SCOTUS Votes to Uphold Mifepristone Approval, Maintaining Access

On Friday, April 21, 2023, the Supreme Court of the United States (SCOTUS) issued a ruling upholding mifepristone approval, pending ongoing cases. The SCOTUS decision does not guarantee unlimited access to medication abortions; however, it slows a Texas judge’s attempt to reverse approval.

Earlier this month, on April 7, 2023, two conflicting preliminary injunctions surrounding access to mifepristone left many wondering about the future of medication abortions in the US. Among those injunctions was a decision by Trump-appointed Texas judge Matthew Kacsmaryk on the Alliance for Hippocratic Medicine v. United States FDA court case.

Kacsmaryk’s preliminary injunction on this case, introduced on January 13, 2023, attempted to reverse the FDA approval of mifepristone, marking the first time a judge has tried to override the FDA’s authority.

Meanwhile, halfway across the country, a judge, Thomas O. Rice of the Eastern District of Washington, issued a directly opposing preliminary injunction, ensuring access to abortion pills in 17 states and Washington, DC. The injunction also emphasized that no additional restrictions should be put on mifepristone.

Following the Texas ruling, the US Department of Justice (DOJ) and the Biden administration issued statements criticizing the verdict and its healthcare implications. The DOJ appealed the decision before the Supreme Court, prompting this recent ruling.  

Before any decisions were made, Supreme Court Justice Samuel A. Alito, Jr. issued an order that lifted restrictions on the abortion pill, pending a final ruling. The final SCOTUS ruling was initially expected Wednesday, April 19, 2023, but was delayed, presumably due to conflicting opinions among the SCOTUS judges.

After much anticipation, SCOTUS issued the following statement:

“The April 7, 2023, order of the United States District Court for the Northern District of Texas, case no. 2:22–cv–223, is stayed pending disposition of the appeal in the United States Court of Appeals for the Fifth Circuit and disposition of a petition for a writ of certiorari if such a writ is timely sought. Should certiorari be denied, this stay shall terminate automatically. In the event certiorari is granted, the stay shall terminate upon the sending down of the judgment of this Court.”

Mifepristone has been approved in the US since 2000, following meticulous analysis of its safety and efficacy. As part of the medication abortion process, the drug is used for most abortions worldwide. A reversal of approval without data indicating a lack of safety or efficacy undermines the judgment of the FDA and may endanger those looking to access abortions.

As the proceedings continue, healthcare professionals and other public health leaders must advocate for comprehensive reproductive healthcare.