SCOTUS Just Made a Final Decision About Abortion Pill Access

For decades, abortion pills have been used to end pregnancies in the first trimester, but for the last year or so, mifepristone, one of the main drugs in the two-step process, has been under federal scrutiny.

After a ton of other moving parts and lots of drama, the Supreme Court heard oral arguments about the drug from opposing sides in March 2024. And on June 13, the Court gave a final ruling in an unanimous vote that mifepristone will remain legal and widely available.

So what was all the fuss about? Girl, it's messy as hell. But very long story short really quick: The FDA approved mifepristone for nationwide use more than 24 years ago, but in 2016 and 2021, the organization loosened restrictions on the medications to make abortions pills more accessible. Then, all this drama started in April 2023 when two federal judges gave very confusing, seemingly out-of-nowhere opposing rulings about the pills—one district court judge, a conservative in Texas, invalidated the FDA’s ruling of the medication, while another district court judge in Washington state declared the drug should remain available without restrictions as it has been for decades. Then, SCOTUS stepped in. So, yeah. Sh*t got messy quick.

That said, keep reading for the full timeline of everything that's happened to get us to SCOTUS's recent decision. Below is every single thing you should know about the abortion pill federal rulings, and how they impact abortion pills in general as well as overall abortion access nationwide.

A reminder first: What exactly are abortion pills?

Great question. In 2000, the FDA approved this noninvasive method of abortion that is safe to take at home. In essence, abortion pills are a set of two separate pills: The first, mifepristone, blocks the hormone that allows an embryo to attach to the uterus and grow, and the second, misoprostol, empties the uterus, basically causing a super-heavy period.

Their processes are pretty different (one you take with a sip of water; the other involves letting the medication dissolve either under the tongue or through the vagina), but together, these work to fully terminate a pregnancy that isn’t further along than 11 weeks.

Gotcha. So what are the rulings involving abortion pills?

A lot has gone down, so buckle up. It all mostly started back in April 2023 when Texas-based, Trump-appointed U.S. district court judge Matthew Kacsmaryk ruled that the FDA’s 23-year approval of mifepristone should come to an end.

In his 67-page ruling opinion, Judge Kacsmaryk wrote that part of his reasoning for appealing the FDA’s ruling is that the government organization, he says, didn’t take into account “the intense psychological trauma and post-traumatic stress women often experience from chemical abortion.” Judge Kacsmaryk also used typical anti-choice rhetoric like “abortionist,” “unborn human,” and “chemical abortion.”

In the other case, which was filed just a few hours after Kacsmaryk’s, Washington district court judge Thomas O. Rice ruled the opposite—that the FDA should keep its original approval and the medication should remain legal and available in 17 states plus D.C. after some blue states sued to keep the medication abortion access legal.

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Then on April 12, 2023, the U.S. 5th Circuit Court of Appeals halted part of Kacsmaryk’s request to end mifepristone’s approval, but ultimately, that decision made obtaining the drug harder. Essentially, being able to receive the pill via mail from a telehealth organization—an extremely common and preferred way to get it—was off the table at that time, per CNN. The decision also gave a shorter window for when the drug could be taken, closing the cap from 11 weeks of pregnancy to 7 weeks.

Later in the same month, Supreme Court Justice Samuel Alito temporarily blocked the ruling that put tighter restrictions on mifepristone, preserving full access to mifepristone in a 7-2 vote for the time being.

After aaaall of this, the Supreme Court announced in December 2023 that it would hear oral arguments and then give a final ruling on the 5th Circuit’s decision that restricted access to mifepristone (which is the decision we got today).

Has a final decision been made about mifepristone yet?

Yes. On June 13, 2024, SCOTUS decided to keep mifepristone access legal and widely available in a unanimous vote. If they would have banned the drug, the ruling would have went into effect across the entire country, regardless of whether abortion is permitted, per CBS News.

In March 2024, SCOTUS heard oral arguments from opposing sides, and the mostly conservative court was surprisingly leaning toward keeping mifepristone legal and widely available, according to NBC News. This is because the judges were mostly focused on whether there were actually any legal grounds to this lawsuit as opposed to questioning if the FDA should have loosened restrictions on mifepristone (which they did in 2016 and 2021 to make the drug more accessible, like through telehealth), based on reports from AP News.

Justice Amy Coney Barrett, one of the conservative judges who was appointed by President Donald Trump, said that a lot of the anti-abortion arguments sounded more like "conscience objections," and Justice Brett Kavanaugh, who was also given his seat by Trump, made a similar point. "Under federal law, no doctors can be forced against their consciences to perform or assist in an abortion, correct?" he asked.

Can I still access mifepristone right now if I need an abortion?

Yes! The pill is available in states where abortion pills are still legal and don’t have any restrictions. According to a statement from Elisa Wells, co-founder of Plan C, the campaign and educational resource spreading awareness about self-managed abortions, she asserted that not only are all abortion pills safe forms of medicine, but that there might be way of getting access to the medications in restricted states too. She said:

We want to be clear – abortion pills remain safe and effective medicines. And, they remain available in all 50 states, including places where abortions are restricted. This is possible due to a robust system of alternative suppliers that has emerged in the United States in response to unjust bans, including community support networks, new telehealth services operating from supportive states, international telehealth services, and online pill vendors. These sources have already served more than a hundred thousand people since Dobbs and are poised to expand to meet demand.

Additionally, reproductive justice advocates and abortion providers have committed to offering misoprostol-only abortions, which are just as safe and effective as those involving mifepristone. Get the full scoop on those below:

So, what happens next?

Abortion is a huge topic on the ballot in this election year, so anything can happen. Until then, if you or someone you know needs an abortion, be sure to check out resources like:

  • Abortion Finder for their state-by-state guide on service providers and any type of assistance resources needed.

  • Hey Jane for getting abortion pills through the mail discreetly to your front door.

  • Plan C that offers another state-based guide on how you can access pills, whether by in-person clinic, online clinic, traveling, or other supplier.

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