Post-Dobbs Abortion Pill Surge Highlights Stakes of Looming Supreme Court Case

As abortion bans and restrictions have taken hold in at least 21 states since the right-wing majority on the U.S. Supreme Court voted to overturn Roe v. Wade nearly two years ago, Americans' reliance on medication abortion became increasingly clear—with the use of abortion pills reported in 63% of all abortions that took place within the formal healthcare system in 2023.

Medication abortion represented 53% of all abortions in the U.S. in 2020, signifying a substantial increase since the court ruled in Dobbs v. Jackson Women's Health Organization.

The Guttmacher Institute released the results of its Monthly Abortion Provision Study on Tuesday, a week before the Supreme Court is set to hear oral arguments in Food and Drug Administration, et al., Applicants v. Alliance For Hippocratic Medicine, et al., a case brought by the right-wing Alliance Defending Freedom on behalf of anti-abortion doctors.

The group filed the case aiming to revoke the FDA's approval of mifepristone, one of two drugs used in medication abortions, more than two decades after it was approved following years of research.

"As our latest data emphasize, more than 3 out of 5 abortion patients in the United States use medication abortion," said Amy Friedrich-Karnik, director of federal policy for Guttmacher. "Reinstating outdated and medically unnecessary restrictions on the provision of mifepristone would negatively impact people's lives and decrease abortion access across the country."

Right-wing Judge Matthew Kacsmaryk ruled last year in the U.S. District Court for the Northern District of Texas that mifepristone's registration should be invalidated, a decision that was quickly put on hold by the Supreme Court.

Next week, the Supreme Court will hear the U.S. Department of Justice's appeal of Kacsmaryk's decision with a focus on two issues: whether the Alliance of Hippocratic Medicine has legal standing and whether the FDA did adequate research before it expanded access to mifepristone in 2016 and 2021. A ruling is expected this summer.

Guttmacher's research showed a 10% increase in all abortions in the U.S. between 2020-23, with a rate of 15.7 abortions per 1,000 women of reproductive age last year—the highest rate and number of abortions in more than a decade.

States without total abortion bans saw a 25% rise in abortion care compared to 2020, and the increase was even sharper in states bordering those with bans—37% between 2020-23.

"Next week as we hear oral arguments in the FDA v. Alliance for Hippocratic Medicine case, remember who will be impacted," said Whole Women's Health, which runs reproductive health clinics in several states.

Rachel Jones, principal research scientist for Guttmacher, said the group's findings show that "as abortion restrictions proliferate post-Dobbs, medication abortion may be the most viable option—or the only option—for some people, even if they would have preferred in-person procedural care."

Reproductive rights advocates and medical experts including the American College of Obstetricians and Gynecologists have long warned that restrictions on mifepristone—adopted by the FDA under pressure from the pro-forced pregnancy movement—are medically unnecessary and aim only to stop people from receiving care.

Advocates fear that the Supreme Court could rule that the FDA's 2021 decision to allow mifepristone to be dispensed via telemedicine and the mail violates the Comstock Act, a law that dates back to 1873 and prohibited the distribution of "obscene" materials through the mail.

"The modern anti-abortion movement wants to reinvent the Comstock Act as an abortion ban," University of California, Davis, law professor Mary Ziegler told Ms. magazine on Tuesday.

If healthcare providers can no longer dispense mifepristone via telemedicine, people seeking abortions would be forced to go in person to get care, "exposing them not only to delays and increased costs but also to harassment, threats, and other types of violence from anti-abortion extremism, which has increased dramatically since the fall of Roe," reported Ms.

Ahead of the Supreme Court's hearing in the Alliance for Hippocratic Medicine's "groundless case challenging FDA approval of mifepristone," said Guttmacher, "mifepristone is available and the facts remain clear: medication abortion is safe, effective, widely used, and critical to bodily autonomy for all."