The Abortion Pill Rulings, Explained

Editor’s note: This story was updated on April 14 to reflect the Biden admin's emergency application to the Supreme Court and Justice Samuel Alito's decision to temporarily hold lower court rulings.

Is abortion medication legal in my state right now? It’s a question that’s likely on many Americans’ minds after two conflicting legal decisions left the fate of mifepristone, aka “the abortion pill,” uncertain. Mifepristone is the first of two drugs — the second being misoprostol — used in medication abortions, which account for more than half of abortions in the US.

What happened with the abortion pill? 

On April 7, two federal judges issued dueling rulings on the pill. In Texas, Judge Matthew Kacsmaryck ruled to suspend the FDA’s approval of mifepristone nationwide.Soon after, in a separate case, Judge Thomas Rice in Washington ordered the FDA to maintain access to mifepristone in 17 Democratic-led states plus DC (these states had sued the government to make abortion pills more accessible).  

A federal appeals court partially blocked Kacsmaryck’s ruling on April 12, temporarily preventing the drug from being taken off the market. But the court allowed other aspects of the ruling to remain, including prohibiting the delivery of abortion medication via mail and setting a stricter limit on when the medication can be taken (up to seven weeks of pregnancy). The Biden admin filed an emergency application to the Supreme Court to block those restrictions on April 14, and Justice Samuel Alito temporarily paused the restrictions a few hours later so the court could consider the issue. His stay will last until April 19 at midnight.

What does this mean for me? 

Mifepristone remains available for now, but its long-term status will likely depend on a decision from the Supreme Court.

In states where medication abortion is legal, residents may continue to have access while these legal battles play out. Over the past few days, governors in California, Massachusetts, and Washington have announced plans to stockpile mifepristone or misoprostol to help ensure future access. 

However, many other states have limited medication abortions with laws that place stipulations on how patients can access the drugs, and in the 13 states with an abortion ban, medication abortion is already illegal. But the Biden admin has argued that the US Postal Service can still deliver the pills in these states. The admin also proposed a new rule to protect women who travel out of their state to seek abortions by prohibiting medical systems from sharing information about their abortions with law enforcement. 

If mifepristone were banned, some legal experts argue that the FDA may have the authority to choose not to enforce the ruling, especially since doing so would mean disregarding the contradictory Washington ruling. But there are also other options. Misoprostol could be used alone to end a pregnancy, and it would still be 75-95% effective, compared to mifepristone and misoprostol together, which is between 95% and 99% effective. But misoprostol alone could require higher doses and may cause more side effects. Abortions performed in a medical office (called an in-clinic abortion) are 99% effective. 

theSkimm

The recent rulings on the abortion pill show that the battle around reproductive healthcare access is only intensifying, leaving American women in a gray area regarding their rights.