In a significant development regarding reproductive rights, the Supreme Court is set to reconsider access to mifepristone, the first pill used in medication abortion. Doctors and patient advocates are expressing concerns about the potential consequences if the court decides to restrict access to the drug. This revisiting of the issue comes two years after the Supreme Court overturned Roe v. Wade.

Currently, in the wake of the Dobbs ruling in 2022, 14 states in the United States have completely banned all forms of abortion, including medication abortion. Additionally, some other states prohibit the delivery of abortion drugs by mail and require in-person doctor visits for prescriptions of mifepristone. According to the Guttmacher Institute, medication abortions accounted for nearly two-thirds of all abortions in the US in 2023.

Central to the discussion on Tuesday is whether the Food and Drug Administration (FDA) overlooked crucial safety concerns when it expanded access to mifepristone in 2016. This expansion included making the drug available through mail-order pharmacies. Notably, two studies used in a Texas court ruling last year were later retracted due to significant flaws in study design and conflicts of interest.

The potential tightening of access to mifepristone has raised alarm bells among professionals. Dr. Kristyn Brandi, an OB-GYN and former board chair for Physicians of Reproductive Health, expressed her concerns and stated that while alternatives exist, restricting mifepristone availability will still impact the majority of people seeking abortions. Kristen Moore, the director of the Expanding Medication Abortion Access Project, warned that stricter limitations would set an "incredibly dangerous precedent" and disrupt the existing system.

Since its initial approval by the FDA in 2000 for pregnancies of up to seven weeks, mifepristone has undergone revisions to expand accessibility and convenience. These changes included allowing prescriptions without in-person doctor visits and broadening the number of eligible pharmacies to dispense the drug. Furthermore, the FDA extended the timeline for using mifepristone for up to 10 weeks of pregnancy. The Supreme Court has the power to roll back these changes, regardless of the legality of abortion in individual states.

The final ruling by the Supreme Court is expected by the end of June, and experts emphasize the significance of this case. Arthur Caplan, the head of the Division of Medical Ethics at NYU Langone Medical Center, stated that if the court upholds the limitation, it could undermine abortion by pill across the country. The FDA, on the other hand, stands by its assertion that medication abortion is safe and effective.

Mifepristone is just one part of a two-drug regimen used in early abortions. The second drug, misoprostol, is administered one to two days after taking mifepristone. A study published in the journal Obstetrics & Gynecology in 2015 found that this two-drug regimen successfully ends a pregnancy in almost 100% of cases.

Dr. Michael Belmonte, a fellow at the American College of Obstetricians and Gynecologists, highlighted the safety and preference for medication abortion among his patients. He expressed concerns that limiting access to mifepristone would make it harder for patients for whom medication abortion is the right choice or their only option.

Dr. Brandi also emphasized the potentially disproportionate impact of restrictions on marginalized communities, including those with disabilities and those without the means to travel for surgical abortions. Furthermore, undocumented women may face additional challenges crossing state lines to access abortions. It's important to note that mifepristone is also used to aid in the recovery process after a miscarriage.

Providers are preparing for the worst-case scenario, with doctors already stockpiling medication in their clinics in case they need to act as both the prescriber and dispenser. However, even before the court ruling, some patients are mistakenly under the impression that medication abortion is banned nationwide, causing confusion and hindrances in accessing care.

The voices of individuals like Audrey Wrobel, a patient advocate for Planned Parenthood, serve as a reminder of the impact these decisions have on women's lives. Wrobel shared her personal experience with medication abortion, highlighting the privacy and autonomy it afforded her. She firmly believes that women should have the freedom to make decisions about their own bodies and hopes that the Supreme Court recognizes this.

As the Supreme Court deliberates on the limits of reproductive rights and access to mifepristone, the outcome of this case could have far-reaching implications for women across the United States.