The US Supreme Court decided Wednesday to hear a case challenging access to abortion pills in the United States, including in states where abortion is legal.

This will be the most consequential case for access to reproductive health care since the overturning of Roe v. Wade in 2022. Following the Roe decision, many patients seeking abortions turned to telehealth providers, who could then send abortion pills by mail. Pills are now the most common abortion method in the US; curtailing the availability of medication abortion would be a major blow to reproductive health care.

“The future of telehealth for medication abortion care now hangs in the balance,” says Dana Northcraft, the founding director of the Reproductive Health Initiative for Telehealth Equity and Solutions. “Telehealth for medication abortion is safe and effective and helps people overcome barriers to care, whether it be long travel distances or getting time off from work or school.”

The Supreme Court will hear the case this term, which means a decision may come in summer 2024, in the midst of the US presidential election season.

The ongoing legal saga centered on access to mifepristone began way back in 2002, when an alliance of anti-abortion activist groups first challenged the approval of the drug with a citizen petition. (The standard two-step regimen of medication abortion, which couples mifepristone with another drug, misoprostol, has been legal in the United States since 2000, when the Food and Drug Administration first approved mifepristone.) The FDA ignored that initial challenge, but the coalition of activists persisted.

In November 2022, the group brought suit in Texas, claiming that the FDA’s original approval process was flawed because it did not properly assess safety risks. An initial ruling from Judge Matthew Kacsmaryk of the Northern District of Texas sided with the plaintiffs, invalidating the FDA’s approval. (Kacsmaryk is a President Trump appointee known for his anti-abortion views.)

In April, shortly after the initial ruling, the Fifth Circuit Court of Appeals partly overruled Kacsmaryk, allowing mifepristone to stay on the market but overturning the ability to receive the medication by mail. At the urging of the Biden administration, the Supreme Court then ordered a stay until the appeals process concluded. This bought virtual abortion clinics some time, as they would have otherwise been forced to modify how they operated. Some clinics have planned to continue offering medication abortion, but with a one-pill regime of misoprostol.

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