On Tuesday, March 26, the United States Supreme Court heard a case that could decide the future of reproductive rights in America. Mifepristone, an abortion pill that blocks progesterone, a hormone necessary for pregnancy, and its federal approval was under scrutiny in the hearing. Mifepristone was approved by the U.S. Food and Drug Association over two decades ago, and it is used in roughly two out of three abortions in America. Although most commonly used as an abortion pill, mifepristone is also used to treat Cushing’s disease and endometriosis.
Last April in Amarillo, Texas, a lawsuit was filed over mifepristone. The plaintiffs, the pill’s opponents, claimed that the FDA’s approval of the drug had been flawed. The location of this lawsuit was no mistake; Judge Matthew Kacsmaryk, who was nominated by Trump during his presidency, is the only district court judge within Amarillo, thus ensuring that all cases filed within the city will end up in front of him. Kacsmaryk ruled for a complete retraction of the FDA’s approval of mifepristone. However, on the same day in a state up north, Judge Thomas O. Rice of Washington state ruled the opposite within a lawsuit brought by 17 liberal states seeking to maintain access to mifepristone. Rice ruled that the FDA not do anything to affect the current accessibility to the drug. These contrasting rulings created conflict within the lower courts, landing it in front of the Supreme Court.
At the center of the case are the plaintiffs: 11 anti-abortion doctors who claimed that mifepristone had caused their patients complications. Within this group was a Republican state Senator, a doctor who claims to be an expert in an anti-abortion procedure that has proven to be both “unproven and unethical,” and lastly, a doctor whose license has been expired for years. Furthermore, none of the doctors prescribe mifepristone nor have proof of having dealt with a medical abortion, and therefore no proof of having had patients with complications from the drug.
When mifepristone was first approved, it required pregnant women to have at least three in-person appointments with their doctor before they could be prescribed the drug. However, starting in 2016, the FDA relaxed the regulations of prescribing the drug, now allowing for it to be prescribed via telehealth and obtained via mail. The case that begins today will be the first time that the Supreme Court has the potential to reverse an FDA decision. In this case, the court is being asked to rule on whether the FDA overstepped boundaries by making mifepristone more accessible.
However, for the case to go any further, the court must first decide whether the doctors who are suing have been harmed by mifepristone in a way that allows them to file this lawsuit. This concept is called “standing.” So far, the evidence that the doctors have filed is vague and therefore not conclusive. The standing that the doctors are using is based on other physicians and their experience with patients; none of the participating doctors have dealt with the drug firsthand.
If this lawsuit is processed, it will affect medicated abortion across the U.S. where about half of abortions are performed with medication. Not only will it hinder abortion within states where abortion is still legal, but it will create an influx of in-person abortions, which will thus increase wait times in brick-and-mortar hospitals that are already under strain from out-of-state patients. Hospitals reported an increase in wait times after the reversal of Roe v. Wade, and the same consequence is predicted in this case.
The overall implication of this case extends further than the accessibility to legal abortion. If passed, it will open the floodgates, allowing anyone to file lawsuits that second-guess the FDA’s expert opinion on approving drugs. This action will then politicize routine reviews of drugs in the future. Since COVID-19, public trust in the medical industry has been fragile, and a case like this is the last thing that is needed. If passed, this will pose a serious threat to the U.S. government’s regulatory authority which will affect far more than mifepristone. It would delegitimize the FDA and its ability to make science-based public health decisions. So, what should you know about how to prepare? Even if the Supreme Court rules that mifepristone cannot be mailed, there will still be places that ship to all 50 states. Visit either Plan C Pills or MayDay Health. Both of these sites also have alternative abortion pills that are also available to be mailed. Lastly, you can order mifepristone before the court rules and store them in case of emergency (read storing requirements before). The court is expected to have a decision by summer, so the most important thing to know is that nothing is changing right now.