Legal challenges are aiming to take mifepristone off the market. An alternative, however, exists.
A series of legal challenges working their way through the federal courts and now taken up by the Supreme Court has raised questions about the future of access to mifepristone, an abortion medication that is used in more than half of all US abortions with high effectiveness and few severe side effects.
Mifepristone is the first of two drugs usually prescribed together to induce an abortion. The second, misoprostol, however, can be used to terminate a pregnancy on its own. The fate of mifepristone has been in limbo since April, and abortion providers have since scrambled to prepare for a new set of logistics and side effects that might accompany misoprostol-only abortion — all while evaluating the legal risks of providing a medication that is now sure to face increased scrutiny.
The Texas lawsuit heard by Kacsmaryk and filed by the Alliance for Hippocratic Medicine, an anti-abortion group, also sought to ban the use of misoprostol in abortions, but the group did not ask the judge to rescind the medication’s FDA approval, and Kacsmaryk’s ruling addressed only mifepristone. Abortion rights groups, however, say they expect that opponents of the procedure will continue to try to ban the use of misoprostol in abortions.
“Anything could happen,” Farah Diaz-Tello, senior counsel and policy director at the reproductive justice legal group If/When/How, told Vox this spring. “I wouldn’t put anything past them at this point.”
With another sea change in abortion access potentially on the horizon, here are answers to some common questions about the drug. What is misoprostol?
Before the Texas lawsuit, the FDA-approved protocol for medication abortion consisted of a dose of mifepristone to stop the pregnancy from progressing, followed 24 hours later by up to two doses of misoprostol to induce contractions and cause the uterus to empty.
The two drugs work in concert to end a pregnancy, but they have very different histories. Mifepristone was developed in the 1980s in France specifically as an abortion drug, and was approved for use in the US in 2000. Misoprostol, however, was developed in the 1970s to treat stomach ulcers. Its use in abortion was pioneered by a group of feminists in Brazil, where surgical abortions were largely inaccessible, said Ushma Upadhyay, a professor with Advancing New Standards in Reproductive Health at the University of California San Francisco.
While mifepristone was tightly regulated even before the Texas lawsuit, misoprostol is available with a prescription at most US pharmacies. It is also available over the counter in many other countries, including Mexico.
