The Food and Drug Administration (FDA) has lifted restrictions on mifepristone, commonly known as the "abortion pill," allowing physicians to prescribe the drug online and have it mailed to patients or sent to local pharmacies. The drug can be used in combination with misoprostol to terminate pregnancies in the first 10 weeks. Previous long-standing restrictions had required women to obtain prescriptions for the drug in person from their providers. But last April, the Biden administration eased these regulations to allow patients to access the drug by mail during the pandemic. The FDA has now made that change permanent.

Figure. Abortion rights advocates demonstrate in front of the U.S. Supreme Court on December 1, 2021, as the court hears arguments from the state of Mississippi to uphold a 2018 law to ban abortions after 15 weeks of pregnancy, nine weeks before viability. Photo by Jose Luis Magana / AP Photo.

The decision came at the end of a year marked by increased challenges to women's reproductive choices. Last year, 90 abortion restrictions were passed by state legislatures, according to the Guttmacher Institute-more than in any year since the Supreme Court made abortion legal in many circumstances in its 1973 landmark decision, Roe v. Wade. In September, the Supreme Court allowed a Texas law to take effect that prohibits abortion after detection of a fetal heartbeat, which occurs at about six weeks gestation, when many women don't yet know they're pregnant. And, in December, the high court heard arguments on a Mississippi case that seeks reversal of all prior federal abortion decisions, effectively returning control to the states. A decision in this case is expected by summer.

If the Court sides with Mississippi, a woman's access to the procedure would depend on the state she lives in, and state legislatures and state courts would have the authority to decide whether and how abortion is restricted. According to the Guttmacher Institute, 22 states are poised to implement restrictions on abortion, while 15 states and the District of Columbia have passed laws to protect women's access to abortion services.

According to the Centers for Disease Control and Prevention, 79% of all abortions occur before 10 weeks' gestation, a time during which many more women could potentially choose abortion pills over an in-clinic procedure. But while the FDA's decision to lift restrictions on mifepristone will improve abortion access for these women, some states have signaled that they might crack down on medication abortions. Nineteen states have already banned telemedicine visits for medication abortion.-Amy M. Collins, managing editor