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Supreme Court ruling on mifepristone causes uncertainty for advocates

Anti-abortion advocates demonstrate against abortion pills outside the Supreme Court on Friday.
Jacquelyn Martin
Anti-abortion advocates demonstrate against abortion pills outside the Supreme Court on Friday.

Updated April 21, 2023 at 11:30 AM ET

Activists on both sides of the abortion issue are awaiting a Supreme Court decision on the medication mifepristone, used in more than half of the abortions in the U.S. It is also used in miscarriage management.

How did we get here?

Mifepristone was called into question on April 7, when U.S. District Judge Matthew Kacsmaryk imposed a nationwide ban, saying the Food and Drug Administration (FDA) had improperly approved mifepristone 23 years ago. Within minutes, a judge in Washington state, U.S. District Judge Thomas Rice, issued a contrary ruling directing federal authorities not to make any changes in mifepristone access in at least 17 states where Democrats had sued to protect availability. Five days later, the 5th Circuit Court of Appeals narrowed Kacsmaryk's ruling. It declared that the time had passed for challenging the original FDA approval, but it also tightened the agency's window for using the drug from 10 weeks, as approved in 2016, to seven weeks.

The Biden administration asked the U.S. Supreme Court to preserve access to mifepristone. And the high court temporarily paused lower court rulings while setting the Friday deadline to decide whether to let any restrictions take effect.

Advocates cite one study to counter a green light from FDA

An attorney for an advocacy group that filed an amicus brief on behalf of parties suing for mifepristone restrictions argues that the drug declared "safe and effective" by the FDA is dangerous. Attorney Chelsey Youman, who represents Human Coalition, tells Morning Edition that despite 23 years of study and repeated reviews, the FDA has not fully accounted for possible complications.

In an interview with NPR's Michel Martin, Youman cites a single advocacy study of post-abortion emergency room visitsthat suggested an ER visit was more likely within 30 days of a medication procedure. "We're serving these women, sometimes in the middle of their abortions, calling us, panicking about what they're experiencing and what their bodies are experiencing," she says.

Since mifepristone was first approved by the FDA in 2000, the drug has been used for abortions by more than 5 million women in the U.S. A study from KFF, an independent health policy organization, determined that medication abortion successfully terminates pregnancy 99.6% of the time. The foundation found a .4% risk of major complications and a mortality rate of less than .001%.

The FDA issued its most recent summary report of adverse events in June 2022, saying it "did not identify any new safety signals."

Youman, whose group aims to eliminate abortion in the U.S., contends that the number of women requiring emergency follow-up care is "astronomical."

"That doesn't even include the FDA not requiring reporting of adverse events," Youman says, adding, "It's not safe for women."

Court rulings prompt anxiety and uncertainty

Dr. Audrey Lance, an OB-GYN with Northland Family Planning near Detroit, told Michigan Radio's Kate Wells that conflicting legal rulings and the wait for answers is complicating care and making it difficult to help patients.

"Am I allowed to do that? I don't know yet," Lance tells NPR. "I don't know what's going to happen."

Whether there's any consensus among justices on the high court is also unclear, as NPR legal affairs correspondent Nina Totenberg tells All Things Considered. "If there was a clear consensus on this at the court, I think the justices would have acted [earlier]."

Totenberg points to the early days of the pandemic, when some abortion rights activists were trying to ease restrictions on access to abortion pills. Then, conservatives on the Supreme Court deferred to the FDA's expertise. Justice Samuel Alito, who would later author the decision overturning the landmark Roe v. Wade abortion protections, expressed amazement in 2020 that a district court judge in Maryland "took it upon himself to overrule the FDA on a question of drug safety."

Miranda Kennedy, Matteen Mokalla and Diane Webber edited this interview. contributed to this story

Copyright 2023 NPR. To see more, visit https://www.npr.org.

Jan Johnson
[Copyright 2024 NPR]
Michel Martin is the weekend host of All Things Considered, where she draws on her deep reporting and interviewing experience to dig in to the week's news. Outside the studio, she has also hosted "Michel Martin: Going There," an ambitious live event series in collaboration with Member Stations.