As the question of the availability of mifepristone in the US is debated in federal courts, states and health care providers are seeking the only other abortion pill approved for use here and the impacts it would have on the reproductive outlook trust her.
In most cases of medical abortion, a medication called misoprostol is taken shortly after mifepristone is given. This two-drug regimen has become the standard in the US, and studies have found it to be highly safe and effective.
As concerns about the accessibility of mifepristone grow amid a conservative challenge to its federal approval, states including New York and California have begun stockpiling supplies of misoprostol to ensure access to medical abortions, which account for half of all abortions in the country.
New York Gov. Kathy Hochul (D) announced the purchase of five years’ worth of misoprostol this week, while California Gov. Gavin Newsom (D) said his state had secured 2 million pills after the initial ruling to block the authorization of mifepristone.
Hochul said this week that he is also working on legislation that would require private insurers to cover the drug when it is used for abortions. California previously passed a bill requiring insurers to cover abortion services at no cost, including medical abortions.
What is misoprostol? Why is it combined with mifepristone?
The two drugs commonly used for medical abortions in the US have separate effects on a pregnant woman’s body, and the combination of the two is highly effective in terminating pregnancies.
A 2015 study of more than 13,000 women found that the two-drug course was almost 98 percent effective and had an infection rate of just 0.01 percent.
Mifepristone blocks the hormone progesterone, which is necessary for pregnancies to continue. Once progesterone is blocked, the lining of the uterus breaks down and the pregnancy fails.
Misoprostol is then taken up to 48 hours later. It causes the uterus to empty itself causing cramping and bleeding.
In the absence of mifepristone, providers would likely prescribe higher doses of misoprostol alone. This course of treatment is more common internationally than in the US, but providers have already begun to consider this route in light of the recent court battle.
“We are certainly looking at misoprostol-only regimens,” Gopika Krishna, a board-certified OB/GYN and member of the advocacy group Physicians for Reproductive Health, told The Hill.
“Misoprostol-only regimens are also a safe and effective way to control an abortion through medication,” Krishna said. “It’s a regimen that we’re certainly prepared to use.”
Not an exact replacement
Although misoprostol is considered to be highly safe and effective, switching to a single-drug regimen for medical abortions would still present challenges and represent a potential drop in ideal medical outcomes.
The Society for Family Planning (SFP) said in a report last month that misoprostol abortions are only 80 to 100 percent effective in terminating pregnancies, a small but significant difference from a plan of two drugs, which has consistently been found to have an efficacy rate close to 100 percent.
Along with a slightly lower effectiveness rate, the side effects associated with misoprostol abortions would only linger longer due to the higher doses. These effects may include nausea, abdominal pain, diarrhea, fever, and chills.
“The addition of mifepristone generally allows us to use fewer doses of misoprostol. It can also allow the procedure to be completed in a faster way,” Krishna said. “Overall, it can be a little bit longer process and maybe a little bit more uncomfortable process for patients.”
Could misoprostol also be on the block?
Unlike mifepristone, which is authorized by the Food and Drug Administration (FDA) to terminate pregnancies, the use of misoprostol in medical abortions is considered off-label.
Misoprostol is approved to treat gastric ulcers in women, but doctors often use it to control miscarriages and induce labor.
The drug is not part of the ongoing legal furor and is expected to remain available regardless of how the courts decide on mifepristone.
The lack of official approval as an abortifacient makes it unclear whether anti-abortion activists have a legal avenue to stop the use of misoprostol in medical abortions.
Where is he now
The Fifth Circuit Court of Appeals ruled this week that mifepristone’s authorization could not be challenged, given its time on the market, and allowed the drug to remain available, albeit with some additional limitations.
The court struck down expansions to medical abortion access the federal government had made after 2016, lowering the 10-week limit on taking the medications to seven weeks and blocking the ability to mail the medications.
However, the Supreme Court on Friday stopped the limitations enacted by the lower court, maintaining the status quo on the availability of mifepristone.
The two-drug treatment should still be accessible to most women for now, though mifepristone’s status could also be revoked. The Supreme Court could refer the case back to the conservative-led Fifth Circuit Court.
The standstill order will remain in effect until midnight Wednesday.
“We are pleased that the court took the only sensible action here, which was to pause a deeply dangerous decision that has been widely criticized by pundits across the ideological spectrum as unprecedented and unprincipled,” said the American Union of Civil Liberties Association (ACLU) in a statement. Friday statement.
“Today’s ruling is just the first step: the courts must now put an end to this baseless case, which is part of anti-abortion extremists’ plan to ban abortion nationwide. It threatens access not only to abortion and miscarriage care, but also to a wide range of critical and life-saving medicines. Whatever happens next, we know this fight is far from over.”
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