FACULTY Q&A

The Supreme Court on Friday issued an order that allows mifepristone, a pill commonly used in medication abortions, to stay on the market while a legal challenge advances through the appeals process. This follows two decisions by lower courts that severely restricted the availability of the drug.

The anti-abortion group behind the lawsuit is challenging the FDA’s approval of the drug, which has been widely used for more than 20 years. Ruth Zielinski, a midwife and professor at the University of Michigan School of Nursing, discusses what mifepristone does and what a ban would mean.

What is mifepristone and how does it work?

Mifepristone is one of two oral medications most commonly used for medication abortion, the other being misoprostol. Mifepristone blocks progesterone, which is needed for a pregnancy to continue. It was approved by the FDA in 2000 and has been very well researched for safety. Typically, mifepristone is given first, followed by misoprostol 24-48 hours after.

What will happen in Michigan and elsewhere if this ban is enacted?

It will certainly make it more difficult at a time when medication abortion is being used more because of the increase in states that are restricting abortions. Mifepristone is also used for “missed” or “incomplete” abortions/miscarriages where the embryo/fetus has stopped developing, so banning mifepristone will also affect these people. In fact, my daughter-in-law had a missed abortion (miscarriage where the fetus stops developing but the products of conception do not pass) and her provider in Indiana did not prescribe Mifeprex because of the strict anti-abortion laws. It is unconscionable that people who already are going through a difficult time (whether induced or spontaneous abortion) are met with these unnecessary challenges.

Medication abortion is safe and when given an option, preferred by most people seeking an abortion. Decision regarding a pregnancy is time sensitive and this will be a barrier for many people seeking an abortion because they will need to travel to where they can get a surgical abortion. With fewer providers performing surgical abortion, this will greatly increase the number of unwanted pregnancies, disproportionately for people with less means to travel and fund a surgical abortion.

How do women get this drug now?

Mifepristone is available by prescription only and there are restrictions about who can prescribe it. In 29 states, including Michigan, only physicians can prescribe medication abortion, even though it is in the scope of practice for certified nurse midwives and other advanced practice providers.

Is this the same as the “morning after” pill?

This medication is different. The “morning after pill” or “plan B” stops a pregnancy from occurring and needs to be taken within three days of unprotected sex.

Can women still get medication abortions without this drug?

Another reasonable option is misoprostol only—it is safe and only slightly less effective than using Mifeprex and misoprostol. In fact, it is the more commonly used method worldwide. I am concerned that anti-abortion groups will go after misoprostol next.