The U.S. Supreme Court on Thursday ruled unanimously to preserve access to the abortion pill mifepristone, a pill used in the most common way to end a pregnancy. The medication was used in nearly two-thirds of all abortions in the United States last year.

The ruling is the court’s first abortion decision since conservative justices overturned Roe v. Wade two years ago.

The justices ruled that abortion opponents lacked the legal right to sue over the federal Food and Drug Administration’s approval of the medication, mifepristone, and the FDA’s subsequent actions to ease access to it.

The case had threatened to restrict access to mifepristone across the country, including in states where abortion remains legal.

Massachusetts reactions to the decision

Since the court was considering mifepristone and how it is administered to patients, it could have curtailed telehealth abortions nationwide, including in states like Massachusetts. New estimates show that about 1 in 7 abortions now happen via telehealth in the Bay State, with patients getting prescribed medication from afar and receiving the pills through mail.

Gov. Maura Healey told reporters Thursday she felt the ruling was a “no brainer,” and that it had been a politically motivated case.

“The fact that it even got this far is ridiculous, but it shows something about where we are in terms of the courts these days,” Healey said.

She welcomed the ruling, but added that there’s “no comfort” to take in this decision, given the fraught landscape surrounding life sciences and health care.

“The Supreme Court still left open an idea that someone could challenge mifepristone and medication abortion,” she said.

Congresswoman Ayanna Pressley said this case had been brought as a “continuation” of the 2022 Supreme Court decision on Dobbs v. Jackson Women’s Health Organization, which did away with a longstanding constitutional right to abortion.

“You know, the dominos have continued to fall after Dobbs. It started with abortion access and they moved to birth control, contraceptives,” the Congresswoman said.

She said she believed this case was “just one more step” in the anti-abortion movement, which she feels is marching toward a nationwide ban on abortion.

Abortion health care providers in the Bay State also responded Thursday to the court’s decision.

Kristie Monast is executive director of the Massachusetts-based sexual health clinic Health Quarters.

She says the ruling is a relief, but the fight is far from over.

“I wish that we could do a deep exhale and say, 'Okay, we are done with that,' but we know that that’s not the case. So we’ll take the win for now and we’ll be prepared for any other challenges they want to put forth.”

Monast says she wishes the case had been decided on the merits, and not focused on the plaintiff’s lack of standing.

National groups respond to abortion pill ruling

Nancy Northup, president and CEO of the Center for Reproductive Rights, expressed relief at Thursday’s decision by the U.S. Supreme Court on access to mifepristone but also expressed frustration that the case made it the court at all, calling it “meritless.”

“Unfortunately, the attacks on abortion pills will not stop here — the anti-abortion movement sees how critical abortion pills are in this post-Roe world, and they are hell-bent on cutting off access,” she added.

Mini Timmaraju, president and CEO of the national abortion rights group Reproductive Freedom for All, echoed similar feelings. While expressing relief she also said, “This baseless push to block abortion access should never have been heard by them in the first place.”

How the case ended up at the US Supreme Court

The mifepristone case began five months after the Supreme Court overturned Roe v. Wade. Abortion opponents initially won a sweeping ruling nearly a year ago from U.S. District Judge Matthew Kacsmaryk, a Trump nominee in Texas, that 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 Supreme Court put the appeals court’s modified ruling on hold and agreed to hear the case. However, Justices Samuel Alito — the author of the decision overturning Roe — and Clarence Thomas would have allowed some restrictions to take effect while the case proceeded.

Here’s what each side argued in the case

Health care providers have said that if mifepristone is no longer available or is too hard to obtain, they would switch to using only misoprostol, which is somewhat less effective in ending pregnancies.

U.S. President Joe Biden’s administration and drug manufacturers had warned that siding with abortion opponents in the case could undermine the FDA’s drug approval process beyond the abortion context by inviting judges to second-guess the agency’s scientific judgments. The Democratic administration and New York-based Danco Laboratories, which makes mifepristone, argued that the drug is among the safest the FDA has ever approved.

The abortion opponents argued in court papers that the FDA’s decisions in 2016 and 2021 to relax restrictions on getting the drug were unreasonable and “jeopardize women’s health across the nation.”

More than 6 million people have used mifepristone since 2000. Mifepristone blocks the hormone progesterone and primes the uterus to respond to the contraction-causing effect of a second drug, misoprostol. The two-drug regimen has been used to end a pregnancy through 10 weeks gestation.