Supreme Court to Rule Again on Abortion: A Primer on FDA v. Alliance for Hippocratic Medicine

Here’s what you need to know ahead of the Supreme Court’s oral argument in FDA v. Alliance for Hippocratic Medicine on March 26.

Why was the FDA sued?

A group of anti-abortion activists and organizations sued the U.S. Food and Drug Administration (FDA) over its approval of mifepristone, one of two medications most commonly used in medication abortion in the United States. This case was purposely filed in the Amarillo division of the Northern District of Texas, a single-judge division where the cases are automatically assigned to Judge Matthew Kacsmaryk. The Leadership Conference opposed the nomination of Judge Kacsmaryk because of his extreme record of attacking the rights of LGBTQ+ people and people’s access to reproductive health care.

The plaintiffs asked the court to order the FDA to rescind its approval of mifepristone from more than 20 years ago in order to remove it from the market and limit access to medication abortion. The plaintiffs were emboldened by the Dobbs ruling and have asked the court to further curtail reproductive rights.

What is medication abortion?

Medication abortion, also referred to as the “abortion pill,” is the common name for the use of two different medicines to end a pregnancy: mifepristone and misoprostol. Mifepristone, the drug anti-abortion activists are attacking, was first approved by the FDA more than 20 years ago, and it has since been used by more than 5 million people in the United States for abortion and miscarriage care. Medication abortion has an extremely high safety and efficacy record when provided in various settings, including remotely and at a health center, and is the most common method of abortion in the country.

Why is access to medication abortion important?

Medication abortion helps people make their own private medical decisions based on the type of care that is right for their circumstances. Medication abortion can be easier to access, particularly for patients in communities already facing obstacles to care. Although procedural abortions are also a safe and effective way to end a pregnancy, medication abortion allows patients to have an abortion in private, at a place where they are comfortable, and with the support of their immediate network.

A decision limiting access to mifepristone would disproportionately burden communities who already experience barriers in access to health care, including Black, Indigenous, and other people of color, people with low incomes, LGBTQ+ people, young people, immigrants, people with disabilities, people living in rural areas, and people living at the intersection of these identities.

What have the courts said so far?

Extremist judges, including Judge Matthew Kacsmaryk on the district court in Texas and Judge Cory Wilson and Judge James Ho on the Fifth Circuit, have sided with the plaintiffs to reinstate various burdensome and medically unnecessary restrictions on access to mifepristone. The Supreme Court granted a stay, requested by the FDA, allowing mifepristone’s FDA approval to remain unchanged as it proceeds through the Supreme Court, and agreed to hear the case.

What will happen in the Supreme Court?

Oral arguments will take place on March 26, and we expect a decision by the end of this term (likely in June). The Supreme Court will consider whether or not to uphold the lower courts’ rulings reinstating burdensome and medically unnecessary restrictions on the drug. Its ruling would apply regardless of whether you live in a state where abortion is legal. It’s important to note that right now, access to and approval of mifepristone remains unchanged.

What happens if the Supreme Court rules against the FDA?

If the lower court’s ruling were to take effect, it would exacerbate the current reproductive health care crisis by making it substantially more difficult, or even impossible, for people to access medication abortion. And the implications of a decision revoking the FDA’s approval of mifepristone would go beyond access to medication abortion. It would threaten the FDA’s authority over the medication approval process more broadly and could have far-reaching consequences for patients’ access to other FDA-approved medications.

What is The Leadership Conference’s take on the case?

We believe access to abortion and reproductive health care is a civil rights issue. We joined a “friend of the court” brief in support of the FDA’s approval of mifepristone. We argued that the Supreme Court should reverse the lower court’s judgment and protect access to mifepristone. Restricting access to mifepristone would be a huge blow to abortion access across the country, and in particular for the communities our coalition represents, leading to worse health outcomes for people of color and other groups who have historically faced discrimination in our health care system.