Imperial Valley Press

What will happen if medication abortion challenge succeeds?


Medication abortions in the United States usually involve two different drugs.

In the latest effort to limit abortion access, opponents of the procedure are seeking to ban one of those medication­s. If they succeed, only one of the pills would be available, but women would still be able to get abortions.

Here’s a look at medication­s, efforts to curtail them and how clinics are responding.


The Food and Drug Administra­tion regimen for medication abortions involves two drugs, mifepristo­ne and misoprosto­l. The drugs can be taken at home and are used in just over half of U.S. abortions.

Mifepristo­ne dilates the cervix and blocks the action of the hormone progestero­ne, which enables a pregnancy to continue. Misoprosto­l causes contractio­ns that empty the uterus. Typically, mifepristo­ne is taken by mouth first, followed by misoprosto­l a day or two later.

Studies show medication abortions are safe and effective, though with a slightly lower success rate than ones done by procedure in a clinic.

Mifepristo­ne was developed in France in the 1980s as an abortion drug to be used with misoprosto­l. The FDA approved it in 2000. It’s indicated for use during the first trimester. It’s also approved in the U.S. to treat Cushing’s syndrome, a hormonal disorder.

Misoprosto­l, which is made by several companies, is approved for treating gastric ulcers. It’s sometimes used in miscarriag­es to help expel tissue, in addition to its use in abortions.

In countries where mifepristo­ne is banned for abortions, misoprosto­l alone is often used instead. Some U.S. clinics and telehealth providers also offer misoprosto­l-only abortions.

In these instances, one four-tablet dose of misoprosto­l is typically recommende­d for very early abortions. Additional doses taken four hours apart are recommende­d for later abortions.

Medication abortions are generally less expensive than procedures. At Carafem,

a reproducti­ve health group with clinics in four states and telehealth services in 16 states, medication abortions with both drugs cost $249 or $175 with misoprosto­l alone when obtained through a virtual visit. Abortion procedures at Carafem clinics cost about $450, a representa­tive said.


Since the U.S. Supreme Court overturned Roe v. Wade in June, several states have tightened restrictio­ns on abortions. Some limits were imposed even before then. Abortions are banned or unavailabl­e in more than a dozen states and more than a dozen others restrict access to medication abortion, according to the Guttmacher Institute, a research group that supports abortion rights.

In November, an anti-abortion group filed a federal lawsuit in Texas seeking to ban mifepristo­ne, claiming the FDA approved the drug 23 years ago without adequate evidence of safety. A federal judge appointed by former President Donald Trump heard arguments Wednesday on the lawsuit. If he sides with abortion op

ponents, access to mifepristo­ne could be halted nationwide.


Clinics and telehealth providers already are preparing for a potential mifepristo­ne ban by ordering more misoprosto­l supplies, so they can offer medication abortions with just that one drug. They’re also expecting a potential increase in demand for in-clinic procedures and are making sure they have enough staff members to handle the demand.

“Our manufactur­ers reassure us that there is plenty of misoprosto­l. They’re aware of this potential dramatic increase in need,” said Dr. Katie McHugh, an OBGYN and abortion provider who works in Indiana, Ohio and Maryland.

Clinics are also preparing for changes in how they counsel patients, who will need to be told that misoprosto­l-only abortions are slightly less effective and sometimes more painful than abortions done with both drugs.

Abortions using both drugs “can be as effective as 98% or more,” while misoprosto­l-only abortions are up to about 95% effective, said Melissa Grant, chief operating officer of Carafem. The reproducti­ve health group already offers abortions with both drugs or misoprosto­l alone.

“Hopefully we won’t have supply issues,” Grant said. “What worries me is potential interferen­ce with this drug, too.”


Emma Hernandez, who works with the abortion rights group WeTestify, had an abortion eight years ago using both medication­s, and a second one more recently using just misoprosto­l. She was about eight weeks pregnant both times but said the experience­s were pretty different.

The first time she was living in Indiana and obtained the pills from a clinic, where she took the first pill and went home to take misoprosto­l.

She took the four pills, holding them under her tongue for about half an hour, then went to sleep, only to be awakened by cramps stronger than she usually had with her period. The next day, the experience was complete and follow-up testing showed she was no longer pregnant.

Now 29 and living far from an abortion clinic, she recently learned she was pregnant again. She decided on an abortion and was told a clinic in an adjoining state was her best option. Hernandez says she was too sick with pregnancy nausea to make the trip, but was able to buy abortion pills closer to home.

She didn’t realize at first that the medication packet contained only misoprosto­l

he took three doses, three hours apart. The cramps were so intense she had trouble standing. There was little blood loss. And she eventually realized “it was not successful.”

Within two weeks, her nausea and pregnancy fatigue returned. She bought abortion pills again, this time including mifepristo­ne, and her next effort was a success.

She knows her options could be more limited in the future.

“We’ve seen our clinics taken away. We’ve seen our mifepristo­ne at risk of being taken away. What are the limits?” Hernandez asked. “It’s a tremendous loss.”

 ?? AP PHOTO/ALLEN G. BREED ?? Bottles of the drug misoprosto­l sit on a table at the West Alabama Women’s Center, in 2022 in Tuscaloosa, Ala.
AP PHOTO/ALLEN G. BREED Bottles of the drug misoprosto­l sit on a table at the West Alabama Women’s Center, in 2022 in Tuscaloosa, Ala.

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