Supreme Court maintains access to abortion pill in unanimous decision

The Supreme Court unanimously rejected a lawsuit challenging the Food and Drug Administration’s approach to regulating the abortion pill mifepristone, allowing the drug to stay on the market.

The court ruled that the doctors and anti-abortion groups that had challenged access to the drug did not have standing to sue. Though technical, the court’s reasoning is important because it might encourage other mifepristone challenges in the future.

Medication abortion accounts for nearly two-thirds of all US abortions, according to some estimates. The FDA approved mifepristone in 2000 as part of a two-drug regimen to end a pregnancy and it has been shown to be safe and effective. The pill is also often prescribed for miscarriage treatment.

Here’s what we know about the ruling:

CNN’s Tierney Sneed and John Fritze contributed reporting to this post.

Joe Biden speaks at the G7 Summit in Savelletri, Italy, on Thursday.

President Joe Biden cast blame on Republicans for the very existence of a Supreme Court case on the abortion medication mifepristone, taking aim at GOP elected officials’ “extreme and dangerous agenda” on reproductive rights following today’s ruling.

The Supreme Court’s decision maintaining access to mifepristone, he said, “does not change the fact that the fight for reproductive freedom continues. It does not change the fact that the Supreme Court overturned Roe v. Wade two years ago, and women lost a fundamental freedom. It does not change the fact that the right for a woman to get the treatment she needs is imperiled if not impossible in many states.”

He reiterated that mifepristone “remains available and approved” and emphasized that it has been FDA-approved for more than 20 years.

Meanwhile in Italy during the G7 summit, Biden pushed to keep language about reproductive rights in a leaders statement after the summit host, Italian Prime Minister Giorgia Meloni, sought to strip some language from the document, according to US officials.

Biden has worked to make protecting abortion rights a centerpiece of his reelection bid, and the issue has proven galvanizing for Democrats.  

CNN’s Kevin Liptak contributed reporting to this post.

A patient prepares to take mifepristone for a medication abortion during a visit to a clinic in Kansas City, Kansas, on October 12, 2022.

Research has long found that medication abortion is highly safe and effective, even when the patient does not see a doctor in person and gets the medicine through a telehealth or text appointment, a February study found.

Common side effects include vomiting, diarrhea, nausea, weakness and dizziness. These usually happen in the first 24 hours after the person takes the second drug in the two-medication regimen. Rare side effects include a fast heartbeat, fainting and fatal infections. There is a 0.4% risk of major complications, studies show.

There were about 5.9 million medical terminations of pregnancy with mifepristone from its approval in the US in 2000 through the end of 2022, with 32 reports of death in these patients. The deaths cannot be directly attributed to mifepristone, the FDA says, because of information gaps about patient health status and clinical management.

An abortion using mifepristone is effective 99.6% of the time, studies show. If the abortion is not complete, the person may need to take the medicine again. In extremely rare cases, they may have to have a surgical abortion.

Mifepristone’s safety is on par with common over-the-counter pain relievers like ibuprofen and acetaminophen, studies show.

Data analyzed by CNN shows that mifepristone is even safer than some of the most common prescription medications. The risk of death from penicillin, an antibiotic used to treat bacterial infections like pneumonia, for example, is four times greater than it is for mifepristone. The risk of death after taking Viagra — used to treat erectile dysfunction — is nearly 10 times higher.

Vice President Kamala Harris warned Thursday that she believes people must remain “vigilant” and that the Supreme Court ruling earlier today preserving access to the abortion pill mifepristone is “not a cause for celebration.”

“This ruling is not going to change that. This ruling is not going to change the fact that Trump’s allies have a plan that if all else fails to eliminate medication abortion through executive action, so we must remain clear eyed about the threats to reproductive freedom in America and we must remain vigilant,” she said in brief remarks Thursday.

The Supreme Court unanimously rejected a lawsuit challenging the Food and Drug Administration’s approach to regulating the abortion pill mifepristone with a ruling that will continue to allow the pills to be mailed to patients without an in-person doctor’s visit.

See a timeline of mifepristone access since it was approved in 2000:

Meanwhile on Capitol Hill, Senate Republicans voted to block a bill put forward by Democrats that would guarantee access to in vitro fertilization nationwide.

The legislation failed to advance in a procedural vote by a tally of 48-47. It needed 60 votes to advance. Republicans criticized the Democrat-led legislation as unnecessary because IVF is not threatened anywhere and called it a political show vote. 

Democrats, however, seized on action by Southern Baptist delegates who expressed alarm Wednesday over the way in vitro fertilization is routinely being practiced, approving a resolution lamenting that the creation of surplus frozen embryos often results in “destruction of embryonic human life.”

Two Republicans, Sens. Susan Collins of Maine and Lisa Murkowski of Alaska voted with all Democrats for the measure. Senate Majority Leader Chuck Schumer switched his vote to no at the end in order to preserve his ability to call it back up for another vote if he chooses to.  

The Senate vote is part of a broader push by Senate Democrats to draw a contrast with Republicans over reproductive health care in the run up to the November elections.

A patient prepares to take mifepristone at Women's Reproductive Clinic of New Mexico in Santa Teresa, on January 13, 2023.

Mifepristone, one of two drugs used for medication abortions, can continue to be mailed to patients without an in-person visit with a doctor following the US Supreme Court rejection of a lawsuit challenging regulation of the abortion pill.

“While many women obtain medication abortion from a clinic or their OB-GYN, others obtain the pills on their own to self-induce or self-manage their abortion,” said Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco.

“A growing body of research indicates that self-managed abortion is safe and effective,” he said.

Mifepristone blocks the hormone progesterone, which is needed for a pregnancy to continue. The drug is approved to end a pregnancy through 10 weeks’ gestation, which is “70 days or less since the first day of the last menstrual period,” according to the US Food and Drug Administration.

In a medication abortion, a second drug, misoprostol, is taken within the next 24 to 48 hours. Misoprostol causes the uterus to contract, creating cramping and bleeding. Approved for use in other conditions, such as preventing stomach ulcers, the drug has been available at pharmacies for decades. 

Together, the two drugs are commonly known as the “abortion pill,” which is now used in more than half of the abortions in the United States, according to the Guttmacher Institute, a research group that supports abortion rights.

“Some people do this because they cannot access a clinic — particularly in states with legal restrictions on abortion — or because they have a preference for self-care,” said Grossman, who is also the director of Advancing New Standards in Reproductive Health, a research group that evaluates the pros and cons of reproductive health policies and publishes studies on how abortion affects a woman’s health.

Read more about the process here.

Anti-abortion organizations are reacting after the Supreme Court rejected a challenge to regulate the widely-used abortion pill, mifepristone.

After many states banned abortion following the overturning of Roe v. Wade, Thursday’s ruling means that the pill can continue to be mailed to patients without an in-person doctor’s visit.

Susan B. Anthony Pro-Life America, an organization that aims to end abortion in the US, according to its website, called it a “sad day for all who value women’s health and unborn children’s lives,” State Policy Director Katie Daniel said.

”The fight to stop dangerous mail-order abortion drugs is not over,” Daniel said in a statement. “Planned Parenthood boasts about dispensing these high-risk drugs by app, ‘completely free of face-to-face interaction with a clinician,’ to anyone with a mailing address – including traffickers and abusers.”

The organization’s president, Marjorie Dannenfelser, attacked Democrats for peddling “pro-abortion fearmongering” to benefit them in the upcoming election and “forcing abortion on demand any time for any reason, including DIY mail-order abortions, on every state in the country.”

March for Life said it is disappointed by the Supreme Court’s decision, saying it “enables the FDA to continue disregarding the health and safety of women and young girls across the nation,” according to a statement from the organization’s president, Jeanne Mancini.

“We will continue to educate and advocate on the need for commonsense protections when it comes to women’s health and well-being and defending the most vulnerable,” Mancini said.

Data analyzed by CNN shows mifepristone is even safer than some common, low-risk prescription drugs, including penicillin and Viagra.

Senate Majority Leader Chuck Schumer, on the heels of the Supreme Court ruling that the abortion pill mifepristone could remain on the market, praised the ruling, proclaiming himself “relieved” by the court’s decision, and emphasizing that “the decision should have been an obvious one” but warned that the attack on reproductive healthcare is not yet over.

He also assailed the continuing attack on reproductive rights, saying “the anti abortion movement is not yet finished. Now that Roe is gone, they have set their sights on a new target: in vitro fertilization,” he said in Thursday floor remarks. “So today the question before the Senate is very simple. Do we agree that Americans should be free to use IVF if they want to, yes or no? If yes, then the only right answer is to vote in favor of today’s bill.”

Reproductive rights groups across the US are responding to the Supreme Court’s decision to throw out a challenge to how mifepristone is accessed.

Nancy Northup, president and CEO of the Center for Reproductive Rights said she felt “both relief and anger about this decision.” She said she was glad the decision had been rejected, but did not believe it should have made it to the Supreme Court in the first place.

Jennifer Dalven, director of the American Civil Liberties Union Reproductive Freedom Project warned that while today seemed like a victory for reproductive rights, “we know that this is far from the end of the line.” Dalven said other politicians were prepared to pose challenges to abortion rights in the US.

Destiny Lopez, acting Co-CEO of the Guttmacher Institute said the case was “rooted in bad faith and lacking any basis in facts or science.” Lopez said it should not have ever reached the top. court, echoing Northup’s sentiment. She also warned that further challenges to anti-abortion rights would arise despite the outcome.

President of the American College of Obstetricians and Gynecologists Stella Dantas said the decision from the Supreme Court “provides us with long-awaited relief.” Dantas said the findings meant “patients and clinicians across the country will continue to have access to mifepristone for medication abortion and miscarriage management.”

The President of the American Medical Association (AMA) Bobby Mukkamala released a statement applauding the Supreme Court’s decision. “Efforts to second guess the FDA’s scientific judgment and roll back access to mifepristone were based on a sham case that not only lacked standing, but relied on speculative allegations and ideological assertions,” the statement said.

Phyllis Arthur, executive vice president and head of Healthcare Policy and Programs at BIO said they were pleased that the authority would remain with the FDA to approve new medicines. “Today’s decision ensures patients and drug developers can rely on the rigorous FDA approval process as the scientific and trusted standard for drug approvals.”

Meanwhile, Danco, the manufacturer of mifepristone, said it was pleased with the outcome of today’s ruling, which “safeguards access to a drug that has decades of safe and effective use.” The manufacturer said it remained committed to providing safe access to abortion across the US.

This post will continue to be updated as more reactions are released.

While the Supreme Court maintained access to the abortion pill mifepristone in an unanimous decision Thursday morning, former President Donald Trump is holding a meeting with the House Republican Conference.

Trump cautioned House Republicans to not go too far on abortion, advocating for exceptions, according to a member.

In a low voice, Trump advised Republicans to not be afraid of the issue, per sources in room, and that Democrats are the extreme ones on the abortion debate.

According to members in the room, he also talked about how Roe v. Wade finally put the decision to the states as they always wanted. According to a second source in the meeting, Trump told Republicans to follow their convictions but to be smart on how they talk about abortion in the campaign. He added that he believes it’s an issue that should be left to the states, per the source.

Empty boxes of mifepristone pills fill a trash can at Alamo Women's Clinic in Albuquerque, New Mexico, on January 11.

Congress gave the US Food and Drug Administration the authority to regulate drugs more than 60 years ago, and in 1962 it was also given the authority to require that drug companies prove that the drugs are effective. Mifepristone, one of the drugs used in medication abortion in the US, was initially approved in 2000, but regulations around its use have shifted since then.

For a medicine to be approved by the the FDA, drugmakers needs to meet rigorous standards that show that the drug is safe and effective. They do this through data from lab, pre-clinical and clinical studies.

Here’s a timeline of FDA’s regulations around mifepristone:

2000: Initially, mifepristone was approved for medical termination of pregnancy with several restrictions. It could only be prescribed through seven weeks of gestation and only doctors could prescribe it in-person.

2016: The FDA expanded the use of mifepristone after Danco Laboratories, the drug’s sponsor, submitted additional materials to change the way the drug could be used. The FDA took a closer look at 16 years of data on mifepristone use and took into account the way it was prescribed in other countries, as well as professional organization guidelines. Using data from 20 additional studies that looked at the safety and effectiveness of the drug, the FDA allowed clinicians to prescribe the medicine up to 10 weeks of pregnancy.

2021: Due to the Covid-19 pandemic along with studies looking at the effectiveness and safety of telehealth, the FDA eliminated the in-person dispensing requirement. After additional review of the available safety and effectiveness data, and based on the experience of millions of people who used the drug, the FDA made that change permanent in 2023 and eliminated the in-person dispensing requirement.

An abortion using medication, rather than a procedure, is the most common option in the United States.

Nearly two-thirds of all abortions in the US in 2023 — an estimated 642,700 — were medication abortions, according to a March report from Guttmacher Institute, a research and policy organization focused on sexual and reproductive health that supports abortion rights.

This option has become steadily more common over the past two decades, rising from less than 10% of all abortions in the US in 2001 to 53% in 2020 and 63% in 2023.

From its FDA approval in 2000 to 2016, the last year for which data was available, more than 2.75 million women in the US used mifepristone for an abortion, according to Danco Laboratories, a company that distributes the drug. 

The pills can be obtained in person from a provider or through telehealth in states where the practice is not banned.

A patient prepares to take Mifepristone at a clinic in Illinois in April 2023.

The Supreme Court justices suggested that abortion opponents had other ways to seek stricter rules for abortion drugs in the court’s unanimous ruling that rejected a group of anti-abortion organizations and doctors challenging the Food and Drug Administration’s current regulations for a widely used pill.

He wrote that, under the Constitution, “a plaintiff’s desire to make a drug less available for others does not establish standing to sue.” 

He said the court would not adopt the legal theories the challengers were pushing, warning that, “(that) path would seemingly not end until virtually every citizen had standing to challenge virtually every government action that they do not like.” 

The appeal had been vehemently opposed by the pharmaceutical industry, which warned that a ruling that second-guessed the regulations for mifepristone could open the door to legal challenges targeting all sorts of medications.    

Much of Kavanaugh’s opinion covered the various legal thresholds a plaintiff must reach to make it appropriate for courts to intervene in a dispute. 

Turning to the anti-abortion doctors and medical groups that sued the federal government over the current regulatory regime for the drug, Kavanaugh wrote that the plaintiffs suffered neither the monetary injuries nor the physical injuries that could have established standing.

He noted that federal law already protects individual health care providers who have objections to performing abortions for moral reasons.  

Justice Clarence Thomas wrote a concurrence to bring up other issues he had with the anti-abortion groups’ standing claims.  

As the Supreme Court rejected a lawsuit challenging the Food and Drug Administration’s approach to regulating the abortion pill mifepristone on Thursday, the court still has to make a decision on abortions in emergencies.

That case relates to what happens when pregnant women show up to the hospital with medical emergencies in states that have strict bans on abortion. 

An Idaho law bars doctors from performing abortions unless the mother’s life is at risk, but it makes no exception if that she would suffer long-term health consequences.

The Biden administration argues a federal law requires hospitals to perform abortions if the health of a mother is at stake, and an appeals court agreed.

The decision in Moyle v. US will place abortion access on the forefront again this summer after today’s decision.

New York Attorney General Letitia James has called the Supreme Court ruling on the mifepristone pill, a “significant victory” for reproductive rights in the US.

James led a coalition of attorneys who urged the Supreme Court to reverse the Fifth Circuit decision that restricted how mifepristone was prescribed.

The Democrat said the Supreme Court’s decision was an important step towards “ensuring that science is the guiding light for medical decisions and rulemaking.”

But, the Attorney General said she recognized the work was not done, as anti-choice legal challenges would continue to come up into the future.

“Abortion care is health care, and regardless of what happens on a national level, my office will always do everything in our power to protect and safeguard these rights for New Yorkers,” James said.

An abortion rights advocate shows a box of mifepristone outside the Supreme Court on March 26.

The legal dispute over mifepristone could come back in the future, CNN legal analyst Elie Honig said on CNN, following the Supreme Court’s decision to reject a lawsuit challenging the Food and Drug Administration’s approach to regulating the abortion pill.

He added that in the future, if there is someone who can establish proper legal standing they can try to revive this case, but that would take a long time and probably years to work its way through the federal courts back up to the Supreme Court.

And while the door is still open for future legal battles regarding the abortion pill, this decision will make it more difficult for other potential plaintiffs, Steve Vladeck, CNN Supreme Court analyst and professor at the University of Texas School of Law, noted.

“Today’s decision doesn’t cut off the possibility of future challenges to mifepristone, including by a handful of red states that were already allowed to intervene in the district court in this case,” Vladeck said. “But the reasoning of the case should make those challenges less likely to succeed, because those plaintiffs (and others) will have a hard time showing that they were harmed by the FDA’s actions,” he said.

The Supreme Court on Thursday rejected a lawsuit challenging the Food and Drug Administration’s approach to regulating the abortion pill mifepristone with a ruling that will continue to allow the pills to be mailed to patients without an in-person doctor’s visit.

Read the full ruling below:

The Supreme Court on Thursday rejected a lawsuit challenging the Food and Drug Administration’s approach to regulating the abortion pill mifepristone.

Justice Brett Kavanaugh wrote the opinion for a unanimous court.

The court ruled that the doctors and anti-abortion groups that had challenged access to the drug did not have standing to sue. Though technical, the court’s reasoning is important because it might encourage other mifepristone challenges in the future.

“We recognize that many citizens, including the plaintiff doctors here, have sincere concerns about and objections to others using mifepristone and obtaining abortions,” Kavanaugh wrote.

The Supreme Court on Thursday rejected a lawsuit challenging the Food and Drug Administration’s approach to regulating the abortion pill mifepristone with a ruling that will continue to allow the pills to be mailed to patients without an in-person doctor’s visit.

The ruling is a significant setback for the anti-abortion movement in what was the first major Supreme Court case on reproductive rights since the court’s conservative majority overturned Roe v. Wade in 2022.