The US Supreme Court is hearing the first major abortion case since the Roe decision

Abortion is back at the U.S. Supreme Court, with arguments on Tuesday in the first major case on the issue since a 6-3 majority ruled in 2022 to overturn Roe v Wade and end the national right to abortion – a decision that unleashed abortion bans across the country a political response that Democrats hope will serve them in the upcoming presidential elections.

This case concerns the future of mifepristone drug commonly used in medication abortions in the US. The right-wing groups that brought the case are seeking to reverse measures the Food and Drug Administration (FDA) has taken in recent years to expand the drug’s availability.

A decision in their favor would apply nationwide, including to states that protect abortion access, and likely would make it more difficult to obtain the drug. The loosening of restrictions on mifepristone has helped soften the effects of the post-Roe abortion ban; If these restrictions are reinstated, abortion rights groups expect it will become significantly more difficult to access abortions in the US.

“More than 60% of abortions in the US are medication abortions, so that would impact a significant number of people whether you live in a protective state or a restricted state,” said Nicole Huberfeld, a health law professor at the Boston University School of Science. Public health.

Since the fall of Roe in June 2022, more than a dozen states have banned abortion. The result is legal and medical chaos. Dozens of women have come forward to say they were denied medically necessary abortions. Abortion clinics in states that still allow abortion are overwhelmed by the flow of patients fleeing states with bans. In 2023, more than 1 million abortions were performed in the US, an all-time high.

The availability of medication abortions, usually performed using mifepristone and another drug called misoprostol, has helped soften the impact of the bans. Telehealth medicine abortions, which have been allowed by the FDA since the pandemic, have eased some of the burden on abortion clinics; Shield laws, passed in a handful of states, even allowed providers to offer abortions via telehealth to people living in states with abortion bans.

But also the accessibility of medication abortion made it the next target of the anti-abortion movement after Roe was overturned. In 2022, a group called the Alliance for Hippocratic Medicine challenged the FDA’s 2000 approval of mifepristone. The group, which also includes anti-abortion doctors and is defended by the Christian legal firm Alliance Defending Freedom, argued that the FDA was exercising its authority exceeded and that mifepristone is unsafe. (More than 100 studies have been completed that mifepristone can be safely used to terminate a pregnancy.)

A federal judge ruled in favor of the Alliance for Hippocratic Medicine, a move that could have taken mifepristone off the market entirely. But an appeals court limited that ruling, ruling that it was too late to challenge the original 2000 approval of mifepristone.

Instead, the appeals court ruled to reverse subsequent FDA actions that expanded access to mifepristone, including by eliminating requirements that abortion providers personally deliver mifepristone. A recent analysis found 16% of all abortions in the US are provided via telehealth.

Oral arguments on Tuesday are expected to focus on these later measures. The availability of Mifepristone has remained unchanged as the litigation progressed.

Regardless of what the Supreme Court decides, Americans will still be able to order mifepristone online from providers that help people “self-manage” their own abortions. A study published Monday shows that the number of self-managed abortions has skyrocketed since Roe fell.

The outrage over the overturning of Roe has made abortion a major election issue, as most Americans support at least some level of access to abortion. Voters in several states, including conservative strongholds like Kentucky and Kansas, voted in favor of abortion rights through ballot initiatives; About a dozen states are now expected to put abortion-related ballot measures before voters in November. Democrats hope the issue will boost turnout for their candidates, including Joe Biden.

The Supreme Court is expected to rule on the mifepristone case by the summer, just months before the 2024 election.

The implications of the case could extend far beyond abortion. If the judge gives the green light, ideologically driven groups try to have doubts the authority of the FDA, the agency’s regulation of all kinds of drugs — such as birth control and vaccines — could be challenged in court.

“If the court weakens the FDA’s authority on this issue, states will be encouraged to create other exceptions for other drugs, perhaps for political reasons. And that is something that is problematic for everyone,” Huberfeld said. “If you think this is someone else’s problem, you’re wrong.”