The Supreme Court Rejected an Attack on Medication Abortion, But the Fight Is Far From Over.

The court ruled against anti-abortion groups on a technicality, but extremist politicians have vowed to continue efforts to restrict access to abortion nationwide.

Julia Kaye, Senior Staff Attorney, Reproductive Freedom Project, ACLU

This month, the Supreme Court refused to consider a request by anti-abortion groups to impose nationwide restrictions on mifepristone, a safe medication used in most U.S. abortions and for miscarriage care. Without addressing whether mifepristone should be further restricted, the court found that these anti-abortion plaintiffs lack “legal standing” – meaning they do not have a sufficient connection to the Food and Drug Administration’s (FDA) regulation of mifepristone to be able to challenge the agency’s decisions in court.

The court’s decision is a relief, but we should not be dazzled by the fact that the justices did the right thing based purely on a legal technicality. While the Supreme Court refused to allow these particular anti-abortion groups to bring this case, extremist politicians have vowed to continue to use the courts and the law to strip away access to medication abortion nationwide. Below, we break down why this case matters, and what happens next.


COURT REFUSES TO CONSIDER ANTI-ABORTION DOCTORS’ CHALLENGE TO MIFEPRISTONE

The plaintiffs in Alliance for Hippocratic Medicine v. FDA are organizations and doctors who want to see all abortion banned nationwide. To further their agenda, they used junk science to target access to mifepristone, a medication used in most U.S. abortions. They filed this lawsuit in Amarillo, Texas, where they could guarantee it would be heard by a Trump-appointed district court judge with a record of hostility to abortion. That district judge rubber-stamped all of their requests, and the Fifth Circuit Court of Appeals largely did the same – overriding the consensus of the FDA and every leading national medical authority in order to impose medically unnecessary restrictions on mifepristone.

In its decision, the Supreme Court did not address the plaintiffs’ arguments that mifepristone should be severely restricted. The court found that the lawsuit suffered from a critical defect: the anti-abortion groups and doctors who brought the case lack legal standing. As the court explained, these anti-abortion plaintiffs don’t prescribe mifepristone and have no actual connection to the FDA’s regulation of the drug. Instead, “the plaintiffs want [the] FDA to make mifepristone more difficult for other doctors to prescribe and for pregnant women to obtain.” But under the Constitution, “a plaintiff ’s desire to make a drug less available for others does not establish standing to sue.”

For now, the court’s decision preserves the state-level patchwork access to medication abortion that has existed since the Supreme Court overruled Roe v. Wade in 2022. That means that, for the time being, people across the United States can continue to fill their mifepristone prescriptions through mail-order and retail pharmacies, just as they would for any other similarly safe medication – without having to travel, sometimes hundreds of miles, just to pick up a pill. Health care professionals with specialized training, like nurse-practitioners, will also maintain the ability to prescribe mifepristone where state law allows. Furthermore, in the U.S. nearly 1 in 5 abortions relies on telemedicine. For many people – including low-income patients, people of color, folks in rural areas, and women in abusive households – retaining accessibility options, such as telemedicine, is essential – especially when it may be impossible to arrange and afford lengthy transportation and childcare, to secure time off work, or to escape the surveillance of an abuser in order to access time-sensitive care.

The court’s order also forestalls the dire consequences the American Cancer Society and many other patient advocacy groups warned of should the court override the FDA’s actions and undermine drug development and impede access to critical medications well beyond reproductive health care.


MEDICATION ABORTION REMAINS SAFE AND EFFECTIVE

There is no credible dispute about mifepristone’s safety. The nation’s leading medical associations describe the science confirming its safety as “overwhelming.” While all drugs carry risks, medical experts have explained that mifepristone is among the safest medications used in medical practice today – safer than Viagra or penicillin – with serious complications experienced by fewer than 1 percent of patients.

By contrast, the plaintiffs’ evidence rested on testimony and research from a few anti-abortion doctors who travel the country peddling junk science about abortion safety. As the ACLU explained in a friend-of-the-court brief, when other courts have heard these folks testify, time and again, they have discredited them. For instance, Dr. Ingrid Skop – cited 17 times in the appellate court’s ruling– had her testimony on abortion thrown out by a Florida court two years ago for being “inaccurate.” Dr. Skop admitted under oath in 2020 that she is “not a really good researcher,” so it’s no surprise that her research on mifepristone was published by a fringe advocacy group known for promoting blatantly false conspiracy theories, such as that President Barack Obama hypnotized listeners with his speeches. Several of the studies relied on by these plaintiffs have been retracted because they are so profoundly flawed. Another study is based on 98 anonymous blogs.

Maintaining access to mifepristone has never been more crucial. Since it was approved in 2000, nearly 6 million people in the United States, and millions more globally, have used this medication. Today, medication abortion comprises almost two-thirds of all abortions in this country.

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A demonstrator holds up a poster eading "ABORTION IS OUR RIGHT, WE WON'T STOP FIGHTING" while another holds a poster reading "MORE ACCESS. MORE PROVIDERS. FEWER POLITICIANS." as others protest the proposed limited use of mifepristone outside the U.S. Supreme Court on the 26th of March 2024.


WE’RE NOT OUT OF THE WOODS YET

The Supreme Court refused to allow these particular anti-abortion groups to bring this case, but extremist politicians are waiting in the wings to continue this campaign to strip away access to medication abortion nationwide. Indeed, the same Trump-appointed district judge in Texas has already permitted Idaho, Kansas, and Missouri to intervene in the district court proceedings on the same side as the anti-abortion groups. And these extremist politicians have said that they will try to continue this case in Texas – even though the Supreme Court just found that the original plaintiffs lack standing – or else bring copycat lawsuits in other jurisdictions.

Moreover, in the coming weeks, the Supreme Court will decide another abortion case that will determine whether politicians can force doctors to withhold emergency room care from their patients suffering severe pregnancy complications. These cases show how far politicians will go to prevent people from getting the reproductive health care they need.


WE ALL MUST ADVOCATE FOR OUR RIGHT TO REPRODUCTIVE FREEDOM

Since Roe was overturned, every time an abortion issue has been put to the ballot, the people have voted in favor of access. Politicians are relentless in their attacks, but a majority of this country believes that people must have the power to make personal decisions during pregnancy. We’ll continue using every tool at our disposal to fight back against these cruel and deeply unpopular attacks on our health, our futures, and our bodily autonomy.

Join us in this fight to expand and restore our rights by urging legislators to pass federal legislation that safeguards our reproductive freedom – including abortion, birth control, AND IVF care.