Women have turned to a pill called Mifepristone to safely and completely abortions. This has been done for more than 20 years now. However, a federal district judge in Texas is expected to provide a ruling soon. He will decide if the FDA will need to withdraw its approval of mifepristone. This will garner several reactions, both positive and negative, because this has been used in more than half of the abortions in the U.S.
After the previous landmark U.S. Supreme Court ruling that had sought to overturn the federal right to abortion, individual states were given the freedom to decide on their own whether or not to allow women terminate their pregnancies early on. However, a court fight in Amarillo, Texas, has the ability to limit nationwide access this most common type of abortion. This will also affect the firmly pro-choice states such as New York and California.
People are now expecting to hear the ruling of U.S. District Judge Matthew Kacsmaryk of the Northern District of Texas any time soon about a case brought by an anti-abortion group. This covers an issue that seeks to rescind the U.S. Food and Drug Administration’s approval of the abortion pill mifepristone, something that has been used safely in a two-drug regimen for pregnancy termination for more than 20 years, according to the FDA. If the judge grants them a preliminary injunction to take mifepristone off the market as the case makes its way to the courts, the decision may possibly require pharmacies to quickly remove the drug in every state.
“The most disruptive scenario would involve a broad remedy against the FDA — ordering them to revoke mifepristone’s approval, applying that ruling throughout the country, and commanding that it take effect immediately,” said Alan Trammell. He is a doctor of jurisprudence and an associate professor at the Washington and Lee University School of Law in Lexington, Virginia.
“It would be an extraordinary remedy, especially for a drug that’s been marketed this long,” Dr. Trammell also said.
A Washington State Lawsuit Could Modify Rulings Texas has Made
There may be different scenarios to possibly come out of this, including a ruling that allows the drug to remain on the market as the case continues in count. “This would be the most prudent course,” Trammell explained. This may be due to the novelty of the case and how it can disrupt markets from removing mifepristone off their shelves.
At the same time, a separate federal lawsuit that was filed February of this year in Washington state by a dozen attorneys general sought out to ease the current FDA restrictions on mifepristone so that it’s made more available to those who need it.
Clashing rulings in Texas and Washington “would be a recipe for chaos,” Trammell said. “In the face of such potential chaos, courts have tended to narrow the scope of injunctions and left the status quo in place as appeals play out. So this new lawsuit could be a way of preventing an immediate disruption to medical abortion access, even if it doesn’t succeed in making mifepristone more widely available.”
More Abortions from the U.S Come from This Medication
More than 50 percent of the abortions in the United States are now done with medication instead of surgery, as per a report from the Guttmacher Institute, which is a reproductive health policy group. In fact, abortion pills were legalized for more than two decades to give women the choice on how to terminate their pregnancies of up to around 10 weeks of gestation.
Those who opted for abortion were usually given a two-drug regimen of mifepristone, which serves to halt the body’s production of a hormone vital for the pregnancy, and then this is followed by misoprostol, this results to cramping and bleeding as tissue from the uterus is removed. This is what usually happens when a woman goes through a miscarriage.
In December of 2021, the FDA had permanently lifted a federal requirement for patients to get access for prescriptions used as medication abortions during visits to the doctor. This allowed them to get the meds by mail as they are assisted by telemedicine visits.
It will all depend on the possible outcome in the Texas case. This will determine if telehealth abortion will be banned, and patients will once more be required to get in-person checkups just to gain access on medication abortion pills, said Chelsea Thibodeau, DO. She is a family medicine physician in Minnesota and a fellow with Physicians for Reproductive Health.
“If the ruling applies at a federal level, it is unlikely that obtaining mifepristone through the mail in the U.S. will be a legal option,” Dr. Thibodeau said.
Medication Abortion May be Available Without Mifepristone, but These May Not be as Effective
While a two-drug regimen of the abortion pills mifepristone and misoprostol has be considered the standard of care in the United States when it comes to nonsurgical pregnancy terminations. However, it is also possible to safely and effectively terminate the pregnancy with just misoprostol, Thibodeau shared.
“Both regimens have an excellent safety profile,” Thibodeau said. Unfortunately, just using misoprostol alone is not as effective. Plus, the side effects can be more intense when compared to the usual standard two-drug regimen.
“Medication abortion with both mifepristone and misoprostol has a success rate of over 95 percent, versus 80 to 90 percent with misoprostol alone,” Thibodeau said. “A misoprostol-only regimen typically causes more symptoms and side effects, including cramping, nausea, vomiting, diarrhea, and chills.”
Misoprostol Could Still be Made Available Via Mail for Telehealth Abortions
The reproductive health providers who have been offering telehealth options for abortion care and who give patients medications via the mail may continue doing what they do if mifepristone is pulled from the market. That’s because they are still allowed to offer just misoprostol, said Melissa Grant. She is the cofounder and chief operations officer of Carafem, an online abortion provider.
“If mifepristone becomes restricted in the United States by the actions of anti-abortion extremists, Carafem hopes to be able to continue to provide abortion care with misoprostol alone,” Grant said. “This regimen is safe, effective, and used by pregnant people around the world in countries where mifepristone is not available.”
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