San Francisco Frontiers - Legal whiplash over abortion pill undermines care, say providers

In recent weeks, US courts have restricted the drug -- and then paused the restriction -- triggering uncertainty as to whether patients can receive the pill by mail following a virtual medical appointment.

Mifepristone is key to a common protocol for abortion as well as miscarriage management, and its restriction could have devastating effects nationwide, medical professionals say.

"It's dizzying," New Jersey abortion provider Kristyn Brandi told AFP.

"How do we navigate a system where we kind of know what's best for our patients, but can't give it to them, because we don't know what the rule is today."

In a major win for anti-abortion advocates, a federal appeals court on May 1 rolled back mail access via telehealth to the medicine, which has been allowed nationally since 2021.

Quickly thereafter, two drugmakers filed an emergency motion asking the Supreme Court for a stay to allow time for an appeal, which was granted for one week.

The justices are now considering whether to further extend the stay while litigation proceeds -- meaning telemedicine access to mifepristone would remain legal, for now -- or allow it to expire. That decision is expected by Monday.

- 'Monumental tragic consequences' -

In the meantime, the legal seesawing has sown uncertainty over the pill that the US Food and Drug Administration approved more than a quarter-century ago.

More than one in four people who have an abortion obtain medication via telehealth, according to the Guttmacher Institute, which tracks reproductive health data.

Many major medical societies say mail access makes reproductive health care safer and more equitable, especially for people of limited means or who live in rural areas far from clinics.

Medical providers in US states where abortion rights are protected also were able to prescribe and mail the medication to patients who might not otherwise have access.

The appeals court ruling sided with officials in Louisiana, who had argued that mailed mifepristone prescribed via telehealth was undermining state abortion laws, which count among the country's most restrictive.

If that decision is allowed to come into effect, delivering mifepristone by post would be prohibited everywhere across the country -- in states with strict limits, but also where abortion rights are protected.

The move, according to lawyer Julie Dahlstrom, would have "quite simply, monumental tragic consequences."

- Alternative protocol -

Mifepristone blocks the hormone progesterone. It is used to end pregnancies through 10 weeks gestation in combination with the drug misoprostol, which stimulates contractions and softens the cervix, allowing tissue to expel.

If the ruling on mifepristone is upheld, in-person dispensing requirements would be reinstated nationwide. Providers also are preparing to prescribe a single-drug protocol via telehealth using misoprostol only.

That method is also long-proven, safe, and effective, Brandi said.

But broadly speaking, the combination regimen is preferred, as it can help hasten the process and curb uncomfortable side effects including cramping and bleeding.

"Should this really take effect, it will be yet another step backward in the care of pregnant people," Helen Weems, an abortion provider in rural Montana, told journalists.

The two-drug protocol is also used to manage miscarriage, but Brandi fears the legal wrangling over mifepristone is creating "stigma."

The back-and-forth fosters confusion but also distrust, she said: "It further perpetuates the myth of like, the sketchy abortion doctor in the back alley."

- 'We shouldn't be here' -

Brandi, the obstetrician-gynecologist in New Jersey, also warned that political theater prevents future advances.

Drugs often have more than one application, and Brandi said continuous research is needed not just for abortion and miscarriage care, but to better treat a gamut of health issues such as uterine fibroids.

Jen Castle, the national director of abortion service delivery at Planned Parenthood, vowed that "no matter what the Supreme Court does, we are still working to get people the care they need."

She noted the wealth of peer-reviewed research supporting mifepristone's safety and efficacy as well as decades of real-world use.

"Let's just remember," Castle said, "the bottom line is that we shouldn't be here at all."

R.Moore--SFF