The Supreme Court is preparing to address the controversial topic of abortion by considering a case involving a common medication used to terminate pregnancies. This case could have major consequences for women across the United States and potentially impact the upcoming presidential election.

Two years following the Supreme Court’s decision to reverse Roe v. Wade and permit restrictions and bans on abortion in numerous Republican-dominated states, those against abortion will appeal to the high court on Tuesday to endorse a decision from a conservative federal appeals court that would restrict the availability of the medication mifepristone. This medication was utilized in almost two-thirds of all abortions in the country in the previous year.

The choice to overturn Roe v. Wade had a swift impact on politics, as Democrats argued that the court’s decision deprived women of a right they had held for 50 years, ultimately leading to their success in elections. Surprisingly, even traditionally conservative states such as Kansas and Ohio voted against abortion limitations. If the court were to support restrictions on medication abortions, it could significantly impact the outcomes of upcoming Congressional and presidential races.

The decision to reverse modifications made by the Food and Drug Administration regarding mifepristone would limit the availability of the drug through mail and enforce stricter requirements, regardless of the legality of abortion in certain states. These requirements would reduce the window of time in which mifepristone can be used during pregnancy from 10 weeks to 7 weeks.

In May 2023, a KFF survey found that 55% of American adults believe that taking medication abortion pills as directed by a doctor is either very or somewhat safe. Additionally, 65% express “a lot” or “some” confidence in the FDA’s ability to ensure the safety and effectiveness of medications sold in the U.S.

A ruling is expected by the end of June, but even if the outcome is decided, the Supreme Court will still face future abortion cases. There are ongoing legal disputes regarding state regulations, and if former President Donald Trump, the presumptive nominee for Republicans in 2024, is re-elected, there may be additional federal restrictions.

In the upcoming month, the judges will listen to discussions regarding whether a national law regarding emergency care at hospitals must incorporate abortions, even in states where they are otherwise prohibited.

Mifepristone, made by New York-based Danco Laboratories, is one of two drugs, along with misoprostol, used in medication abortions. Their numbers have been rising for years, and they accounted for 63% of the more than 1 million abortions in the U.S. last year, according to an estimate by the Guttmacher Institute, which supports abortion rights. More than 5 million people have used mifepristone since 2000.

Mifepristone is taken first to dilate the cervix and block the hormone progesterone, which is needed to sustain a pregnancy. Misoprostol is taken 24 to 48 hours later, causing the uterus to contract and expel pregnancy tissue.

Some health care providers have stated that if mifepristone becomes inaccessible or difficult to obtain, they would instead administer only misoprostol, which is not as efficient in terminating pregnancies.

Highlighting the significance of the issue, there has been a noticeable increase in medication abortions for various factors. Administering pills at one’s residence to terminate a pregnancy is less intrusive than undergoing surgery, more practical than having to commute to an abortion facility, and offers more confidentiality, allowing women to steer clear of anti-abortion demonstrators who protest at clinics.

It is now simpler to obtain the two medications in certain states as CVS and Walgreens have recently launched pilot programs to distribute them at their stores.

For women living in states with abortion bans or restrictions, mail order delivery may be their only practical option, said Julie F. Kay, executive director of the Abortion Coalition for Telemedicine.

The medication is sent by providers in states that have laws meant to shield them from any legal trouble for working with people who live in states that don’t permit medication abortions. The pills cost $150 and usually arrive within three to five days, Kay said.

Dr. Rebecca Gomperts, founder of the abortion provider Aid Access, reported that 85,000 women utilized their services for obtaining medication through mail-orders last year. Among them, 50,000 reside in states with strict abortion laws.

The existing situation closely mirrored the ruling of the Supreme Court in 2022 that overturned the constitutional protection for abortion. As a result, 14 states have implemented bans on abortion at any stage of pregnancy, with a few exceptions. In two other states, abortion is banned once cardiac activity can be detected, which typically occurs around six weeks.

Abortion opponents filed their challenge to mifepristone the following November and initially won a sweeping ruling six months later from U.S. District Judge Matthew Kacsmaryk, a Trump nominee in Texas, which would have revoked the drug’s approval entirely. The 5th U.S. Circuit Court of Appeals left intact the FDA’s initial approval of mifepristone. But it would reverse changes regulators made in 2016 and 2021 that eased some conditions for administering the drug.

The highest court paused the altered decision by the lower court and agreed to review the case. However, Justices Samuel Alito and Clarence Thomas, who previously overturned Roe, would have permitted certain limitations to be implemented during the ongoing proceedings.

The initial advocates for the removal of mifepristone from the market, including doctors and organizations, now state in their primary brief to the Supreme Court that the recent modifications “put women’s health at risk across the country” and did not adhere to the strict procedures mandated by federal law for altering safety regulations on medications.

Lawyer Sarah Parshall Perry from the Heritage Foundation, who is in favor of the challenge, stated that the Supreme Court has an opportunity to determine if certain agencies are exempt from decision making processes.

According to Erin Hawley, the lawyer for anti-abortion advocates at the Supreme Court, pregnant women no longer require a face-to-face appointment with a doctor to obtain a prescription for mifepristone.

According to Hawley, our customers are requesting for the FDA to reinstate protections that were previously in effect for almost two decades. She is the spouse of Senator Josh Hawley, a Republican from Missouri. Both individuals worked as clerks for Chief Justice John Roberts at the start of their professional careers.

However, the authorities claim that the removal of doctor appointments and other revisions were a result of over two decades of overseeing mifepristone, which involved examining safety information and research on numerous women. This perspective is also supported by various prominent medical groups, such as the American College of Obstetricians and Gynecologists.

Seven former commissioners of the FDA stated in a legal document that the agency took extra precautions when initially approving mifepristone, as it is an abortion drug. They further explained that any changes made afterwards were based on a comprehensive and unbiased scientific review process, as mandated by Congress for the FDA.

Mary Ziegler, a professor of law at the University of California, Davis, who has extensively studied abortion laws, stated that reversing the FDA regulations would classify a large portion of the mifepristone doses in the market as inaccurately labeled. This could potentially lead to significant disruptions in the accessibility of the drug for several months.

Ziegler explained that this case has the possibility to significantly change the process of approving drugs. The pharmaceutical industry has also strongly expressed their support for the administration’s stance.

Both the administration and Danco put forth lengthy arguments, which are disputed by the opposing side, claiming that the individuals who oppose abortion do not have the necessary legal authority or grounds to bring this case.

If the court concurs with their stance, it would maintain the availability of mifepristone without addressing the controversial aspects of the disagreement.

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This report was supplemented by Linley Sanders, a writer for the Associated Press.