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This week, the topic of conversation at the Supreme Court was the “abortion pill” or mifepristone. Mifepristone is one of two pills that doctors typically prescribe for medical abortions. According to CNN, two-thirds of all abortions in the United States are medicated abortions.
On Tuesday, March 26th, the Supreme Court heard arguments on the pill, how it is currently prescribed, and whether it should be banned nationwide. While the Supreme Court will not issue a decision on the case until early this summer, the arguments alone have reignited a conversation around access to abortion and abortion care.
Here’s what you need to know about the Supreme Court case and how it impacts women, including those navigating infertility or recurring pregnancy loss.
What is Mifepristone?
According to the FDA, “mifepristone is a drug that blocks a hormone called progesterone that is needed for a pregnancy to continue.” It is typically taken in conjunction with another pill, misoprostol, and is available for up to 10 weeks gestation.
Doctors can prescribe the medication via telehealth appointment, one of the sticking points that the plaintiffs in the case, Alliance for Hippocratic Medicine, find cause against.
How does Mifepristone tie back to those trying to conceive?
While often, the conversation around access to abortion centers on women who are choosing an abortion because of family planning reasons, the reality is that the same medication can be prescribed for any abortion or miscarriage, regardless of the reason. Currently, about 63% of abortions turn to these medications as their abortion method.
As Dr. Jessica Ryniec explains to Rescripted, there is a reason why doctors turn to mifepristone:
“The addition of mifepristone to misoprostol safely and significantly increases the effectiveness of medical management and is the current preferred recommendation over misoprostol alone, which has a higher risk of needing additional medication doses or eventual surgical management if unsuccessful.”
Throughout yesterday’s hearings, many of the justices pointed to nuances in women’s health and use cases for the medication.
In one specific exchange, Justice Amy Coney Barrett brought up a point around the implication that one of the plaintiffs stated that she had been forced to perform a dilation and curettage (D&C) even though she was anti-abortion.
Justice Barrett stated to the plaintiff’s lawyer, Erin Hawley:
"The fact that she performed a D&C does not necessarily mean that there was a living embryo or a fetus because you can have a D&C after a miscarriage."
What is important to keep in mind about the medication?
Miscarriages or complications in early pregnancy are taxing situations, both emotionally and physically.
Reporting by NPR illustrated the many ways that women found taking the pill helped ease some of the emotional strain of miscarrying because it allowed them to choose their where and when.
“Being diagnosed with a miscarriage is an often devastating experience that can be especially surprising when there havent been any negative signs or symptoms (like bleeding or cramping) before the diagnosis is made and pregnancy loss can be associated with a loss of control,” explains Dr. Ryniec. “When someone is experiencing an early pregnancy loss, they typically have three options for management: expectant management or waiting for the pregnancy to pass on its own, medication management, or a surgery/procedure to remove the pregnancy. Medical management of miscarriage can give someone more control by reducing the length of time and unpredictability that can come with expectant management, while also eliminating the invasiveness, risks, and costs of an office or surgical procedure.”
While there was mention throughout the hearing of potential risks associated with mifepristone, regulating bodies like the FDA have underscored its efficacy and safety.
According to the FDA, “The FDA approved Mifeprex more than 20 years ago based on a thorough and comprehensive review of the scientific evidence presented and determined that it was safe and effective for its indicated use.”
Dr. Ryniec echoed the FDA’s statement that while there some common symptoms may include nausea or diarrhea, the medication rarely leads to excessive side effects.
The American College of Obstetricians and Gynecologists also added this week:
“Imposing needless restrictions on any safe and effective medications harms all patients seeking obstetric and gynecologic care and challenges the ethical and professional obligations of our members.”
We will have to wait a few months to learn more about mifepristone’s future, but in the meantime, the medication is still readily available and organizations like ACOG are advocating for its use.
Vivian Nunez is a writer, content creator, and host of Happy To Be Here podcast. Her award-winning Instagram community has created pathways for speaking on traditionally taboo topics, like mental health and grief. You can find Vivian @vivnunez on Instagram/TikTok and her writing on both Medium and her blog, vivnunez.com.