As the Supreme Court preserves access to mifepristone for now, an expert explains the science, safety, and legal landscape around the abortion pill also used in miscarriage care
“If access were restricted in the future, medication abortion would not disappear, but care could become harder to find, more fragmented, and more delayed,” says Liana Woskie, assistant professor of community health. Photo: Shutterstock
The U.S. Supreme Court has preserved access to mifepristone—the medication used in the majority of abortions in the United States and in some miscarriage care—for now. The action maintains current rules that allow certified clinicians to prescribe the drug through telehealth and pharmacies to dispense it by mail while legal challenges continue.
But the ruling likely will not end the broader debate over how the drug can be accessed in the future.
Medication abortion accounts for the majority (63%) of abortions provided by clinicians in the United States, with about 642,700 medication abortions reported in 2023, according to research published by Guttmacher Institute.
“The steady increase in medication abortions in the United States reflects several factors,” says Liana Woskie, assistant professor of community health. “This includes restricted access to procedural care, including the closure of free-standing clinics, as well as patient preference for a private, affordable, and noninvasive option. The FDA removal of in-person dispensing requirements in 2023 has also allowed for greater expansion of medication use via telehealth.”
Woskie studies reproductive policy and is currently focusing on how regulatory choices affect medication use, safety monitoring, and access to abortion and broader obstetric care. Here, she explains what the research says about mifepristone’s safety and what the Supreme Court’s action means for patients.
What is mifepristone and how is it typically used?
Mifepristone blocks progesterone, a hormone needed to sustain an early pregnancy. In abortion care, it is typically used together with misoprostol, a medication that causes the uterus to contract and empty.
Although best known for abortion care, mifepristone is also used to manage miscarriage in early pregnancy loss. Mifepristone also is approved for certain adult patients with Cushing syndrome, a disorder that causes dangerously high levels of the “stress hormone” cortisol.
What does the scientific evidence say about its safety and effectiveness?
Mifepristone has been studied extensively to see if there are safety risks. This includes before it was approved: randomized trials and clinical studies, as well as FDA monitoring of safety reporting, and real-world studies using health system and insurance claims data for the 25 years after approval. Across studies, the mifepristone-misoprostol regimen has been shown to be highly effective, with serious complications rare.
One important distinction: Follow-up care or complications are not the same as serious drug-related safety problems. Some patients seek emergency or urgent care after medication abortion for expected symptoms, confirmation that a pregnancy has ended, or even care unrelated to the use of mifepristone; right now, these care interactions are being confused for safety risk.
What did the Supreme Court ruling preserve, and how does telehealth prescribing work now?
The Supreme Court recently preserved current access rules while litigation continues, meaning certified clinicians can still prescribe mifepristone through telehealth and certified pharmacies can dispense it by mail. But legal challenges continue, so future access could still change.
In a typical telehealth visit, a clinician reviews a patient’s symptoms, medical history, and pregnancy timing to confirm the medication is appropriate. If eligible, the patient receives the medication by mail along with instructions for follow-up care.
For some patients—especially those in states with abortion restrictions or in rural areas with limited access to clinics—telehealth may be the only way to receive clinician-supported abortion care.
What could future restrictions on telehealth prescribing mean for patients?
Although the Supreme Court preserved current access for now, future restrictions could still significantly change how patients receive care. Medication abortion would not disappear, but access could become more difficult, particularly for people who already face barriers to in-person care.
Misoprostol—the medication typically used in combination with mifepristone for abortion care—would remain available and is not subject to the FDA rules that govern prescribing of mifepristone. Misoprostol-only regimens have long been used worldwide and are supported by guidance from the World Health Organization.
The people most likely to be affected by potential restrictions include those already facing the greatest barriers to in-person abortion care: Residents of states with abortion bans or severe restrictions; young people; those with low incomes; patients living in rural areas; individuals without paid medical leave or childcare; people experiencing intimate partner violence or reproductive coercion; and patients who cannot safely travel.
If access were restricted in the future, medication abortion would not disappear, but care could become harder to find, more fragmented, and more delayed. Some patients would likely travel out of state or out of country, while others may use misoprostol-only regimens, or informal medication sources. Patients with miscarriage or other pregnancy complications could also face delays if clinicians or pharmacies are uncertain about whether mifepristone or misoprostol can be provided.
How would a ban affect people experiencing miscarriage?
Mifepristone is also commonly used in miscarriage care. For early pregnancy loss, adding mifepristone before misoprostol can improve the likelihood that the miscarriage is completed medically, reducing the risk of infection and need for an invasive procedure in some patients.
Restrictions on abortion can also affect miscarriage care because abortion and miscarriage management rely on many of the same medications, clinicians, pharmacies, and clinical protocols. When access rules change, patients may face pharmacy barriers, clinician uncertainty, delays in receiving medication, or greater need for invasive procedures, even when they are seeking treatment for pregnancy loss rather than abortion.
The Supreme Court has left current FDA rules in place for now, but Louisiana v. FDA has not been finally resolved. The case will continue in the lower courts. This means current access to mifepristone remains in place while the case continues but that the final legal outcome remains unknown.
