Overview
Medication abortion, the preferred method of ending pregnancy in the U.S., faces a legal challenge as the Supreme Court prepares to hear a case on the drug mifepristone next year. The demand for abortion pills has surged due to the imposition of bans and restrictions on abortions after the landmark Roe v. Wade reversal in June 2022. Conservative groups have targeted mifepristone, the only FDA-approved drug for abortion, seeking to reverse its approval and restrict access. The Supreme Court case may block mail-order access to mifepristone and impose additional restrictions on its use, even in states where abortion remains legal.
How the Drugs Work
Mifepristone and misoprostol are prescription medications taken several days apart for medication abortion. Mifepristone is taken first, orally, and works by dilating the cervix and blocking the hormone progesterone, essential for sustaining pregnancy. Misoprostol, taken 24 to 48 hours later, causes cramping and contractions in the uterus, leading to bleeding and the expulsion of pregnancy tissue. While the two-drug combination is more effective, misoprostol alone is sometimes used in countries where mifepristone is banned. Currently, abortion medication is approved for use up to the 10th week of pregnancy.
Legal Challenges
Abortion pills are responsible for more than half of all U.S. abortions. Studies show that when taken together, the pills are safe and up to 99% effective. Serious complications are rare, with only 32 reported deaths in women using mifepristone over the past 20 years. However, conservative groups argue against its approval and seek to restrict access. The Supreme Court case could result in the blocking of mail-order access to mifepristone and the imposition of additional restrictions, such as shortening the window for use and requiring in-person office visits for prescriptions.
Access and Costs
Access to medication abortion varies depending on the patient’s location. Currently, 14 states enforce laws that ban abortion throughout pregnancy, while 15 states have laws specifically limiting the prescription and distribution of mifepristone. The cost of medication abortion varies but can exceed $500. Health insurance coverage also varies, with some plans offering free or low-cost pills and others providing no coverage.
The Supreme Court Case
The Supreme Court case originated from a legal challenge by Christian conservatives seeking to overturn mifepristone’s FDA approval. While a Texas judge initially ruled in favor of removing the drug from the market, an appeals court upheld its approval but sought to reverse recent FDA policy changes that eased access. The Supreme Court has put these changes on hold pending the case’s resolution. If the court sides with abortion opponents, it could mean the end of mail-order access, a shorter window for use, and increased requirements for in-person visits and higher dosages.
The Supreme Court is expected to reach a decision by late June.
