On April 21, the U.S. Supreme Court ruled that pregnant people in the country have full access to mifepristone, one of the two pills used for medical abortions. Between Dobbs v. Jackson Women’s Health Organization overturning Roe v. Wade and the at-first reversed decision on mifepristone to the stop-gap dates regarding its use until Friday’s ruling, there’s only one word for this.
“It is a mess,” said Paula Thornton Greear, President and CEO of Planned Parenthood of Michigan. “I’m outraged. But, like much throughout the history of Planned Parenthood of Michigan, we are not deterred,” Thorton Greear stated. “It’s unfortunate that we have to keep on fighting in this but, like so many other things, it’s what we do.
“It is simply outrageous that abortion providers are being forced to have meetings and consult with attorneys during the majority of a given week when we should be giving that time, spending that time with their patients.”
As far as educating patients, Thorton Greear said, mifepristone is safe—in, fact, it’s safer than Viagra.
“It is the gold standard of care for medication abortion. And we’re going to continue providing it and the other part of the medication abortion, misoprostol, in our health centers.”
Thorton Greear acknowledged that the centers might have to switch to misoprostol because of the Supreme Court rulings.
“We’re living in this time of constantly looking over our shoulder regarding what action will be next. This flurry of recent court cases is so confusing and alarming for everybody.”
The U.S. Supreme Court’s recent decision about the abortion pill, also known as medication abortion, has sparked controversy and debate across the nation. On January 12, 2021, the Supreme Court declined to hear a case challenging the FDA’s regulations around the medication abortion pill, leaving in place a lower court ruling that requires patients to pick up the pill in person, rather than receiving it through the mail. This decision had significant implications for patients seeking abortion care, particularly in the midst of the COVID-19 pandemic.
The medication abortion pill, also known as mifepristone, was approved by the FDA in 2000 for use in the United States. It is a safe and effective way to end a pregnancy in the early stages, up to 10 weeks gestation. The pill works by blocking the hormone progesterone, which is necessary for a pregnancy to continue. It is typically taken in combination with another medication, misoprostol, which helps to expel the pregnancy.
For many patients, medication abortion offers a safe, convenient, and private option for ending a pregnancy. However, FDA regulations have made accessing the medication more difficult than it needs to be. Patients were required to visit a healthcare provider in person to receive the medication, and they must take it under the supervision of a healthcare provider.
In 2020, during the COVID-19 pandemic, advocates for reproductive health and rights argued that the in-person requirement for medication abortion was particularly burdensome and potentially dangerous for patients. They argued that requiring patients to travel to a healthcare facility during a pandemic increased the risk of exposure to COVID-19, and that many patients faced additional barriers to accessing care, such as lack of transportation or childcare. In response to these concerns, a coalition of reproductive health organizations sued the FDA, asking that they temporarily lift the in-person requirement for medication abortion and allow patients to receive the medication through the mail.
In July 2020, a federal judge in Maryland granted a preliminary injunction, which allowed patients to receive the medication through the mail during the pandemic. The judge found that the in-person requirement imposed a substantial obstacle to obtaining abortion care and was likely unconstitutional. However, the FDA appealed the ruling, and in January 2021, the Supreme Court declined to hear the case, leaving the lower court ruling in place.
Early in 2023, the FDA ruled that people who wanted access to the abortion pill could get them in the mail instead of picking them up in person. Then, a Texas judge ruled on April 7, 2023 that the FDA violated its own approval guidelines, which essentially stopped pregnant people from having access to the pill. The FDA’s approval has stood for 20 years. After that, a judge from the state of Washington countered the Texas judge’s ruling the same day by stating the pill will remain available for his and 18 other states.
The Fifth Circuit countered the Texas judge’s claim that the Food and Drug Administration should remove the pill because its approval wasn’t valid. The court said that “too much time had passed for the plaintiffs, a consortium of groups and doctors opposed to abortion, to challenge that decision,” according to the New York Times.
However, the Fifth Circuit court did agree with the Texas judge’s ruling that mifepristone cannot be mailed to people who need them. To do so violates the Comstock Act, an 1873 law that prohibited the distribution of birth control and abortion methods, including information about them.
“I want to be clear: abortion, including medication abortion, remains safe and legal in the state of Michigan,” Governor Gretchen Whitmer said in recent written statement.
She won her re-election last November partly on an abortion-rights platform. She also recently repealed the 1931 abortion ban, which prohibited abortions without exceptions. The voters also voted in November to enshrine the rights and access to abortion into the state constitution.
Whitmer stated that, in foreseeing the ruling about medical abortions, she worked with insurers “to make sure they would not withdraw coverage for mifepristone.”
In Michigan, mifepristone — in combination with another drug, misoprostol — is used in more than half of all abortions, according to Bridge Michigan. In 2012, 51 percent of Michigan’s 15,367 abortions in Michigan were nonsurgical, according to the Michigan Department of Health & Human Services.
The Supreme Court’s decision also underscores the chipping-away attacks on reproductive health and rights in the United States. Over the past several years, states have passed a record number of restrictions on abortion care, including mandatory waiting periods, ultrasound requirements, and bans on abortion after a certain point in pregnancy. These restrictions disproportionately impact marginalized communities, such as low-income people, people of color, and LGBTQ+ people, who already face significant barriers to accessing healthcare.
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