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Understanding the pending Supreme Court decision on mifepristone

The Supreme Court will deliver its decision any day whether to undo FDA approval of mifepristone, which is used in almost two-thirds of abortions in America today.

The court may decide to require women to take three times the effective dose (600mg instead of the current, more effective, and cheaper 200mg), to limit its use to the first seven weeks of pregnancy (which is the same as five weeks after conception) instead of the current 10 week limit or the 12 week limit the World Health Organization recommends, and to restrict prescribing to doctors only. Additionally, the court may decide to eliminate telemedicine abortion care, thus requiring three office visits.

A vast amount of data confirms that provision of medical abortion via telemedicine is as safe and effective as in-person visits and that providers such as nurse practitioners, physician assistants and midwives deliver equally good care as MDs.

A single Texas judge who is not medically trained and who was hand-picked (judge-shopped) by opponents of safe, legal abortion ruled in 2023 that the FDA was “wrong” in 2000 when it approved the drug. One higher court (the 5th Circuit Court) decided that the 2000 approval could stand but that all of the subsequent FDA-approved changes are “wrong,” despite years of rigorous data confirming that the current guidelines for mifepristone, the abortion-pill, are safe. Mifepristone has been held to a very high standard, higher than for most other drugs. The abortion pill is 18 times safer than full term pregnancy overall and much safer for underserved populations. Mifepristone is safer than ibuprofen, penicillin and Viagra.

Over 100 amicus briefs as well as pages and pages of signatories from medical, legal, local, state and federal governmental organizations, religious, scientific, military, pharmaceutical, disability rights, academic and other groups attested to the Supreme Court that reversal of current guidelines will cause desperation for women and their families, death or permanent impairment of women’s health and fertility, degradation of military readiness due to difficulty recruiting both men and women who must accept stationing around the country, and chilling of investment in drug development due to the chance of a drug’s FDA approval being reversed in the future for non-medical reasons.

Limiting access to the most prevalent method of abortion has consequences. Many health professionals at all levels of training are exiting abortion-restricted states thereby leaving already disadvantaged women even worse off in “care deserts.” Access to routine and modern emergency reproductive health care is getting harder. Routine care includes cancer screening, pre-natal and post-natal care, sexual assault response, birth control including vasectomies, infertility assessment, high risk-pregnancy management and primary care. Emergency care includes modern miscarriage and ectopic (tubal) pregnancy management and treatment of maternal and fetal pregnancy complications. This emergency care is increasingly denied at the door of the ER due to provider fear, confusion, and a culture of distrust. All patients are therefore at risk of delayed care.

Applications to medical schools and residencies in abortion-restricted states have already plummeted, and competition for spots in training programs in abortion-access states is increasing, not only in OB-GYN. Reproductive health care provider recruitment has proven next to impossible in Idaho where 22% of OB-GYNs left the state in the 15 months after the 2022 Dobbs decision overturning Roe v. Wade that legalized abortion nationwide in 1973.

Pressure on abortion-access states such as New York to care for women from abortion-restricted states is causing reduced access and delays in all care due to limited resources. Everyone is getting diminished reproductive health care, even in New York.

This decision may have been handed down by the time this commentary is printed. This will help you understand it.

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Dr. Dorothy Federman lives in Saranac Lake.

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