A Texas judge’s ruling could take mifepristone off the market. An alternative, however, exists.
In a move that could further curtail Americans’ already limited reproductive options, a federal judge in Texas ruled on Friday to reverse the FDA’s approval of mifepristone, an abortion medication that has been used in the US for more than 20 years 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, remains available because it is also commonly used to treat stomach ulcers. However, it can be used to terminate a pregnancy on its own. Now, with the fate of mifepristone in doubt, abortion providers are scrambling to change their dosages and appointments and help patients deal with a new set of logistics and side effects — all while evaluating the legal risks of providing a medication that is now sure to face increased scrutiny.
While the Texas lawsuit filed by anti-abortion group the Alliance for Hippocratic Medicine also sought to ban the use of misoprostol in abortions, 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,” said Farah Diaz-Tello, senior counsel and policy director at the reproductive justice legal group If/When/How. “I wouldn’t put anything past them at this point.”
With the latest sea change in abortion access 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.
