Medication Abortion Without Mifepristone? What To Know About Misoprostol-Only Abortions In Wake Of Court Ruling

Topline

A federal judge halted the government’s approval of mifepristone on Friday, one of two drugs typically taken in a medication abortion, prompting abortion providers and multiple states to look to providing the procedure using only the drug misoprostol—a regimen that hasn’t been federally approved, but is still recommended by health authorities as a safe alternative.

Bottles of the drug misoprostol sit on a table at the West Alabama Women’s Center, March 15, 2022, … [+] in Tuscaloosa, Alabama.

Key Facts

The most common method of medication abortion, approved by the Food and Drug Administration, uses two drugs: mifepristone, which terminates a pregnancy by blocking the hormone progesterone, and misoprostol, which induces contractions to expel the tissue.

Medication abortion can also be done using only misoprostol—which is more widely available to be prescribed, as it’s also used for other conditions like treating ulcers—in which pills are taken in three or four doses of four pills each, spaced three hours apart, in order to terminate a pregnancy up to 12 weeks.

While the FDA hasn’t formally approved misoprostol-only abortion regimens, the World Health Organization and other major groups, including the American College of Obstetricians and Gynecologists, have recommended the protocol as an acceptable alternative if mifepristone isn’t available.

Studies have found the misoprostol-only method to be effective at terminating anywhere between 78% to nearly 100% of pregnancies—with some studies finding efficacy rates of up to 99%—while studies have found medication abortion using mifepristone to be effective in terminating as high as 99.6% of pregnancies.

While misoprostol-only abortions are very safe—an analysis of the protocol in the journal Contraception noted only up to 0.7% of patients in studies had complications requiring hospitalization—it can have more side effects than using mifepristone, including higher incidences of fever, chills and diarrhea.

Many abortion providers have already been using only misoprostol for medication abortions, including telehealth providers and in other countries, and Melissa Grant, chief operations officer of abortion provider carafem, told CBS News the regimen was “an important option during the pandemic,” as until the FDA relaxed rules around mifepristone that required it to be dispensed in person in 2021, misoprostol was significantly easier to obtain and send through the mail.

News Peg

U.S. District Judge Matthew Kacsmaryk ruled Friday to block federal approval of mifepristone in response to a lawsuit from anti-abortion rights advocates, finding the FDA did not have authority to approve the drug. The ruling is being appealed and will not take effect until Friday unless higher courts block the decision first. There’s still significant uncertainty about what the ruling means for mifepristone access if it does take effect, as opponents of the decision have argued the judiciary can’t force the FDA to revoke approval of a drug. The decision has prompted California and New York to announce stockpiles of misoprostol—versus other states that are loading up on mifepristone instead—in anticipation of providing misoprostol-only abortions should mifepristone be outlawed. Multiple major abortion providers, including Planned Parenthood, said prior to the ruling they intend to provide medication abortions using only misoprostol if access to mifepristone was cut off, and Dr. Jamie Phifer, the medical director of Abortion on Demand, told NPR following the ruling that the provider could switch to providing misoprostol-only abortions “within hours” if needed.

Crucial Quote

“This regimen is still incredibly safe and effective,” Dr. Kristyn Brandi, a fellow with the American College of Obstetricians and Gynecologists, told NPR. “Medication abortion and miscarriage management will not go away with the loss of mifepristone, but it may look a little different.”

Big Number

53%. That’s the percentage of all abortions in the U.S. that were medication abortions in 2020, the most recent year for which data is available, according to the pro-abortion rights Guttmacher Institute. Of those, researchers for the Guttmacher Institute found more than 98% were done using both mifepristone and misoprostol. That percentage would likely be higher now, as medication abortion has become increasingly important to abortion access in the wake of the Supreme Court overturning Roe v. Wade, given that pills are easier to obtain for people in states where the procedure is banned and clinics have shuttered. That resulted in the increased attacks on medication abortion from anti-abortion advocates, including the mifepristone lawsuit that led to Kacsmaryk’s ruling.

What To Watch For

While misoprostol so far hasn’t been subject to the same legal attacks as mifepristone, if misoprostol-only abortions become more common, it’s anticipated anti-abortion advocates will step up their attacks on the drug. “If it becomes more widely used … I do think think that the next step for these plaintiffs is to bring some sort of lawsuit” targeting misoprostol, Allison Whelan, a law professor at Georgia State University specializing in health law, told Forbes prior to Kacsmaryk’s ruling, noting that could “greatly impact a large number of other conditions that misoprostol is used for.” State lawmakers could also target misoprostol legislatively. A ban on abortion pills that was recently enacted in Wyoming—the first of its kind in the country—would cover misoprostol for the purposes of abortion, for instance, as it makes it illegal to “prescribe, dispense, distribute, sell or use any drug for the purpose of procuring or performing an abortion.”