Abby Johnston Health human rights Reproductive Justice Supreme Court

Supreme Court Decision Allows Abortion Pill to Continue Being Distributed by Mail

Friday’s ruling on the use of mifepristone will help ease the time, travel and cost associated with medication abortions.
Demonstrators rally in support of abortion rights in front of the Supreme Court in Washington, D.C. on April 15, 2023. (ANDREW CABALLERO-REYNOLDS/AFP/GETTY IMAGES)

By Abby Johnston / The 19th

The Supreme Court blocked tighter restrictions on a commonly used abortion pill for the foreseeable future. Friday’s ruling — the court’s first major decision on abortion since it overturned Roe v. Wade — will continue to allow the drug to be distributed by mail, easing the time, travel and cost associated with medication abortions. 

With 7-2 vote, justices blocked a ruling from the U.S. Court of Appeals for the 5th Circuit that put restrictions on the use of mifepristone, one of two drugs commonly used in medication abortions. The restrictions would have meant the pill could not be used past seven weeks of pregnancy, would have required three in-person doctors visits to obtain and could not be mailed. The Supreme Court’s ruling returns the case to the 5th Circuit, and it could take months or years for the legal battle to be resolved. Justices Samuel Alito and Clarence Thomas dissented. 

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Experts say that barring patients from receiving the pill by mail could have led to long and costly travel to receive the drug. Both the Food and Drug Administration (FDA) and the World Health Organization have endorsed using telemedicine to distribute mifepristone.

Medication abortions account for over half of abortions in the United States, using a combination of mifepristone and a separate drug, misoprostol. With the two-pill regimen, medication abortions are 99 percent effective in ending a pregnancy. 

“As a result of the Supreme Court’s stay, mifepristone remains available and approved for safe and effective use while we continue this fight in the courts,” President Joe Biden said in a statement Friday. “I continue to stand by FDA’s evidence-based approval of mifepristone, and my Administration will continue to defend FDA’s independent, expert authority to review, approve, and regulate a wide range of prescription drugs.”

Mifepristone was initially approved by the FDA in 2000 under the same guidelines just blocked by the court. The FDA eased some of those restrictions over the years, expanding usage of the pill up to 10 weeks of pregnancy and allowing it to be mailed. But last week, the U.S. Court of Appeals for the 5th Circuit, though stopping short of blocking access to the pill entirely, reverted to the drug’s initial approval guidelines, prompting the Biden administration to ask the Supreme Court to intervene. That decision did not take effect before the Supreme Court blocked it on Friday.

The case began in the courtroom of Judge Matthew Kacsmaryk, a federal district judge in Texas appointed by former President Donald Trump. Kacsmaryk’s ruling blocked access to mifepristone entirely, siding with a group of anti-abortion physicians who said the drug was unsafe and the FDA had improperly approved it. Kacsmaryk is a longtime abortion opponent. 

When states began banning abortion after Roe v. Wade was overturned last June, patients flooded clinics in states where the procedure remained legal. Medication abortion was often used to help ease the increased volume, allowing patients to access abortion pills through telemedicine and limiting more time-intensive surgical abortions. 

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Abby Johnston

Abby Johnston is our editorial director. Before joining The 19th, she edited and managed digital strategy for the Texas Observer, Frontline and Texas Monthly. She is a graduate of the University of Texas and the University of Missouri.

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