Today, the United States Supreme Court heard oral arguments in a follow-up case that threatens to limit access to medication abortion nationwide.
A central issue in the case is the safety of the drug mifepristone, the first in a two-pill regimen used to induce an abortion. The drug blocks a hormone needed for pregnancy and has been approved by the U.S. Food and Drug Administration since 2000.
That FDA approval is being challenged by a coalition of anti-abortion doctors and activists, the Alliance for Hippocratic Medicine, which is calling for the pill to be taken off the market. The group has claimed that mifepristone is dangerous to patients, citing a 2021 study which showed that emergency room visits were higher after medication abortion. However, that study was retracted in February after an independent review found there were problems with the way the authors analyzed and presented the data.
During Tuesday’s oral arguments, judges’ questions focused mainly on emergency room visits after using mifepristone and whether the FDA’s relaxation of regulations on the drug in recent years has resulted in an increase in those visits.
“I think ER visits are absolutely the wrong metric when it comes to safety,” says Michael Belmonte, an obstetrician and fellow at the American College of Obstetricians and Gynecologists. “It is important to recognize that the vast majority of people who go to the emergency room are only going for reassurance and not for safety reasons.”
Belmonte says the most important measure is serious side effects, which are extremely rare with drug abortion. “Side effects occur with any drug or procedure and honestly, the side effects that occur with these medications are extremely rare compared to things we use every day,” he says.
Major side effects include hospitalization, blood transfusion, infection and death. A 2013 peer-reviewed research found that among 233,805 medication abortions in 2009 and 2010, these significant side effects or outcomes were reported in 1,530 cases, less than 1 percent.
“Many women may go to the emergency room because they are experiencing heavy bleeding, which looks like a miscarriage, and they may just need to know whether or not they are having a complication,” said U.S. Attorney General Elizabeth Prelogar. in defense of the FDA, in oral arguments Tuesday.
Belmonte says it’s worth noting that the abortion pill regimen is designed to cause bleeding and cramping. While these effects may be disturbing to some patients, it is a function of the medication and a sign that it is working. “Mifepristone really just prepares the uterus for evacuation, so mifepristone itself inherently does not cause bleeding, cramping, or other side effects,” he says. Misoprostol, the second drug used in a medication abortion, causes bleeding and cramping.
Ushma Upadhyay, a public health social scientist at UC San Francisco who researches medication abortion, says that many patients who visit an emergency department after a medication abortion are alarmed by the bleeding the medication causes, but That doesn’t mean they have a serious side effect. “When people have a medication abortion, they experience it alone, and they don’t have a counselor with them to ask questions,” she says. “People go to the emergency room to understand whether the bleeding they are experiencing is normal and to assess whether the medications are working.”