Abortion pill mifepristone legal battle: What it means for Philadelphia-area residents
Abortion pill mifepristone remains available in Pennsylvania and New Jersey as legal battle originating in Texas advances.
EDITOR’S NOTE: A Supreme Court order late Friday afternoon has extended a hold on a Texas federal court ruling that would have restricted access to the abortion medication mifepristone. The stay remains in place until 11:59 p.m. ET on Wednesday to give the justices more time to consider an emergency appeal of the Texas order by the Biden administration and the drug’s manufacturer.
Philadelphia-area abortion providers are stocking up on the abortion medication mifepristone and preparing for alternatives as a legal battle over the medication advances.
Two conflicting federal court rulings on mifepristone, the first of a two-drug regimen used to terminate pregnancy, have caused confusion about where the abortion pill is available and for how long:
A federal judge in Texas ruled that the Food and Drug Administration should never have approved the pill, which has been on the market for more than 20 years and is used in more than half of abortions. The case seeks to ban access to mifepristone nationwide.
In a separate case, a federal judge in Washington state ruled that federal authorities should not make any changes to restrict access to the medication in 17 Democratic-led states — including Pennsylvania and Delaware — that are suing to expand access to the drug.
A federal appeals court said mifepristone should remain available while the Texas case plays out, with two important limitations:
It cannot be used after the seventh week of pregnancy, even though it is approved by the FDA for use through the 10th week of pregnancy.
It cannot be mailed to patients. Under current FDA rules, mifepristone is only available directly from a prescribing doctor — it can’t be bought at a pharmacy. Mail-order access is important for people who do not live close enough to an abortion provider to pick up pills in person.
“This really impacts already marginalized communities the most,” including people who lack transportation, live in rural areas, or can’t take time off work, said Melissa Reed, CEO of Planned Parenthood Keystone, which operates clinics in central and Southeastern Pennsylvania.
The federal government is appealing the Texas decision and has asked the U.S. Supreme Court to restore full access to mifepristone.
Here’s what the dueling lawsuits mean for access in the Philadelphia area:
What is mifepristone?
Mifepristone is a prescription medication used to end a pregnancy. It is typically used in combination with another medication, misoprostol. The FDA approved mifepristone in 2000 to terminate a pregnancy up to seven weeks gestation and in 2016 expanded use to 10 weeks.
Mifepristone is highly regulated and only available from a doctor who is specially licensed to dispense it, meaning it can’t be prescribed for pickup at a local pharmacy.
Is mifepristone still available in Pennsylvania?
Yes. Philadelphia-area clinic operators believe that their ability to dispense abortion pills through the mail is protected because Pennsylvania is part of the Washington lawsuit, in which a judge has ordered that access remain intact, said Lisa Perriera, the medical director of the Women’s Center in Philadelphia. Some providers may opt to dispense only in office, rather than through the mail, “to be safe,” she said.
Patients seeking an abortion may be prescribed mifepristone and misoprostol after an in-person or virtual consultation with an abortion provider. They can pick up the medication from an abortion clinic or have it mailed to them, so long as their address is in Pennsylvania.
Is mifepristone still available in New Jersey?
Yes, but the mail-order restriction may make it harder for some to access, since it currently must be picked up in person. New Jersey is not part of the Washington case.
What happens if mifepristone is taken off the market?
There are other options for medication abortion. Misoprostol, the drug that is typically used in combination with mifepristone can be used alone, at a higher dose.
Misoprostol is safe and effective for abortion, but has more side effects — such as nausea, vomiting, and diarrhea — when used alone.
Some people may instead opt for surgical abortion.
What are Philadelphia-area providers doing to prepare?
Planned Parenthood Keystone is training staff how to counsel patients about misoprostol-only abortion and refreshing doctors’ medical training to provide medication abortion without mifepristone, Reed said.
“Because of the political climate and the ongoing attacks on reproductive health care, we are having to be very nimble,” she said. “We have prepared.”
Clinics are also stocking up on mifepristone and preparing for the possibility of an increase in demand for surgical abortions, Perriera said.
An increase in surgical abortions would strain clinics that are already seeing more patients since the U.S. Supreme Court decision last summer that there is no constitutional right to abortion, said Dayle Steinberg, CEO of Planned Parenthood of Southeastern Pennsylvania.
Removing mifepristone from the market would add “unnecessary delays” to care for patients, if it takes longer for them to be seen by a doctor in person, she said.