Two conflicting rulings on the legality of a drug often used to end pregnancies or manage miscarriages have many wondering how this could impact reproductive health care access for Black families in the months to come.
Last Friday, a federal judge in Texas ruled that the U.S. Food and Drug Administration’s long-standing approval of the pill mifepristone should be revoked. It is not yet in effect, allowing the FDA a week to appeal, and in Congress, House Democrats have introduced a bill to protect access to the pill. That Texas decision also came around the same time that another judge in Washington state issued the opposite ruling, barring the federal government from reducing mifepristone’s availability.
Black women make up about a third of the people getting abortions in the U.S. Experts fear limiting access to the drug may have significant implications for reproductive health. Black people are already at least three times more likely than white women to die due to pregnancy-related causes, according to data from the Centers for Disease Control and Prevention.
“All of these communities who have limited access to abortion are going to have worse maternal and child health outcomes on top of the horrific outcomes that already exist,” said Jeanine Valrie Logan, a Chicago-based midwife and Leader in Residence at Chicago Beyond, an organization that promotes equity for the city’s youth.
Abortion access and reproductive health care are interconnected, she said.
Mifepristone has been widely available for more than two decades. Although the pill is still legal, here’s what you need to know.
How does mifepristone work, and what is it used for?
The drug is one of two, including misoprostol, that can be used to end pregnancies or manage miscarriages. It works by blocking progesterone, a hormone necessarily to continue pregnancy.
The medications make the uterus contract, cramp, and get rid of blood, according to experts. During pregnancy loss, medications can often help ensure a healthy recovery for pregnant people. Sometimes, miscarriages can result in severe bleeding or other adverse outcomes that can require transfusions and surgeries. And the trauma that results from those experiences can last a lifetime, Logan said.
The medication reduces that risk, she said. “It’s important to look at the whole view of how this medication can support folks throughout their reproductive decision-making.”
Most of the abortion work Logan does involves counseling patients, not prescribing or performing procedures, although she does manage miscarriages, she said.
“We should be doing all that we can to reduce the trauma that that person experiences.”
More than half of abortions nationwide are done using medication, data shows. The medication itself is safe, effective, and very commonly used, experts say. So much so that the vast majority of medication abortion treatments take place outside of clinics and doctor’s offices. After receiving the prescription, most patients complete treatment at home.
“When medications are highly restricted, it leads the public to believe they are dangerous,” said Dr. Jamila Perritt, an OB-GYN. “It is very safe. It is very effective.”
Mifepristone has also been shown to decrease the size of uterine fibroids, which are noncancerous tumors that can cause pain. Black women in their 20s are four times more likely than their white counterparts to have them, and about 60% of Black women experience them by the age of 35.
Why is the debate about this drug coming up or now?
The overturning of Roe v. Wade last June has sent many states into an intense battle around access to abortion care. Some states — many congregated in the South — have swiftly moved toward instituting bans on most abortions after six weeks. Florida, Georgia, and Louisiana are among many others limiting access to abortions.
Several Republican policymakers in states like Texas, South Carolina, and Kentucky have also begun to introduce legislation aimed at adding homicide charges for abortions.
The fight over mifepristone is the latest debate over access to abortions, and beyond the implications for reproductive health care, experts worry about what this could mean for how FDA drug approvals may be affected in the future.
“This is dangerous,” said Jameta Nicole Barlow, an assistant professor at George Washington University, where she teaches writing, health policy, and women’s, gender, and sexuality studies. “This is yet another attack on our agency, our autonomy as people, and given the history of the trans-Atlantic slave trade, the domestic slave trade here in the U.S., our agency is so essential.”
She said it is “a clear strategy where politics are getting in the way of effective policy.”
In the South, where access to comprehensive reproductive health care is already limited in some states, experts worry about what limiting medication abortion can mean for Black, rural communities who face long travel distances to maternal health care.
“They won’t just not have access because of this,” said Perritt, “they have never been the priority for expanding access in the reproductive rights movement.”
What does this ruling mean for access to health care and medication?
The Texas ruling has also left some of Logan’s patients in a state of panic, she said, with some asking if there’s any way they might be able to stockpile a supply in case they need it in the future.
“It’s alarming,” she said.
Perritt is not worried about people using medication for abortions without a prescription in terms of safety, she said. “Folks are very smart and can navigate their care.” Rather, she is concerned about the risk of criminalization for Black people, in particular, who are already overrepresented in the United States’ justice system. “The risk is not a medical one; the risk is a legal one.”
A few states have begun to stockpile abortion pills in anticipation of the case’s outcome. Gov. Jay Inslee brought in three years worth of pills for Washington state’s patients. California Gov. Gavin Newsom announced the state has an emergency supply of 2 million misoprostol tablets. And in Massachussetts, in response to a request by Gov. Maura Healey, the University of Massachusetts Amherst has purchased around 15,000 doses.
More than 400 pharmaceutical companies have also joined the battle to keep the drugs available. They recently wrote a letter condemning the Texas ruling over concerns that the decision ignored scientific evidence supporting mifepristone’s safety. In it, they wrote that it is a threat to the FDA’s approval process, which serves as a critical touchpoint in the U.S. health care system when it comes to connecting patients to safe, effective drugs.
President Joe Biden said his administration would also fight the Texas ruling.
Barlow, the professor, said she’s afraid of what could be coming on the horizon in terms of how politics pushes back against the FDA’s scientific authority. “There are multiple levels of outrage,” she said. “It’s dangerous ground.”