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:

• The court's opinion: The court ruled that the doctors and anti-abortion groups that had challenged access to the drug did not have standing to sue. Justice Brett Kavanaugh, who wrote the opinion, said the parties do not have standing "simply because others are allowed to engage in certain activities — at least without the plaintiffs demonstrating how they would be injured by the government’s alleged under-regulation of others.”
• Reaction: Reproductive rights groups across the US are responding to the decision. You can read some of their reactions here. Anti-abortion groups also reacted to the ruling, saying they will continue to challenge abortion. President Joe Biden cast blame on Republicans for the very existence of the case, taking aim at GOP elected officials’ “extreme and dangerous agenda” on reproductive rights. Biden has worked to make protecting abortion rights a centerpiece of his reelection bid. Meantime, former President Donald Trump cautioned Republicans not to go too far on abortion in a meeting with the House GOP conference.
• The big picture: Access to mifepristone has become particularly important after the court overturned Roe v. Wade two years ago and many states banned the procedure in clinical settings. The ruling is a significant setback for the anti-abortion movement. But, though technical, the court’s reasoning is important because it might encourage other mifepristone challenges in the future. Much of the opinion covered the various legal thresholds a plaintiff must reach to make it appropriate for courts to intervene in a dispute. 
• About the pill: Data analyzed by CNN shows mifepristone — the first drug in the medication abortion process — is even safer than some common, low-risk prescription drugs, including penicillin and Viagra. Read more about that here.
• Another abortion case looms: The Supreme Court is yet to release a decision on a case related to abortions in health emergencies. The Supreme Court will decide what happens when pregnant women show up to the hospital with medical emergencies in states that have strict bans on abortion.

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

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.

“Attacks on medication abortion are part of Republican elected officials’ extreme and dangerous agenda to ban abortion nationwide,” Biden said in a statement.

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.

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 is not a cause for celebration because the reality is certain things are still not going to change. We are looking at the fact that two thirds of women of reproductive age in America live in a state with a Trump abortion ban," she said.

"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.

 

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.

“Though I am relieved by today’s decision made by the Court, no one should be celebrating,” he said, noting that the decision was not based on merits, but on lack of standing by the plaintiffs. “We are not out of the woods. This shouldn’t be a decision women are forced to fear, yet year after year, case after case, these healthcare decisions must be between women, families and their doctors, not judges nor lawmakers.” 

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.”