On Tuesday 12th January, the US Supreme Court ruled to limit access to medication abortions, at the request of the Trump administration. The order reinstated a federal requirement that people seeking a medication abortion must pick up the pill in person, from a hospital or medical office. This is the court's first ruling on abortion since Justice Amy Coney Barrett, a judge with an anti-abortion track record, was confirmed to a lifetime appointment on the Supreme Court, putting the court at a 6-3 conservative majority.
The pill in question is called mifepristone (brand name Mifeprex). It's one of two pills involved in a medication abortion; the other is called misoprostol. In 2011, the FDA imposed a Risk Evaluation and Mitigation Strategy (REMS) on it. As a result of the REMS, Mifeprex must be dispensed by a certified provider in a clinic, hospital, or medical office. That means patients generally can’t be prescribed via telemedicine, or receive the drug via the mail.
The REMS is incredibly restrictive given that the pill is largely seen as completely safe. A study of over 19,000 medical abortions found "a very low prevalence of clinically significant adverse events among patients undergoing medical abortion," reports the journal Obstetrics & Gynecology.
In May 2020, the American Civil Liberties Union filed a lawsuit on behalf of a coalition of medical experts led by the American College of Obstetricians and Gynaecologists that challenged these restrictions. The ACLU claimed that not allowing patients to be prescribed the medicine via telehealth during the pandemic subjects them to unnecessary risk. Federal US District Judge Theodore Chuang ruled in favour of the ACLU in July. This meant that until the public health emergency was over, the FDA would not enforce its REMS regarding the abortion pill.
This judgment enabled people seeking abortions to receive the abortion pill via telehealth, greatly increasing access to the reproductive care for people who had trouble visiting a qualifying health centre because they lived far away from the nearest facility, they were in a high-risk population for COVID-19, or many other reasons. Some hoped that the ruling would pave the way toward the restrictions around medication abortions being permanently loosened. The latest Supreme Court ruling — which came less than a week after the U.S. Department Of Health & Human Services extended the country's COVID-19 public health emergency status for the fourth time — is a big step backwards.
Justice Sonia Sotomayor agrees. In her dissent, she wrote: "The COVID–19 pandemic has thus made many typical activities more difficult and dangerous. A trip to the doctor’s office is no exception. This country’s laws have long singled out abortions for more onerous treatment than other medical procedures that carry similar or greater risks," Justice Sotomayor continued. "Like many of those laws, maintaining the FDA’s in-person requirements during the pandemic not only treats abortion exceptionally, it imposes an unnecessary, irrational, and unjustifiable undue burden on women seeking to exercise their right to choose."
"As a physician caring for patients during this pandemic, I find SCOTUS’ reinstatement of this unnecessary requirement unconscionable," Kristina Tocce, MD, MPH, vice president and medical director of the Planned Parenthood of the Rocky Mountains, tells Refinery29. "Medication abortion care is safe, whether accessed in person or via telehealth. We must work to dismantle barriers to accessing this care, not uphold arbitrary ones, especially in this moment in history."
This ruling has only proven what we've known all along: that opponents of abortion don't care about the safety or the science, they just want to restrict access. And while the US may have voted Donald Trump out of office and secured a Democratic majority in both the House and the Senate, this ruling makes it clear that the fight for reproductive rights is still far from over.