The U.S. Supreme Court to Review Mifepristone, a Key Abortion Pill

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The U.S. Supreme Court is set to deliberate on mifepristone next year.

As states implement bans or constraints on abortions following the reversal of Roe v. Wade in June 2022, the demand for mifepristone and misoprostol, abortion-inducing drugs, has surged.

Conservative organizations have initiated legal actions against mifepristone, the sole drug specifically approved for abortion, aiming to withdraw its approval or modify policies facilitating its accessibility. The upcoming spring hearing in the Supreme Court could hinder mail-order availability of mifepristone and introduce restrictions on its usage, even in states where abortion is legal.

Proposed limitations include reducing the eligible pregnancy period for the drug’s use and mandating face-to-face consultations for prescriptions.

Here we explore the functioning of mifepristone and misoprostol and the legal challenges they face.

Mechanism of Abortion Medications

These prescription drugs are administered several days apart.

Initially, mifepristone is consumed orally, which widens the cervix and inhibits progesterone, a hormone crucial for maintaining pregnancy.

Misoprostol, also used for stomach ulcer treatment, is taken 24 to 48 hours later. Dissolving either between the gums and cheek or in the vagina, this pill induces uterine contractions and bleeding, expelling the pregnancy tissue.

While more effective together, misoprostol alone is often used, especially in regions where mifepristone is prohibited.

Administration of Abortion Medications

Approved for use within the first 10 weeks of pregnancy, these pills can be taken in medical facilities with possible preliminary ultrasounds or lab tests. Some providers also dispatch these medications via mail following telehealth consultations.

More than half of all U.S. abortions are medication-induced.

Potential Side Effects

Joint administration of these pills is proven to be safe and about 99% effective, based on studies and practical evidence.

Possible side effects include nausea, vomiting, diarrhea, and bleeding, with severe bleeding being rare but necessitating medical intervention.

Adverse complications are extremely uncommon. The U.S. FDA reported that out of 5.9 million mifepristone users since its approval over two decades ago, there have been 32 death reports, including two from ectopic pregnancies. These deaths are not conclusively linked to the medication due to other health factors and concurrent medication use.

The medication is not advised for individuals with suspected ectopic pregnancies or those with IUDs.

Dr. Stephanie Rand, a New York-based OB-GYN and abortion expert, advises that pregnancy tests post-medication abortion may not immediately indicate success due to residual pregnancy hormones. Signs of a successful abortion include bleeding with clots and lighter colored tissue.

Cost of Medication Abortion

Costs vary by region, typically exceeding $500, and are comparable to surgical abortion procedures. Health insurance coverage differs, with some plans offering low-cost or free medication, while others do not cover it.

Mifepristone and misoprostol are marketed as Mifeprex and Cytotec, respectively, and are available as generic drugs.

Legal Standing of Mifepristone

Despite ongoing legal challenges, mifepristone remains fully approved. The FDA and the Biden administration have continuously affirmed its safety and efficacy based on numerous studies since its 2000 approval.

Access is largely dictated by state laws. Currently, 14 states enforce total abortion bans, including medication abortions. An additional 15 states have specific restrictions on mifepristone’s prescription and distribution.

However, women in banned states sometimes access these pills via mail, which is not stringently regulated.

The Supreme Court case originated from a 2022 lawsuit by Christian conservative groups challenging mifepristone’s initial FDA approval. A Texas court initially ruled in favor of the groups, demanding the drug’s market removal. However, an appellate court maintained the approval but reversed FDA modifications from 2016 and 2021 that eased drug access.

The Supreme Court has temporarily suspended these changes while reviewing the case.

Potential Impact of the Supreme Court’s Decision

If the Court rules in favor of abortion opponents, mail-order distribution of the drug, allowed since 2021, could be prohibited. It could also reduce the usage window from 10 weeks to seven weeks, as approved in 2016.

Further implications may include reinstating mandatory three in-person doctor visits before obtaining a prescription and potentially requiring higher dosages than the FDA’s recommended amount.

A final decision by the U.S. Supreme Court is expected by late June.

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Report contributed by AP Writer Mark Sherman.

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Funded by the Howard Hughes Medical Institute’s Science and Educational Media Group, The Big Big News Health and Science Department maintains full responsibility for the content.

Frequently Asked Questions (FAQs) about Mifepristone Supreme Court Review

More about Mifepristone Supreme Court Review

• Mifepristone Legal Challenges
• Mifepristone and Misoprostol Mechanism
• U.S. Supreme Court Abortion Case
• Medication Abortion Administration
• Abortion Medication Side Effects
• Impact of Supreme Court Decision on Abortion Access