Clinics and doctors brace for more restrictions on women's health care after court ruling on abortion drug

CNN

Clinics providing reproductive health care in the United States are preparing for greater restrictions on women's access to care, less than a year since the US Supreme Court revoked legal protection for abortions.

A judge may make it illegal for doctors to prescribe Mifepristone. This drug is one of two that can be used to help women end a pregnancy at-home.

Northeast Ohio Women's Center staff call patients expecting to have medication abortions next week and tell them to reconsider.

"They are scrambling to alter their schedules to get into the clinics earlier," said Dr. David Burkons who is the doctor in charge of the clinics.

Mifepristone is used in about half of all abortions in America. It's sold under the brand Mifeprex.

Mifeprex blocks progesterone which stops a pregnancy from going on. Women take misoprostol first to induce an abortion. Misoprostol is a drug that causes the body to contract, cramp, and bleed similar to heavy periods. It causes the uterus to empty, thus ending the pregnancy. It can be used for up to 10 weeks.

Mifepristone's uses go far beyond abortion.

It helps to soften and open your cervix (the neck of the uterus), and doctors depend on it when you are experiencing a miscarriage or when you need to terminate a pregnancy quickly, if your life is at risk.

When a pregnancy is too risky or in certain circumstances, it's important to act quickly, according to Dr. Alison Edelman who directs the complex family planning division at Oregon Health and Sciences University.

She stated that mifepristone is a way to prevent someone from becoming pregnant.

Mifepristone is also used by doctors before they enter the uterus to treat bleeding polyps. The drug has been shown to reduce the force required to open the cervical cervix, as well as the blood loss.

According to the American Society of Health Systems Pharmacists, studies also showed that mifepristone can induce labor, treat uterine fibroids, and treat endometriosis. Sometimes, it even helps to avoid surgery.

The society stated in a statement that it can be used to control bleeding during periods and hyperstimulation of ovaries during in vitro fertilization.

Although doctors claim they have other options for treating these problems, when they consider the individual needs of patients, they will not be able to provide a useful tool.

"We have our gold standard for what we offer - the most safe and effective. If it isn't available, we use another one. Edelman stated that this is what they would have left with.

The US Food and Drug Administration has approved Mifepristone for 23 years. It has been used by more than 5 million women in the United States. FDA data shows that less then 1% of women who use it experience serious adverse reactions. CNN's analysis of FDA data showed that mifepristone was less dangerous than other common medications like penicillin and Viagra.

After the Supreme Court's decision last year, which ended legal protections for all abortions in every state, medication abortions have been an increasingly popular option for women living in states that restrict abortion access. These are sometimes the only type of abortion that rural women have access to if they lose their abortion providers.

The ease of access to medication has made it a target for abortion opponents.

Kristen Moore, the director of the EMAA Project (a non-profit that aims to make it easier for Americans to obtain abortion medication in the US), stated, "They want to see a ban national,"

The next step is not yet decided. Appeal have been filed in Texas to stop the Texas ruling from being implemented. Higher courts will need to weigh in.

Doctors say that even if mifepristone is taken off the US market, they will still have the ability to perform medication abortions with misoprostol.

Some abortion providers even plan to use misoprostol alone in the event that mifepristone is not available.

Chief Operating Officer Melissa Grant stated that Carafem, which offers telehealth abortion care has used a misoprostol-only protocol since the Covid-19 pandemic.

She said, "In 2020, misoprostol was added to the list as an option." Since then, workers have been tweaking the regimen to gather data.

Grant stated, "We are confident that misoprostol can be used alone, even though it would be more convenient to use both."

However, providers say it isn't ideal.

Misoprostol-only treatment is less effective than that which uses both drugs. It causes more cramping, bleeding, and can lead to more complications.

Dr. Erika Werner is chair of the Department of Obstetrics and Gynecology, Tufts University Medical Center.

Doctors want women to be aware that miscarriage and medication abortions will still be possible even if mifepristone has been discontinued. They hope higher courts will intervene in order to keep the medication on the pharmacy shelves.

Dr. Iffath HOSkins, president of American Congress of Obstetricians and Gynecologists, stated Monday that clinicians would need to consider these options rather than relying on their expertise, knowledge, and judgment when providing such care. "Frankly, I don't want to be there as a clinician."