Less than a year after the U.S. Supreme Court ended legal protections for abortion nationwide, reproductive health care clinics across the United States are bracing for more restrictions on the care they provide to women.
If a judge’s ruling goes into effect Friday, it could soon be illegal for doctors to prescribe mifepristone, the first of a two-drug regimen that can help women terminate pregnancies at home – and has other uses.
At the Northeast Ohio Women’s Center, staff are calling patients expecting medical abortions next week, asking them to change their plans.
“They’re scrambling to change their schedule to see us earlier,” said Dr. David Berkons, the physician who runs the clinic.
About half of all abortions in the United States use mifepristone, sold under the brand name Mifeprex.
Mifeprex blocks the hormone progesterone, which effectively prevents pregnancy from continuing. For abortions, women first take mifepristone, then a day or two later misoprostol, a drug that causes the uterus to contract, cramp and bleed, similar to a heavy period. It empties the uterus, ending the pregnancy. It can be used up to 10 weeks of pregnancy.
But mifepristone’s use goes beyond abortion.
The drug helps to soften and open the cervix, and doctors rely on it to help when women miscarry and need to end the pregnancy quickly if the mother’s life is at risk.
In certain situations, when a pregnancy becomes too risky, time is of the essence, says Dr. Alison Edelman, director of the Department of Complex Family Planning at Oregon Health & Sciences University.
“The more conveniently we can get someone pregnant, the better, and mifepristone helps us speed up that process and make it safer for patients,” he said.
Before doctors use mifepristone, they have to go into the uterus, such as to remove bleeding polyps. Studies have shown that the drug helps reduce the amount of force required to open the cervix and reduces the amount of bleeding associated with the procedure.
According to the American Society of Health System Pharmacists, studies also show that mifepristone has moderate to strong benefits for inducing labor and treating uterine fibroids and endometriosis, sometimes helping to avoid surgery.
It can be used to prevent bleeding between periods and control ovarian hyperstimulation during in-vitro fertilization, the society said in a statement.
Doctors say they still have other ways to treat these problems, but when considering the needs of individual patients, they’re missing out on a valuable tool.
“What we provide is the gold standard – the safest, most effective method – and then if that’s not available, we use the next best. And that’s all we’ll have left,” Edelman said.
Mifepristone has been approved by the US Food and Drug Administration for 23 years and is used by more than 5 million women in the United States. FDA data shows that less than 1% of women who take it have significant adverse events. A CNN analysis of FDA data found mifepristone to be less risky than other common drugs, including Viagra and penicillin.
Medication abortion has become an increasingly important option for women in states that restrict access to abortion after a Supreme Court ruling last year that ended legal protections for abortion in every state. Abortions that have lost providers in rural areas can sometimes be the only type of abortion
This ease of access has made the drug a target for anti-abortionists.
“They want to see a national ban, and that’s actually what they’re going to do in this case,” said Kristen Moore, director of the EMAA Project, a nonprofit that’s trying to make abortion drugs easier to find in the United States. .
What happens next is far from certain. Appeals have been filed to stay the Texas ruling and higher courts will weigh in.
Even if the courts take mifepristone off the market in the United States, doctors say, they will still be able to provide drug abortions using only misoprostol.
In fact, some abortion providers plan to use misoprostol on its own if mifepristone is not available.
Carafem, which provides telehealth abortion care, has been offering a misoprostol-only regimen since the start of the Covid-19 pandemic, said Chief Operating Officer Melissa Grant.
“In 2020, we started using misoprostol alone as an alternative,” he said. Workers have since changed the rules to collect data.
“We now feel confident that, although we prefer to use both, we can use misoprostol alone effectively and a high percentage of our clients or even 100% of our colleagues are ready to switch gears to use that option if necessary. Grant said.
Still, some providers say that’s not ideal.
The misoprostol-only regimen is slightly less effective than the two-drug regimen, and causes more cramping and bleeding, which can mean more complications.
“We see failure and therefore a higher likelihood of needing surgical intervention after misoprostol alone,” said Dr. Erica Werner, chair of the department of obstetrics and gynecology at Tufts Medical Center.
Still, doctors want women to know that medication abortion and abortion care will still be available even without mifepristone. And they hope the high court will intervene to keep the drug on pharmacy shelves.
“Physicians should use these other options instead of choosing based on their own skill, knowledge and judgment when providing such care,” Dr. Effath Hoskins, president of the American Congress of Obstetricians and Gynecologists, said Monday. “Frankly, as a physician, I wouldn’t want to be in that position.”
Correction: This story has been updated to include the correct name of Tufts Medical Center.