Supreme Court Briefly Preserves Broad Availability of Abortion Pill

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The United States Supreme Court has upheld a federal rule that requires patients to receive the abortion pill from a doctor in person, instead of by mail or other remote methods, during the COVID-19 pandemic. This reversal by the court permits the Trump administration to impose its restrictions on medication abortion, continuing the battle over reproductive health rights during a global health crisis.

The ruling on Tuesday came in response to an emergency request from the Trump administration, which asked the court to reinstate a requirement that patients seeking medication to end a pregnancy must pick up the pills in person at a hospital or clinic, rather than receiving them by mail or having them sent to their home, as was temporarily allowed during the pandemic by the U.S. Food and Drug Administration. The court, in a brief order, instructed the lower court to continue to review the matter, but allowed the Trump administration’s restrictions to remain in place while the case moves forward.

The decision was met with criticism from abortion rights activists and healthcare providers, who argued that the in-person requirement created unnecessary barriers to medication abortion care, especially during the pandemic. Anti-abortion advocates, on the other hand, claimed that the restriction protected women’s health and safety.

The abortion pill, also known as mifepristone, is used to end early pregnancies and is typically prescribed along with another drug called misoprostol. Patients take the medications during the first 10 weeks of pregnancy. Medication abortion accounted for about 40% of all abortions in the U.S. in 2017, according to the Guttmacher Institute.

The FDA approved mifepristone for use in conjunction with misoprostol in 2000, and its approval was accompanied by a regimen requiring doctors to dispense the medication directly to patients. In March 2020, amid the COVID-19 pandemic, the FDA temporarily eased the in-person requirement and allowed healthcare providers to offer patients the medication via telemedicine, giving them the option to have the pills mailed to them.

In July, the American College of Obstetricians and Gynecologists and other reproductive health organizations sued the FDA, arguing that the in-person requirement placed an undue burden on patients during the pandemic and violated their constitutional rights to access abortion care.

A federal judge in Maryland agreed, ruling that the FDA had placed an “unjustifiable burden” on women by requiring them to travel to a medical facility during the pandemic. The judge issued an order that would have allowed doctors to send the medication abortion drugs by mail or require lower-risk outpatient visits.

The Trump administration appealed the ruling, arguing that the in-person requirement was necessary to ensure patients received appropriate medical care and were protected from potentially life-threatening complications. The administration also argued that the original regimen for dispensing mifepristone was carefully established to minimize risks associated with the drug.

The Supreme Court’s action on Tuesday suggests that the justices, who have a 6-3 conservative majority, viewed the case as a legal rather than medical matter. By allowing the Trump administration’s restrictions to stay in place while the case is reviewed, the court effectively blocked medication abortion care from being provided remotely, at least temporarily.

The decision comes amid broader concerns about access to reproductive health care during the pandemic, as well as a broader conservative agenda to restrict abortion rights. Several states have passed laws restricting abortion access, and the Supreme Court is scheduled to hear a major case challenging the constitutionality of a Mississippi law that bans most abortions after 15 weeks of pregnancy, which has the potential to overturn or erode the landmark 1973 Roe v. Wade decision that legalized abortion nationwide.

In the meantime, healthcare providers and advocates for reproductive health care will continue to push for expanded access to essential services, including medication abortion, especially in light of the ongoing pandemic. While the Supreme Court’s action on Tuesday temporarily preserved the Trump administration’s restrictions on medication abortion, it also highlighted the urgent need for policymakers and lawmakers to prioritize reproductive health care and ensure that patients can access the care they need, no matter what.