Mifepristone and Public Health Concerns of Shrinking Abortion Rights
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By Lizzie Wilson
A district judge in Texas made a ruling suspending the FDA approval of an early abortion medication called mifepristone, which could halt access to the pill in every state, regardless of their reproductive health policies, for the duration of a lawsuit challenging safety and approval of the drug. The government was given 7 days for appeal on the suspension of Mifepristone, the most commonly used method of abortion in the U.S. On Friday April 14th, Justice Samuel A. Alito Jr. issued an order, which will temporarily maintain the availability of mifepristone to give the Supreme Court time to review a Biden administration request to secure enduring approval of the pill. By Wednesday, April 18th, it is expected that the court will make a decision.
Separately, after receiving an emergency application by a manufacturer of mifepristone called Danco Laboratories, a judge panel for the US Court of Appeals in New Orleans ruled that some aspects of the Texas judge’s ruling went beyond his command over the FDA’s approval, while still letting other portions of the ruling stand. These include a requirement for in-person doctors’ appointments to obtain the medication, reduced availability of the pill to within the first 7 weeks of pregnancy (it had previously been 10), and the ban of disbursement of the drug through the mail[i]. The FDA had been in the process of expanding access to abortion pills, allowing disbursement to a wide range of pharmacies and enabling mail order abortion pills early this year[ii].
Many working in public health are outraged with the potential continued shrinking of abortion rights in this country. For example, Suzanne Bell, who is an assistant professor at John’s Hopkins Bloomberg School of Public Health responded to the Texas judge’s ruling stating that, “Mifepristone is an incredibly safe medicine that has been used in the U.S. for more than 20 years and is approved for use in approximately 80 other countries. This will not stop medication abortions from occurring in the U.S., it will simply force healthcare providers to rely on the misoprostol-only regimen, which, while still very safe, is somewhat less effective and causes more uncomfortable side effects. This ruling is another attempt to interfere with the delivery of evidence-based healthcare and control pregnant people’s bodies.[iii]”
Typically, mifepristone is used in combination with misoprostol. Mifepristone works by blocking progesterone, resulting in the breakdown of the uterine lining and halting of pregnancy progression, while misoprostol is used to induce contractions for expulsion. The FDA has found this combination of medications to be 99.6% effective with a .4% risk of complications, and an associated mortality rate of 0.00064%[iv]. Though misoprostol is safe for use an effective on its own, it can cause more side effects.
But why exactly is abortion a public health issue? To answer that question, we can examine the Advancing New Standards in Reproductive Health Turnaway Study:
The Turnaway Study was a decade-long prospective longitudinal study examining the effects of unwanted pregnancies on mental, physical and, and socioeconomic health. Around 1,000 women visiting abortion facilities were selected to participate and were interviewed every six months for 5 years. Recruited women were either: 1.) Women who sought abortions up to three weeks past the gestational limit and were not permitted to receive an abortion, 2.) Women who received an abortion a maximum of 2 weeks under the gestational limit (the comparison group), and 3.) women who got an abortion within the first trimester of pregnancy, which is more representative of the majority of abortions in the United States.
The study found that, while receiving an abortion did not have an impact on mental health and wellbeing, the denial of an abortion harmed mental, physical, and financial health[v]. For example, compared with women who received an abortion, women denied one experienced higher rates of poverty for at least four years, were less likely to afford basic living expenses, had poorer maternal bonding, experienced worsening credit scores, increased debt, and increased the likelihood of staying with a violent partner in the short-term, while increasing the likelihood of raising a child alone after 5 years. Additionally, the children of women who already have kids at the time they are denied an abortion experience worse developmental outcomes, and children who are born out of abortion denial are more likely to live below the poverty line compared with subsequent children born to a mother who received an abortion, and women denied abortion are more likely to experience life-threatening complications in childbearing and birth[vi].
Despite some claims to the contrary, the study found that 95% of women who had an abortion reported that it was the right decision for them 5 years later.
Data reported by the CDC demonstrates how reduced abortion access disproportionately impacts people who earn low incomes, and people of color, with 75% of those receiving an abortion being low-income, and Black women being 5 times more likely to get an abortion than White women[vii]. Additionally, states with more restrictive reproductive policies make low-birth weight babies more likely, and these states experience higher rates of abortion-related maternal death. Abortion denial has economic impacts, too. In Mississippi alone, if abortion restrictions were halted, Black women would experience an estimated $13.4 million dollars in increased earnings[viii].
Since the overturning of Roe v. Wade last year, medication abortions have become a key tool to increasing access to abortions in the US. As of 2021, more than half of abortions in the US were medication abortions, according to Kaiser Permanente[ix]. We will be keeping an eye out for a decision from the supreme court in the coming days.
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[i] Liptak A. (2023). Supreme Court Briefly Preserves Broad Availability of Abortion Pill. The New York Times. https://www.nytimes.com/2023/04/14/us/politics/supreme-court-abortion-pill.html
[ii] Perrone M. (2023). FDA finalizes rule change allowing mail-order abortion pills. PBS. Retrieved from: https://www.pbs.org/newshour/politics/fda-finalizes-rule-change-allowing-mail-order-abortion-pills
[iii] Bell S. (2023). Ruling on Abortion Pill is “Devastating and Unprecedented”. Johns Hopkins Bloomberg School of Public Health. Retrieved from: https://publichealth.jhu.edu/2023/ruling-on-abortion-pill-is-devastating-and-unprecedented
[iv] Kaiser Permanente Foundation (2023). The Availability and Use of Medication Abortion. Retrieved from: https://www.kff.org/womens-health-policy/fact-sheet/the-availability-and-use-of-medication-abortion/
[v] Advancing New Standards in Reproductive Health (n.d.). The Turnaway Study. Retrieved from: https://www.ansirh.org/research/ongoing/turnaway-study
[vi]Advancing New Standards in Public Health (n.d.). The harms of denying a woman a wanted abortions findings from the Turnaway Study. University of California, San Francisco. Retrieved from: https://www.ansirh.org/sites/default/files/publications/files/the_harms_of_denying_a_woman_a_wanted_abortion_4-16-2020.pdf
[vii]Centers for Disease Control and Prevention (n.d.). Infographic: Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016. Retrieved from: https://www.cdc.gov/reproductivehealth/maternal-mortality/disparities-pregnancy-related-deaths/infographic.html
[viii] Winny A. (2021). Public Health in the Field: The Public Health Case for Abortion Rights. Retrieved from: https://publichealth.jhu.edu/2021/public-health-in-the-field-the-public-health-case-for-abortion-rights
[ix] Kaiser Permanente Foundation (2023). The Availability and Use of Medication Abortion. Retrieved from: https://www.kff.org/womens-health-policy/fact-sheet/the-availability-and-use-of-medication-abortion/