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Supreme Court Justices<\/span> Clarence Thomas and Samuel Alito found themselves in the minority on Thursday, when the court ruled that telehealth access to the abortion drug mifepristone could continue, leaving the dissenting conservatives to foreshadow a future showdown over abortion rights.<\/p>\n Both justices railed against the decision, with Alito calling it a \u201cscheme<\/a>\u201d to get around their ruling in Dobbs v. Jackson<\/a> that eliminated the nationwide right to an abortion in 2022. Abortions have increased since their decision, Alito lamented, largely due to telehealth access.\u00a0<\/p>\n In 2025, far more residents of states with total abortion bans received telehealth provisions<\/a> of medication abortion than traveled out of state to receive care in places with fewer restrictions. And roughly two-thirds of all abortions<\/a> in the U.S. in 2023 were medication abortions. But advocates warn that the dissents from Thomas and Alito highlight that the threat to abortion access still looms large.<\/p>\n \u201cWe\u2019re breathing a sigh of relief. I would say that the immediate threat to mifepristone is over,\u201d said Claire Teylouni, interim co-executive director of Reproductive Equity Now, \u201cBut it\u2019s certainly clear from reading those dissents that the threat \u2026 is far from over.\u201d\u00a0<\/p>\n In his dissent<\/a>, Thomas argues that the Comstock Act, an anti-obscenity law passed in 1873 that remains on the books but has not been enforced in decades, prohibits the mailing of abortion medication. \u201cThe Comstock Act bans using \u2018the mails\u2019 to ship any \u2018drug \u2026 for producing abortion,\u2019\u201d Thomas wrote. \u201cApplicants are not entitled to a stay of an adverse court order based on lost profits from their criminal enterprise.\u201d<\/p>\n The Comstock Act originally prohibited the mailing of \u201cobscene\u201d materials, such as pornography, contraceptives, and any drug or device that can be used to produce an abortion. But legal scholars have argued that the law is unenforceable and unconstitutional<\/a> on First Amendment grounds and other modern case law<\/a>.\u00a0<\/p>\n <\/p>\n In 2022, a Department of Justice memo<\/a> clarified that the law does not prohibit the mailing of drugs that could be used to perform an abortion because there is \u201can insufficient basis for concluding that the sender intends them to be used unlawfully.\u201d\u00a0<\/p>\n Despite the memo and the fact that the Comstock Act has not been enforced in decades, conservatives, including Thomas and Alito, have been eager to use the law<\/a> to push a national abortion ban.<\/p>\n \u201cEnforcement of the Comstock Act has the potential to threaten the broader supply chain with regard to the reproductive health care system as a whole,\u201d warned Teylouni. Arguably if enforced, the law could even jam up access to surgical tools used in abortion care and the shipping of abortion medication to states without bans.<\/p>\n Republican lawmakers have argued<\/a> that the Comstock Act should be enforced by the courts to \u201cprosecute those who obtain mifepristone through the mail.\u201d In Project 2025, policy analysts similarly argue that the Department of Justice should enforce federal laws like Comstock to prohibit the mailing of abortion medication<\/a> writ large.\u00a0\u00a0<\/p>\n President Donald Trump has previously claimed that he would not enforce the Comstock Act in this way, but advocates have seen troubling signs out of the administration about how they might eliminate access to mifepristone in other ways.<\/p>\n \u201cWe\u2019re focusing on some pressing threats that are already ongoing,\u201d said Anna Bernstein, principal federal policy adviser at the reproductive and sexual health research organization Guttmacher Institute.<\/p>\n In late 2025, the Food and Drug Administration began a safety review of mifepristone, despite over 20 years of evidence that it\u2019s a safe medication. Bernstein said her organization is keeping a close eye on the \u201cpolitically motivated\u201d review at the FDA, which she argues flies in the face of the science<\/a>.<\/p>\n The combined regimen of mifepristone and misoprostol, the drug typically used in tandem with mifepristone to induce a medication abortion, carries a less than 1 percent risk<\/a> of serious adverse events. Comparatively, the risk of maternal death associated with childbirth is roughly 14 times higher<\/a> than the risk associated with abortion care.<\/p>\n <\/p>\n