While access to the treatment was protected by the court, each state has different regulations regarding medication abortion.
On Thursday, the Supreme Court maintained the availability of the abortion drug mifepristone. Although state regulations pertaining to access to abortion differ, the verdict was a victory for proponents of such access.
Mifepristone was authorized by the Food and Drug Administration in 2000 as a drug for abortion. The period of time a pregnant woman may take the medication to stop her pregnancy was expanded in 2016 from seven to ten weeks. It changed in 2021 to permanently let mifepristone prescriptions to be accessed via telehealth, and to enable pharmacists and mail-order pharmacies to distribute the medicine.
Nevertheless, not all states provide access to mifepristone.
"Access remains unchanged from the pre-decision state. The problem is that many pregnant people still have difficulty getting access, according to Dr. Monica Saxena, a Palo Alto, California emergency care specialist.
When is it OK to take mifepristone during pregnancy?
A study by the Guttmacher Institute, a research group that promotes access to abortion, states that pharmaceutical abortions account for about two thirds of abortions performed in the United States. The two tablets used in medication abortions are misoprostol and mifepristone, which are taken one or two days apart.
It is authorized to use mifepristone for up to 70 days, or 10 weeks, of pregnancy. But according to Dr. Reagan McDonald-Mosley, a practicing OB/GYN in Washington, D.C., and CEO of Power to Decide, an organization that promotes access to abortion and contraception, some physicians may prescribe it for longer than that—a practice known as off-label usage.
According to McDonald-Mosley, "off-label use is not uncommon in any medication." "The provider has chosen to administer that medication in a manner that deviates from the label based on evidence."
Mifepristone is approved by the FDA for use up to 10 weeks into pregnancy, but according to the American College of Obstetricians and Gynecologists' guidelines, "evidence also exists to support safe and effective use with more advanced gestations." Mifepristone, for instance, is administered up to 12 weeks of gestation in Sweden, according to Guttmacher.
Does mifepristone need an in-person visit with a doctor?
That depends on where a person resides, just as it does for all access to abortion. Guttmacher claims that 14 states have almost complete prohibitions on abortion, including pharmaceutical abortions performed within state borders, either with or without in-person consultations.
Laws pertaining to telehealth in various states have complicated matters concerning the availability of mifepristone.
According to Guttmacher, there are legislation in five states that mandate in-person visits in order to get mifepristone: Arizona, Nebraska, NC, SC, and WI. In fifteen jurisdictions, doctors are required to administer the drug instead of pharmacists or nurse practitioners. Additionally, delivering abortion pills via mail is prohibited in Arizona and North Carolina.
Is mifepristone available via telehealth?
The Society for Family Planning, a nonprofit organization devoted to studying safe access to abortion care, released a report stating that in the first year after the overturning of Roe v. Wade, telehealth providers performed 8% of all abortions.
According to Dr. Jamila Perritt, president and CEO of Physicians for Reproductive Health in Washington, D.C., and an OB/GYN and abortion physician, the medicine is quite safe for the majority of individuals to take at home.
Perritt said, "This medication is safe and effective, whether I give it to you or you get the pills on your own through the internet or telehealth."
The FDA does include cautions about certain individuals for whom mifepristone may be harmful, such as those who use blood thinners or have ectopic pregnancies, in which the egg implants outside the uterus.
The FDA predicted that around 6 million women in the United States have taken mifepristone as of December 2022. 32 fatalities were linked to it in 22 years of usage, according to the EPA. It was used in two ectopic pregnancies and other sepsis instances.
Is it possible to get mifepristone in a state where abortion is forbidden?
There are exceptions for rape, incest, and pregnancies that pose a harm to the women's lives in almost all places where abortion is illegal. However, it may be challenging for both patients and physicians to understand the legal system.
McDonald-Mosley said, "It nevertheless remains legal to travel to get abortion care if that is someone people can navigate and chooses to do." She also mentioned that those who reside in places where abortion is illegal but have the means to do so are permitted to travel to states where abortion is legal.
Additionally, individuals sometimes acquire the prescription online from companies like Plan C and AidAccess, which ship the tablets. However, McDonald-Mosley advised consumers to be mindful of the potential legal repercussions in their states.
Physicians who recommend abortion drugs to expectant patients in areas where the practice is prohibited are shielded by so-called shield laws in certain places where the operation is lawful.
Medically speaking, mifepristone is very safe, but "there could be legal risks, which is important for people to know," the spokesperson said.
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