Photo: Robin Marty via Flickr. Creative Commons license.

California’s stockpile of abortion pills is totally depleted. But after today’s U.S. Supreme Court hearing over whether to restrict medication abortion, Gov. Gavin Newsom’s office says he’s still deciding whether a resupply is necessary.

Last year Newsom announced the state had purchased 250,000 abortion pills after a ruling by a federal judge out of Texas temporarily halted the availability of some medications used for abortions. The state has since distributed its entire stockpile to abortion providers, but conversations about buying more “remain ongoing,” Brandon Richards, a spokesperson for the Newsom administration, said.

“California remains ready to purchase up to another 1.75 million pills given the ongoing attacks to abortion care access happening across the country – not just at the Supreme Court,” Richards said.

Newsom and other Democratic lawmakers have previously pledged to make California a “safe haven” for abortion, signing dozens of laws strengthening abortion protections, but drug regulation is one thing they can’t touch.

Supreme Court justices appeared skeptical of arguments brought by the Alliance Defending Freedom, a conservative Christian legal group, that the U.S. Food and Drug Administration had inappropriately expanded access to the medication mifepristone. The FDA approved mifepristone in 2000 and it is now used in nearly all medication abortions. Justices, including some in the conservative majority, questioned whether the group suing had legal standing to make their claim.

“This case seems a prime example of turning what could be a small lawsuit into a nationwide legislative assembly on an FDA rule or any other federal government action,” Justice Neil Gorsuch, an appointee of President Donald Trump, said.

If the justices were to rule in favor of the anti-abortion group, that could severely restrict the availability of mifepristone, preventing providers from prescribing it via telehealth appointments or sending the medication by mail. It could also limit the medication’s use from 10 weeks of pregnancy to seven weeks. A ruling from the high court is not expected until June.

Mifepristone is part of a two-drug regimen. It halts pregnancy by blocking the hormone progesterone before the second drug, misoprostol, empties the uterus by causing it to contract. Misoprostol, the drug that California stockpiled in case mifepristone use was limited, can be safely used alone for abortions but is more likely to have side effects, studies show. Both drugs are also commonly used to manage miscarriages.

State officials have previously said that California stockpiled misoprostol because its legality was not in question and they wanted medication abortions to remain widely available if there is an increased demand resulting from looming federal restrictions.

Medication abortion is the most commonly used abortion method, accounting for nearly two-thirds of all U.S. abortions, according to the Guttmacher Institute. In the largest study of telehealth abortions, researchers from UCSF’s Bixby Center for Global Reproductive Health found that medication abortions obtained via telehealth appointments are just as safe as in-person medical care, with 98% of patients completing the abortion without the need of additional medical care.

“Telehealth is now a central pillar in the abortion care landscape and a Supreme Court decision that reverses the ability to offer telehealth to patients would be devastating,” lead study author Ushma Upadhyay said during a recent press conference.

Medication abortion accessed through telehealth providers has gained popularity since the Supreme Court eliminated the federal constitutional right to abortion in 2022 and many conservative states implemented total or near total abortion bans. Research shows that patients seeking abortions like telehealth options because they offer privacy, allow them to stay home, and cost less, Upadhyay said.

“This is especially true for those who face the most health inequities — including younger people, those living on lower incomes, people living in rural areas and those who live far from abortion clinics,” Upadhyay said.

In 2022, California lawmakers enacted some of the nation’s strongest abortion protections, including increased privacy protections and prohibitions on sharing patient medical information with out-of-state law enforcement. Voters also overwhelmingly approved a state constitutional amendment protecting the right to abortion.

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