As the U.S. Supreme Court heard oral arguments Tuesday in a case brought by right-wing activists seeking to sharply limit access to a commonly used abortion pill, reproductive rights advocates renewed warnings that Republicans' endgame isn't just making abortion a states' rights issue, but rather forcing a nationwide ban on all forms of the medical procedure.
Thehigh court justices—including six conservatives, half of them appointed by former President Donald Trump, the presumptive 2024 GOP presidential nominee—are hearing oral arguments in Food and Drug Administration v. Alliance for Hippocratic Medicine, a case brought by the right-wing Alliance Defending Freedom on behalf of anti-abortion doctors. The case involves the abortion pill known by the generic name mifepristone, which was first approved by the FDA in 2000 as part of a two-drug protocol to terminate early-stage pregnancies.
"If the Supreme Court refuses to follow the evidence and imposes medically unnecessary restrictions on mifepristone, it will be just another stepping stone in the anti-abortion movement's end goal of a nationwide ban on abortion."
"Mifepristone has been used by millions of women over the last 20 years, and its safety and effectiveness have been well-documented," said Jamila Taylor, president and CEO of the Institute for Women's Policy Research. "The drug has taken on even greater importance for women's health since the Supreme Court overturned Roe v. Wade, and the far right has moved to block women's access to healthcare at every turn."
In a dubious practice known as "judge shopping," the plaintiffs filed their complaint in Amarillo, Texas, where Matthew Kacsmaryk, the sole federal district judge and a Trump appointee, ruled last April that the FDA's approval of mifepristone was illegal. Shortly after Kacsmaryk's ruling, a federal judge in Washington state issued a contradictory decision that blocked the FDA from removing mifepristone from the market. The U.S. Department of Justice subsequently appealed Kacsmaryk's ruling.
Later in April 2023, the Supreme Court issued a temporary order that allowed mifepristone to remain widely available while legal challenges continued. A three-judge panel of the right-wing 5th U.S. Circuit Court of Appeals ruled last August that the FDA's 2016 move to allow mifepristone to be taken later in pregnancy, mailed directly to patients, and prescribed by healthcare professionals other than doctors, was likely illegal. However, the court also allowed the pill to remain on the market pending the outcome of litigation.
In an analysis of the case published Tuesday, jurist Amy Howe explained:
There are three separate questions before the justices on Tuesday. The first one is whether the challengers have a legal right to sue, known as standing, at all. The FDA maintains that they do not, because the individual doctors do not prescribe mifepristone and are not obligated to do anything as a result of the FDA's decision to allow other doctors to prescribe the drug.
The court of appeals held that the medical groups have standing because of the prospect that one of the groups' members might have to treat women who had been prescribed mifepristone and then suffered complications—which, the FDA stresses, are "exceedingly rare"—requiring emergency care. But the correct test, the FDA and [mifepristone maker] Danco maintain, is not whether the groups' members will suffer a possible injury, but an imminent injury.
Destiny Lopez, acting co-CEO of the Guttmacher Institute, called the plaintiffs' claims "baseless."
"If the Supreme Court refuses to follow the evidence and imposes medically unnecessary restrictions on mifepristone, it will be just another stepping stone in the anti-abortion movement's end goal of a nationwide ban on abortion," she said on Tuesday. "As the court weighs its decision, let's be clear that the only outcome that respects facts and science is maintaining full access to mifepristone."
As more than 20 states have banned or restricted abortion since the Supreme Court's June 2022 Dobbs v. Jackson Women's Health Organization ruling overturnedRoe v. Wade and voided half a century of federal abortion rights, people have increasingly turned to medication abortion to terminate unwanted pregnancies. And while Republicans have often claimed that overturning Roe was not meant to ban all abortions but merely to leave the issue up to the states, GOP-authored forced pregnancy bills and statements by Republican lawmakers and candidates including Trump—who last week endorsed a 15-week national ban—belie conservatives' goal of nationwide prohibition.
Project 2025, a coalition of more than 100 right-wing groups including Susan B. Anthony Pro-Life America and other anti-abortion organizations, wants to require the FDA to ban drugs used for medication abortions, protect employers who refuse to include contraceptive coverage in insurance plans, and increase surveillance of abortion and maternal mortality reporting. The coalition is reportedly drafting executive orders through which Trump, if reelected, could roll back Biden administration policies aimed at protecting and expanding abortion access.
"The overturn of Roe was just the first step in the far right's relentless campaign to restrict women's reproductive freedom. We always knew they would come for medication abortion, too," Taylor said. "But conservatives seeking to block access to mifepristone are not concerned about women's safety; they want to block all abortion options for women and prevent them from making their own reproductive decisions, even in their own homes."
Right-wing groups including the Heritage Foundation have been pressing Trump to invoke the Comstock laws, a series of anti-obscenity statutes passed in 1873 during the Ulysses S. Grant administration. One of the laws outlawed using the U.S. Postal Service to send contraceptives and punished offenders with up to five years' hard labor. Named after Victorian-era anti-vice crusader and U.S. postal inspector Anthony Comstock, the laws were condemned by progressives of the day, with one syndicated newspaper editorial accusing Comstock of striking "a dastard's blow at liberty and law in the United States."
Slate senior writer Mark Joseph Stern said Tuesday that far-right Justices Clarence Thomas and Samuel Alito—who wrote the majority opinion in Dobbs—"are clearly eager to revive the Comstock Act as a nationwide ban on medication abortion, and maybe procedural abortion, too."
"That would subject abortion providers in all 50 states to prosecution and imprisonment," he added. "No congressional action needed."
Progressive U.S. lawmakers joined reproductive rights advocates in rallying outside the Supreme Court on Tuesday.
"Mifepristone is safe and effective and has been used in our country for decades," said Rep. Rashida Tlaib (D-Mich.). "These far-right justices need to stop legislating from the bench."
Rep. Ayanna Pressley (D-Mass.) asserted that "medication abortion is safe, effective, and routine healthcare."
"Over half of U.S. abortions are done this way and we have decades of scientific evidence to back up its safety," she added. "SCOTUS must protect access to mifepristone and we must affirm abortion care as the human right that it is."
