3 Questions

What happens to abortion care if the Supreme Court limits mifepristone?

Physicians who oppose abortion have gone to the Supreme Court to challenge the FDA's approval of the widely prescribed pill. Johns Hopkins expert Suzanne Bell explains what this upcoming decision might mean for reproductive health.

Suzanne Bell is an assistant professor of Population, Family, and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, where she is also affiliated with the William H. Gates Sr. Institute for Population and Reproductive Health. She studies patterns of contraceptive use and abortion, particularly in the context of population-based surveys.

A headshot of Dr. Suzanne Bell.

Image credit: Bloomberg School of Public Health

What is mifepristone?

Mifepristone is one of two drugs used in medication abortions. It blocks a hormone called progesterone, which is required to sustain a pregnancy. In the absence of this hormone, a fertilized egg will detach from the uterine wall and the uterus will contract. Misoprostol, the second drug used in a medication abortion, causes further contractions to expel the products of conception from the uterus.

Mifepristone has been safely used by millions of pregnant people globally during the past 36 years since its development in France. It is currently approved for use in approximately 80 countries, including the United States, where the Federal Drug Administration issued its approval in 2000. Mifepristone is incredibly safe and effective, with less than half of one percent of medication abortions experiencing serious complications and only 3% to 5% requiring further intervention to complete the termination.

Why is a case involving mifepristone in front of the Supreme Court right now?

The Supreme Court heard oral arguments on FDA v. Alliance for Hippocratic Medicine on March 26. This case is challenging both the FDA's initial approval of mifepristone in 2000 and decisions by the FDA in 2016 and 2021 that greatly expanded access to the drug. These decisions increased the gestational age at which mifepristone can be used (through 10 weeks' gestation), authorized lower-level healthcare providers to prescribe it, and allowed mifepristone to be prescribed without an in-person visit (enabling the use of telemedicine), among other changes.

The Alliance for Hippocratic Medicine is a group of physicians who oppose abortion and claim they face moral harm by potentially providing care to patients who present in the emergency department after experiencing a serious complication from a medication abortion. Supreme Court Justices appeared skeptical of plaintiffs' ability to demonstrate harm as a result of the availability of mifepristone and thus questioned their standing to bring the legal challenge during oral arguments.

What repercussions could the Supreme Court's decision have on abortion in America?

If the Supreme Court rules in favor of the Alliance for Hippocratic Medicine, it would reduce access to mifepristone across the nation—not just in abortion-hostile states—and set up a dangerous legal precedent as there is no prior instance of an FDA-approved medicine with an excellent safety profile losing approval via judicial ruling.

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Taking the medicine off the market or reversing recent FDA decisions would not stop medication abortions from occurring, it would simply cause worse health outcomes for people seeking abortions. People seeking medication abortions through the formal healthcare system would be forced to rely on the misoprostol-only regimen, which while still incredibly safe, is slightly less effective and can cause more uncomfortable side effects. People self-managing their medication abortions outside the formal healthcare system, however, could continue to use the combined medication abortion regimen that includes mifepristone.

Given more than 60% of abortions obtained through the formal healthcare system currently are medication abortions, a Supreme Court decision in favor of the Alliance for Hippocratic Medicine would have major impacts on the delivery of abortion care in the United States. If the Supreme Court rules in favor of the FDA, the current approvals related to mifepristone would continue and healthcare providers offering medication abortion would continue to be able to care for patients in accordance with evidence-based science.