Photo: Patrick Semansky Associated Press In 2022, the Supreme Court overturned the famous Roe v. Wade” and paved the way for bans or severe restrictions on abortion.
Mark Sherman – Associated Press in Washington
March 25, 2024
- United States
The Supreme Court will once again consider the sensitive issue of abortion this week when it hears arguments on a drug commonly used to end a pregnancy, a case with profound implications for million women and which could also have an impact on the race for the White House.
Two years after the Supreme Court struck down the famous Roe v. Wade and paved the way for bans or severe restrictions on abortion, abortion opponents will ask the highest court Tuesday to uphold a ruling by a conservative federal appeals court that limits access to the drug , mifepristone. It was used in nearly two-thirds of all abortions in the United States last year.
The decision to overturn the ruling had immediate political consequences, with Democrats arguing that the court had taken away a right that women had held for half a century and thus won an election. Even conservative-leaning states like Kansas and Ohio have voted against abortion restrictions. If the court were to uphold restrictions on medical abortions, it could upend the electoral landscape in congressional and presidential races.
By rolling back the Food and Drug Administration's (FDA) changes to the use of mifepristone, the decision would cut off access to the drug through the mail and impose other restrictions, even in states where abortion remains legal . The restrictions would reduce the period of time mifepristone can be used during pregnancy, to seven weeks from the current ten.
Most adults in the United States, 55%, believe abortion pills are very or somewhat safe when taken as directed by a doctor, according to a May 2023 KFF poll. And 65% have “a lot” or “a little” confidence in the product. The FDA must ensure that drugs sold in the United States are safe and effective.
A decision should be made at the end of June. But whatever the outcome, the Supreme Court has not heard its last abortion-related case. Litigation is ongoing over state restrictions, and new federal limits are likely if former President Donald Trump, the Republican's presumptive 2024 nominee, returns to the White House.
Next month, the justices will hear arguments on whether a federal law on emergency treatment in hospitals should include abortions, even in states that have otherwise banned them.
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Widely used drugs
Mifepristone, manufactured by Danco Laboratories in New York, is one of two drugs, along with misoprostol, used in medical abortions. Their numbers have been rising for years, and they accounted for 63 percent of the more than 1 million abortions in the United States last year, according to an estimate by the Guttmacher Institute, which supports abortion rights. More than 5 million people have used mifepristone since 2000.
Mifepristone is taken first to dilate the cervix and block the hormone progesterone, necessary to maintain a pregnancy. Misoprostol is taken 24 to 48 hours later, causing the uterus to contract and expel pregnancy tissue.
Health care providers said that if mifepristone was no longer available or too difficult to obtain, they would only use misoprostol, which is somewhat less effective at ending pregnancies.
Underlining the importance of this case, the number of medical abortions is increasing for several reasons. Taking pills at home to end a pregnancy is less invasive than surgery, more convenient than having to go to an abortion clinic, and more private, allowing women to avoid antiabortion protesters who march past clinics .
It's becoming easier to get both drugs in some states now that CVS and Walgreens have announced pilot programs to distribute the pills through their pharmacies.
For women living in states where abortion is banned or restricted, mail delivery may be their only practical option, said Julie F. Kay, executive director of the Abortion Coalition for Telemedicine .
The medications are sent by providers based in states with laws intended to protect them from any legal issues related to working with people in states that do not allow medication abortions. The pills cost US$150 and usually arrive within three to five days, Ms. Kay said.
Last year, 85,000 women worked with mail-order abortion provider Aid Access to obtain the drug, said Dr. Rebecca Gomperts, the group's founder. Of those, 50,000 live in states where abortion is restricted, she said.
Women’s health “at risk”
The current filing closely follows the June 2022 Supreme Court decision that struck down the constitutional right to abortion. This decision led to the banning of abortion at all stages of pregnancy in 14 states, with few exceptions, and once cardiac activity is detected, which is about six weeks, in two other states.< /p>
Abortion opponents filed their mifepristone lawsuit the following November and initially won a victory six months later thanks to U.S. District Judge Matthew Kacsmaryk, a Trump appointee in Texas, who would have revoked the entire drug ban. approval of the drug. The Fifth U.S. Circuit Court of Appeals left the FDA’s initial approval of mifepristone intact. But that would undo changes made by regulators in 2016 and 2021 that relaxed some conditions for administering the drug.
The Supreme Court stayed the appeals court's amended decision, then agreed to hear the case. Justices Samuel Alito, the author of the decision overturning Roe, and Clarence Thomas, however, reportedly allowed certain restrictions to take effect while the case progressed.
Doctors and groups who initially wanted to remove mifepristone from the market now say in their main brief to the Supreme Court that these recent changes “jeopardize the health of women across the country” and failed to follow due process stringent requirements required by federal law to change safety restrictions on medications.
Pregnant women who want to take mifepristone, for example, no longer need to see a doctor before getting a prescription, said Erin Hawley, the attorney for the Alliance Defending Freedom who represents opponents of abortion before the Supreme Court.
“Our customers are calling on the FDA to restore safeguards that have existed for almost 20 years,” Hawley told the Associated Press. She is married to Senator Josh Hawley of Missouri. Both served as law clerks to Chief Justice John Roberts early in their careers.
But the administration said the elimination of doctor visits and other changes were the product of more than 20 years of experience regulating mifepristone, including evaluating the data safety and studies involving thousands of women. His view is shared by several leading medical organizations, including the American College of Obstetricians and Gynecologists.