Editor's Note: For the last few months, RANGE has been working with the junior and senior students at The Community School to help each of them develop a piece of journalistic writing about a local or recent news topic that interested them. As they reached the end of the capstone project, we selected a few articles that we professionally edited and will be publishing on our website in the coming weeks as part of a series we're calling The Young RANGE. Through this project we've been constantly in awe at the level of student engagement, the quality of work and the RANGE of topics the youth were passionate about. We're beyond excited to introduce you to these students and their work, beginning with Howl Hall's timely piece on the drug mifepristone and its Supreme Court case, which saw a verdict today. - Erin Sellers
Mifepristone is a medication used to block progesterone, the hormone that makes the body retain a pregnancy. It’s been approved by the Food and Drug Administration since September of 2000.
When taken in combination with misoprostol, mifepristone is commonly used for medication abortion, and has a success rate of 91 to 98%. The two drugs in tandem have also been used as treatment for miscarriages.
Since its initial approval of the drug, the FDA has been continually expanding access to mifepristone over recent years. In 2016, they expanded the timeline for approved use up from the first 7 weeks of pregnancy to the first 10 weeks of pregnancy in 2016 (the week number is calculated from the first day of the last menstrual cycle). In 2021, partially in response to the COVID-19 pandemic, the FDA approved mifepristone to be prescribed through telehealth and dispensed through mail.
While some point to this expansion of care as necessary and even “life-saving,” there has been pushback from anti-abortion groups, who ultimately pressed the issue all the way up to the Supreme Court.
On March 26th 2024, the Supreme Court heard arguments from both parties in a case that challenges the FDA’s recent expansion of care access to mifepristone. On June 13, the Supreme Court released its decision in favor of the FDA, preserving access to mifepristone. It was the first time the Supreme Court has revisited an abortion case since Dobbs v. Jackson, the case that overturned Roe v. Wade and handed abortion access to the states to decide, in 2022.
While the decision released on June 13 allowed pro-choice advocates to breathe a sigh of relief, it’s possible mifepristone will continue to face legal challenges in the future, so it’s important to understand the background of the most recent case.
The mifepristone case pitted the FDA against the Alliance for Hippocratic Medicine (AHM), a group that defines themselves as “upholding and promoting the fundamental principles of Hippocratic medicine.”
Hippocratic medicine is defined as a holistic approach to addressing any physical or mental health issues, with a belief that you can’t treat one without treating the other. AHM ties this to the idea that life begins at fertilization, though their challenge to the current level of access to mifepristone is over perceived safety concerns.
The overall mortality rate associated with mifepristone is 0.53 deaths per 100,000 medication abortions, which breaks down to 26 deaths for every 4.9 million uses of the drug for performing a medication abortion. Over the roughly twenty years that mifepristone has been FDA approved, the complication rate leading to death has been so low that it’s statistically less than one death per 100,000 medication abortions. For reference, Tylenol, one of the most common household drugs, is accountable for causing acute liver failure leading to the death of over 600 people annually.
Though a tenant of AHM’s argument to roll back access to mifepristone is safety concerns about the drug itself, statistics show that limiting access could actually harm more patients. According to the CDC, if a patient is forced to carry a pregnancy they did not want, they could then be facing the “maternal mortality rate of 32.9 deaths per 100,000 live births as of 2021.” That is over sixty times the risk of having a medical abortion using mifepristone.
Despite the drug’s safety, AHM’s challenge claims that the expansion of access is putting pro-life doctors at risk of going against their morals in emergency situations where they have to treat a patient who has used mifepristone for a medical abortion.
AHM said they thought there was not enough data on the safety of mifepristone and its complication rates to support the FDA’s approval of mail distribution, use up to 10 weeks into pregnancies and distribution through pharmacies.
AHM also expressed concerns for emergency room doctors. Because the FDA decisions made mifepristone more accessible, it could also mean an increase in patients seeking emergency room care if they experience symptoms or side effects. AHM said this could put pro-life emergency doctors in a tricky moral dilemma where they may have to treat a patient after they had an abortion which would “violate their conscience.”
Pro-choice advocates feared that if the Supreme Court sides with AHM, it will open the door for more challenges to both reproductive care and FDA decisions in general, which could have unpredictable and dangerous ripple effects for years to come. With the June 13 decision to preserve access to mifepristone, those fears are assuaged — for now.
As Washington Senator Patty Murray said in a press release, though she is in favor of the Supreme Court’s decision, it may only be a temporary sigh of relief. Opponents sought to “rip away access to a medication that has been used by millions of women for over two decades and is safer than Tylenol.”
“The ideological extremism by the plaintiffs in this case, who were represented by a designated hate group, should never have made it this far to begin with,” Murray wrote. “But make no mistake: this fight is not over.”
