Why ruling against the abortion pill mifepristone would be a disaster

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The Supreme Court will hear oral arguments Tuesday in the biggest abortion case in the two years since it rolled back women’s reproductive health protections by striking down Roe v. Wade. In that disastrous 6-3 decision, Justice Samuel Alito, writing for the majority, said, “It is time to heed the Constitution and return the issue of abortion to the people’s elected representatives.” The court is about to hear arguments in two consolidated cases that could create even more barriers to reproductive health care in all 50 states. And yet, the court is about to hear arguments in two consolidated cases that could create even more barriers to reproductive health care in all 50 states — including those where the people’s elected representatives have decided abortion should remain legal. Those two cases — Food and Drug Administration v. Alliance for Hippocratic Medicine and Danco Laboratories v. Alliance for Hippocratic Medicine — were brought by anti-abortion extremists last year to challenge the FDA’s approval of mifepristone, a drug used to end early-stage pregnancies and manage miscarriages. Despite extensive scientific research supporting the use of mifepristone, these extremists argue that it’s unsafe, and they’re wagering that the conservative court will side with their ideology and ignore the medical and scientific judgment of the FDA. We, along with the 20 other governors of the Reproductive Freedom Alliance, submitted an amicus brief to the court highlighting why such a decision would be an unmitigated disaster regardless of one’s position on abortion. Make no mistake, the decision in this case has the potential to interfere with every American’s right to make private, informed health care decisions with their doctor. The FDA applied its time-tested gold standard for rigor and risk mitigation when it approved mifepristone nearly a quarter century ago. Mifepristone is a safe, highly effective and widely used medication prescribed for medication abortions and miscarriage management. It is so safe, in fact, that the drug is used in over half of all abortions nationwide. Given mifepristone’s track record of safety, the FDA took steps in 2016 and 2021 to enable easier access under some circumstances, including allowing patients to obtain prescriptions via telemedicine and receive the drug by mail. This increased access to vital health care for women around the country. In New Mexico, medication abortions accounted for more than 80% of all abortions covered by Medicaid in 2023. In North Carolina, the use of medication abortion has steadily increased since 2011, accounting for 59.1% of all abortions by 2020 (as opposed to only 23.4% in 2011). In Asheville, North Carolina, wait times for medication abortion appointments have nearly doubled since 2022 because of the influx of out-of-state patients seeking abortions. New Mexico has seen a similar influx. With increased wait times and more crowded clinics, we should be focused on helping patients access care more easily — especially given that the average American lives 86 miles away from a provider. To have people without medical or scientific backgrounds determine which health care options are allowed sets a dangerous precedent and creates public health risks well beyond reproductive health care. If the FDA’s expert judgment on mifepristone can be challenged by activists and judges who lack medical expertise, then other lifesaving drugs could also be threatened. Do we really want to live in a country where politics — not science — ultimately determines what health care is available to our citizens? If these activists succeed in hindering access to medication abortion, then many women will be forced to instead seek out and undergo surgical abortions, which involve significantly more risk and recovery time. If the FDA’s expert judgment on mifepristone can be challenged by activists and judges who lack medical expertise, then other lifesaving drugs could also be threatened. These extremists pay no mind to the risks and very real harms that would result from the catastrophic decision they seek from the court. They pay no mind to the cycles of poverty they seek to enshrine, nor do they appear to have an ounce of concern for the women who are often making one of the hardest decisions of their lives. They don’t see the irony of arguing for less intrusion by the government and yet, in the same breath, asking the court to creep into the most private areas of women’s lives. The court not only runs the risk of upending state health care delivery and weakening the FDA, but also endorsing a thinly disguised ploy to take decision-making away from women and their doctors, and even the “elected representatives” the court majority professed to give power to decide abortion restrictions when it overturned Roe. As elected representatives in our states, we will fight to protect access to reproductive health care. One of the fundamental ideals that we hold close as Americans is that we have a right to privacy, which includes the right to make informed decisions about health care.