pilot programs to provide the pills in their pharmacies.
For women living in states with abortion bans or restrictions, mail-order delivery may be the only practical option, says Julie F. Kay, executive director of the Abortion Coalition for Telemedicine.
The medication is shipped from providers in states that have laws designed to protect them from any legal problems when working with people who live in states that do not allow medication abortion. The pills cost $150 and usually arrive in three to five days, Kay said.
Last year, 85,000 women worked with Aid Access, a mail-in abortion provider, to obtain the drugs, said Dr. Rebecca Gomperts, the group’s founder. Of those, 50,000 live in states with abortion restrictions, she said.
The current case closely followed the Supreme Court’s June 2022 ruling that struck down the constitutional right to abortion. This ruling led to a ban on abortion at all stages of pregnancy in fourteen states, with few exceptions, and in two other states as soon as cardiac activity can be detected, which takes about six weeks.
Abortion opponents filed their objection to mifepristone the following November and six months later initially won a sweeping ruling from U.S. District Judge Matthew Kacsmaryk, a Trump nominee in Texas, that would have completely revoked the drug’s approval. The 5th U.S. Circuit Court of Appeals left the FDA’s original approval of mifepristone intact. But it would undo changes regulators made in 2016 and 2021 that relaxed some conditions for administering the drug.
The Supreme Court put the appellate court’s amended ruling on hold and then agreed to hear the case, although Justices Samuel Alito, the author of the decision overturning Roe, and Clarence Thomas would have allowed it to some restrictions would come into effect while the case continued.
The doctors and groups who initially wanted mifepristone taken off the market now say in their main Supreme Court brief that these recent changes “endanger the health of women across the country” and did not follow the rigorous procedures required by the federal law are required to change the safety restrictions. to drugs.
“The Supreme Court has an opportunity to decide whether to allow some agencies to make decisions,” said Sarah Parshall Perry, an attorney at the Heritage Foundation who is supporting the challenge.
Pregnant women who want to use mifepristone, for example, no longer need an in-person visit to a doctor before getting a prescription, said Erin Hawley, the Alliance Defending Freedom attorney who represents abortion opponents before the Supreme Court.
“Our customers are asking the FDA to reintroduce safety measures that have been in place for nearly two decades,” Hawley told The Associated Press. She is married to Sen. Josh Hawley, R-Mo. Both Hawleys served as law clerks to Chief Justice John Roberts early in their careers.
But the government said the elimination of doctor visits and the other changes were the product of more than two decades of experience regulating mifepristone, including reviewing safety data and studies of thousands of women. Her position is shared by several leading medical organizations, including the American College of Obstetricians and Gynecologists.
Seven former FDA commissioners said in a lawsuit that the agency exercised special care in initially approving mifepristone because it dealt with an abortion drug. Subsequent changes were “driven by a simple and thorough application of the expert scientific review process that Congress entrusted to the FDA,” they wrote.
Mary Ziegler, a law professor at the University of California at Davis who has written extensively about abortion, said that a rollback of the FDA rules “could result in virtually all doses of mifepristone on the market potentially being misbranded and mislabeled.” getting mislabeled, which could mean, I think, , you know, months of disruption when it comes to the availability of the drug.
More broadly, Ziegler said, the case “obviously has the potential to change the way drug approvals function.” The prescription drug industry has also weighed heavily on the government’s side.
The government and Danco both make extensive arguments, disputed by the other side, that abortion opponents do not have the legal right or standing to bring the case.
If the court agrees they are right, it would preserve access for mifepristone without touching on the more politically sensitive issues in the dispute.
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Associated Press writer Linley Sanders contributed to this report.