Access to mifepristone throughout the country is at stake. In combination with another drug, it is used for more than half of abortions in the United States.

The outcome of the case is extremely uncertain and almost no one dares to predict what the conservative-dominated high court might decide, after striking down the constitutional guarantee to abortion last year.

But some of the options at her disposal would sow chaos, abortion rights advocates warned, and could even challenge the authority of the Federal Drug Administration (FDA).

She also warned that if the high court decided to leave these rulings in force, the existing mifepristone waferlets would immediately become non-compliant and would therefore no longer be able to circulate.

"It's a really tough time," Democratic Rep. Pramila Jayapal said Thursday on CNN.

"If the Supreme Court rules in a way that restricts mifepristone, it would have huge consequences for women across the country. And that's why some states (...) have already stockpiled mifepristone so that, for a few years, we will be able to continue to provide it," she added.

Even in neighbouring Canada, the expected decision is causing concern. Canada's Family Minister, Karina Gould, reiterated her country's intention to help American women if needed.

In combination with another drug, mifepristone is used for more than half of abortions in the United States © Robyn Beck / AFP / Archives

"We remain very committed to making sure we can support American women if they need that access here," she told CTV on Thursday.

"But we also have to make sure we think about their safety," with U.S. states wanting to "criminalize" seeking care elsewhere, she added.

More than five million American women have already taken mifepristone since it was cleared by the FDA more than 20 years ago.

Court battle

The temple of American law had been seized urgently by the government of Joe Biden.

The puzzle began when a federal judge in Texas, known for his Christian faith and ultra-conservative positions and appointed by Donald Trump, withdrew the marketing authorization of mifepristone on April 7 after being seized by anti-abortion activists.

Despite scientific consensus, he considered that it posed risks to women's health.

Demonstration in defense of abortion rights, April 14, 2023 in Washington © OLIVIER DOULIERY / AFP/Archives

An appeals court in New Orleans, seized by the federal government, then allowed the abortion pill to remain allowed, but limited the access facilities granted by the FDA over the years.

His ruling prohibited the mailing of mifepristone and returned to use limited to seven weeks' pregnancy, instead of ten.

The federal government then appealed to the Supreme Court. The latter temporarily maintained access to the abortion pill a week ago, suspending the decision of the Court of Appeal in order to have more time to examine the case.

Deadline

The first suspension decided by the Supreme Court was valid until Wednesday just before midnight. But Judge Samuel Alito said Wednesday that it was extended by 48 hours, until "23:59 p.m. Friday, April 21."

The Court may, at its option, decide to suspend the decisions of the lower courts, uphold them, take up the case or refuse to get involved.

Photo provided by the Plan C Association on May 8, 2020 of mifepristone and misoprostol tablets used together as an abortion © pill Elisa WELLS / PLAN C / AFP / Archives

A coalition of anti-abortion doctors on Tuesday urged the high court to leave the appeals court's decision in place.

"Without a suspensive decision, mifepristone will cause even more physical complications, emotional trauma and even death in women," they wrote.

The abortion pill is already no longer officially available in fifteen American states that have recently banned abortion, even if backdoor routes have developed. The impact of restrictions or bans on this pill would therefore primarily affect states where abortion remains legal -- for many Democrats.

© 2023 AFP