The Supreme Court on Monday restored broad access to the abortion medication mifepristone through telehealth, mail-order and pharmacies, temporarily halting an appellate ruling that would have forced patients to see a doctor in person to obtain the pills. The order, signed by Justice Samuel Alito, will remain in effect for at least one more week while the full court considers the legal fight over the Food and Drug Administration’s authority to regulate the drug.
Medication abortion — a two-drug regimen of mifepristone and misoprostol — now accounts for the majority of abortions in the United States. In states where abortion is banned at all stages of pregnancy, telehealth prescriptions for the combination have surpassed out-of-state travel as the primary way women terminate pregnancies, according to recent analysis. The lower-court ruling, issued by a federal appeals court, had threatened to upend that practice by reimposing in-person dispensing requirements the FDA removed in recent years.
The legal challenge was brought by Louisiana and a woman who alleges her boyfriend coerced her into taking abortion pills, arguing that the FDA’s relaxed restrictions undermined the state’s ban. The plaintiffs also questioned the safety of mifepristone, which was approved 25 years ago and has repeatedly been found safe and effective by agency scientists. Monday’s administrative stay leaves those safety arguments unresolved; the high court will now weigh briefs from both sides before deciding whether to issue a longer-lasting order.
Several telehealth abortion providers had already prepared for the restriction by switching to misoprostol-only regimens — misoprostol can end a pregnancy on its own, though it is less effective than the two-drug combination and carries more pronounced side effects. The Massachusetts Abortion Access Project, led by founder Dr. Angel Foster, had been ready to send misoprostol alone on Monday afternoon. “Regardless of what happens with this regulatory issue, we and other groups will continue to provide high-quality abortion care to patients in all 50 states,” Foster said.
At a Wyoming clinic that provides about 100 medication abortions a year through telehealth, founder Julie Burkhart said the stay bought precious time. “We have a little bit more time to navigate this new landscape with the stay,” she said. “We’re still asking patients to consent to receiving the two-drug combination or misoprostol only, depending on what the court decides.”
Anti-abortion groups said the legal fight would continue. Carol Tobias, president of National Right to Life, called the ruling “a temporary procedural step that leaves unresolved the very real concerns about the safety of these drugs and the decision under the Biden administration’s FDA to recklessly remove longstanding safeguards.” Louisiana Attorney General Liz Murrill criticized the pharmaceutical industry and expressed confidence the restrictions would eventually be upheld. “Big abortion pharma claims they need an emergency stay because they will lose massive amounts of money if they can’t kill more babies quickly and efficiently by mail without medical oversight,” Murrill said in a statement. “The administrative stay is temporary, and I am confident life and the law will win in the end.”
Legal advisers to people seeking abortion stressed that the outcome of the court battle will not create new criminal liability for patients. “The outcome is not going to make it a crime for people to access care,” said Elizabeth Ling, associate director of legal services at If/When/How, which provides legal guidance on abortion. No state ban currently includes penalties for women who obtain abortions.
The Supreme Court is expected to act further on the case after reviewing the filings due later this week.