The Supreme Court is considering two cases related to the approval of the abortion pill mifepristone, which could restrict access to the medication as this method of abortion has become more prominent since the Supreme Court overturned Roe v. Wade in June 2022.
Main Facts
The Supreme Court will review two cases brought by the Food and Drug Administration (FDA) and a manufacturer of mifepristone concerning the legality of the abortion pill, as a decision by the appeals court that overturned updates to the government’s approval of the drug is being challenged.
Mifepristone and How It Works
Mifepristone is one of the medications used to terminate a pregnancy – it stops the pregnancy, and then a second medication called misoprostol is used to induce contractions to expel the tissue – it is approved for use up to ten weeks of gestation, although in practice it is usually used up to twelve or thirteen weeks.
Distribution of the Medication
The medication must be prescribed and cannot be obtained without a prescription. Historically, it was only available in person from a doctor or an authorized clinic to prescribe mifepristone, or more recently through telehealth appointments with distribution through accredited mail-order pharmacies.
Recent Developments
In January, the FDA approved amendments allowing the distribution of mifepristone at retail pharmacies after being prescribed by a healthcare provider, once those pharmacies become accredited to distribute it and agree to certain standards.
Potential Impacts
Access to mifepristone could be restricted if the Supreme Court decides so, reverting the availability of the drug to the state it was in before the 2016 and 2021 updates. This would mean mifepristone could not be prescribed via telehealth or received by mail, meaning the drug could only be used in a doctor’s office and within the first seven weeks of pregnancy instead of ten.
Effects of Restricted Access
If access to mifepristone is restricted, patients receiving telehealth care will be able to terminate pregnancies using misoprostol only. This medication – which has faced fewer legal challenges than mifepristone – can be taken alone to terminate a pregnancy, although it is slightly less effective and carries more side effects than using mifepristone. The FDA has not approved an abortion regimen based solely on misoprostol, but the World Health Organization and other major groups, including the American College of Obstetricians and Gynecologists, have recommended the protocol as an acceptable alternative if mifepristone is unavailable.
Big Numbers
53% is the percentage of all abortions in the U.S. that were performed using abortion pills in 2020, according to the Guttmacher Institute. Research has consistently shown that medication abortion is extremely safe and effective, with a 99.6% success rate in terminating pregnancies, with only 0.4% of medical abortions leading to serious complications. Reports from the FDA indicate that 28 deaths among patients were “linked to mifepristone” between September 2000 and June 2022, although it notes that it is unclear whether those deaths were actually caused by mifepristone or could have been due to other factors.
Key Background
Mifepristone and misoprostol were first approved for abortion by the FDA in 2000. Despite being widely used even when abortion was legal across the U.S., abortion medications gained attention after the Supreme Court’s overturning of Roe v. Wade in June 2022, as it provided an easier method for patients in states where abortion had been restricted to obtain an abortion after clinics offering surgical abortion shut down. A wave of state-level abortion bans has pushed for new tactics to make abortion pills accessible, such as mail-order services and mail forwarding services that can help bypass state bans, and establishing mobile clinics at state borders where abortion is prohibited. According to a report from Vice News, more than 20,000 doses of abortion pills were shipped using clandestine methods in the six months following the Supreme Court decision in an attempt to circumvent state bans. The FDA’s expansion of mifepristone in retail pharmacies has been part of the Biden administration’s broader efforts to mitigate the impact of the Supreme Court ruling, with the administration highlighting medication abortion and the fact that the FDA had authorized the use of abortion pills nationwide as a key way to counter state bans. The Department of Justice has also issued a legal opinion clarifying that abortion pills can be sent to states that restrict abortion under federal law, although it remains unclear how this case will be affected by the Supreme Court’s opinion.
Facts
Interesting
In addition to abortion, mifepristone can also be used for other medical purposes, although it is still unclear how the issue currently before the Supreme Court will affect access to these cases. The medication can also be used for miscarriage and early pregnancy loss or used off-label for other purposes in the field of gynecology, such as treating uterine fibroids. Mifepristone is also used in a separate dosage as a treatment for Cushing’s syndrome, a rare disease caused by excessive secretion of the cortisol hormone, and clinical trials have been conducted to study how the drug can be used to treat multiple forms of cancer and depression.
Further Reading
What is medication abortion? Your questions answered (Association of American Medical Colleges)
The Availability and Use of Medication Abortion (Kaiser Family Foundation)
Abortion Pill Providers Experiment With Ways to Broaden Access (New York Times)
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