After briefly letting a national ban take effect, the Supreme Court blocked a lower court’s ruling that would have prevented mailing a key abortion drug.

The decision, issued Thursday, allows telehealth dispensation of mifepristone, one of two drugs used in most abortions, to continue while the state of Louisiana challenges its legality. 

Research shows the two-drug regimen of mifepristone and misoprostol is safe to take from home and highly effective in ending a pregnancy. The drug’s safety profile led the Food and Drug Administration to approve mifepristone for distribution without an in-person doctors’ visit in 2023, after the agency allowed medical professionals to do so during the COVID-19 pandemic.

Mailed prescriptions have allowed people living in states with bans to continue getting abortions, contributing to an increase in abortions since the fall of Roe v. Wade. Now, about a quarter of all abortions are done through telehealth, and about half are for people living in states with bans. Data released Monday by the Society for Family Planning, which tracks abortions, noted that even in states without abortion bans, about 40 percent of people getting abortions use telehealth.

Medical providers hailed the court’s decision, but argued that the legal back-and-forth could confuse patients seeking abortions and clinicians who provide them.

“Though today’s decision means that mifepristone remains available through telehealth for now, this fight is not over,” Dr. Camille A. Clare, the head of the American College of Obstetricians and Gynecologists, said in a statement. “The chaos and confusion wrought by competing decisions and the revocation and restoration of access on an almost daily basis do real harm to patients and to the clinicians who care for them.”

Telehealth’s popularity has put abortion opponents on a quest to block the option through a variety of legal challenges and state laws. 

The court’s decision comes in response to a case filed by Louisiana Attorney General Liz Murrill who argued that the FDA had insufficiently considered mifepristone’s safety when approving it for telehealth. The state also alleged that the drug’s availability by telehealth had enabled a woman in Louisiana to be forced into an abortion against her will. Abortion opponents have argued often that telehealth has made it easier to force people to get abortions, though research suggests that more often, reproductive coercion involves people being denied the option to terminate a pregnancy.

On May 1, the 5th U.S. Circuit Court of Appeals blocked mifepristone’s approval for telehealth while the case continued, arguing that Louisiana was likely to succeed. Drug manufacturers appealed to the Supreme Court, which on May 4 temporarily blocked the lower court’s ruling while it considered the case. 

The court’s decision blocking the ruling briefly expired at 5 p.m. ET on Thursday, May 14. The court ruled almost half an hour later to enable telehealth to continue.

The Louisiana case will continue to make its way through the courts, and could ultimately end up argued before the Supreme Court. Abortion opponents have also launched other legal challenges to mifepristone’s availability, as well as to the state laws that protect health care providers in states with abortion protections when they prescribe and mail the pills to people living in states with bans.

In separate dissents, Justices Clarence Thomas and Samuel Alito — the court’s two staunchest conservatives — criticized the Supreme Court’s decision to allow telehealth to continue.

Thomas argued that the court should block telehealth, saying the mailing of abortion medications violates the Comstock Act, an 1873 anti-obscenity law that has not been enforced in decades. Abortion opponents argue the law should be resurrected to ban mailing any drugs that can be used for abortions.

Alito, the author of Dobbs v. Jackson Women’s Health Organization, the court’s decision overturning Roe, wrote that mailing mifepristone undercut Dobbs by allowing people to circumvent their states’ abortion bans.

“Some States responded to Dobbs by making it even easier to obtain an abortion than it was before, and that is their prerogative. Other States, including Louisiana, made abortion illegal except in narrow circumstances,” Alito wrote. “But Louisiana’s efforts have been thwarted by certain medical providers, private organizations, and States that abhor laws like Louisiana’s and seek to undermine their enforcement.”

Abortion opponents swiftly criticized the ruling. Kristan Hawkins, who heads the anti-abortion activist group Students for Life, posted “ENFORCE THE COMSTOCK ACT” seven times in a single post on the social media platform X. In a subsequent post, she argued that the White House should step in to block the mailing of abortion pills.

In a statement, John Seago, who heads the Texas-based anti-abortion group Texas Right to Life, said the Trump administration could intervene, directing the FDA to reverse its decision approving telehealth distribution of mifepristone.

“We shouldn’t have to depend on the court to force the FDA to do the right thing,” Seago said. “The administration could choose to restore the in-person requirement themselves right now.”