GBH | Abortion supporters cautiously celebrate Supreme Court preserving access to abortion pill

By Hannah Reale
Story Originally Appeared on GBH

Advocacy groups are applauding the Supreme Court decision handed down on Friday night, an order that will keep a common abortion drug available, for now, without any changes to when and how it can be prescribed. But they continued to express frustration at how close the courts had come to revoking approval of the drug mifepristone, one of two drugs typically used in medication abortions, and emphasized that that ruling could still come as the federal lawsuit works its way through the courts.

“[This] decision from the Supreme Court to uphold the stay on mifepristone allows us to breathe a temporary sigh of relief. As this case goes through the appeals process, millions of people will be able to continue to access mifepristone in states where abortion remains legal,” Rebecca Hart Holder, president of Reproductive Equity Now, said in an emailed statement. “However, we need to be clear-eyed that this is not the end of our battle to protect medication abortion access nationwide. ... Every day that preserves abortion access is a good day, but the fight continues.”

Two weeks ago, a federal judge in Texas ordered the Food and Drug Administration to revoke its approval of mifepristone, taking issue with the original approval process of the drug. The order never went into effect, though, as the Justice Department appealed the case — twice — up to the Fifth Circuit Court of Appeals, and then again to the Supreme Court. The Fifth Circuit’s decision would have allowed years-old restrictions on mifepristone to go back into effect, such as eliminating the ability to send the drug by mail and reducing the number of weeks in pregnancy that it is approved for from 10 weeks down to seven.

But the Supreme Court put a stop to that Friday, ordering that restrictions on the drug will remain unchanged while the case is appealed.

“There’s a lot of uncertainty. On Friday night, it was definitely exuberance and happiness that we will be able to continue providing mifepristone to patients,” said Dr. Tara Kumaraswami at UMass Memorial Health. “There is also frustration this safe and effective medication has been put in place in such uncertainty.”

Such restrictions would change how huge numbers of women get abortions in the United States. More than 40% of medication abortions were at or beyond seven weeks of pregnancy, according to a 2020 federal survey, something that would no longer be approved by the FDA. A recent report found that one in 10 abortions nationally were provided by a virtual clinic, via telehealth, in December of last year.

Kumaraswami emphasized that it’s impossible to know what the impact of the legal murkiness has been on women who wanted to end their pregnancies.

“We’ve been able to continue providing the same care that we have previously provided before any of this uncertainty was raised,” she said. “There are possibly people out there who don't realize that it's still something that they can access with their providers. And so we just don't know if those people are coming to us or not.”

Providers in Massachusetts have previously vowed to continue providing medication abortions with only the second drug, misoprostol, if mifepristone becomes unavailable. That regimen has been shown to be slightly less effective and have different, often more severe side effects.

Gov. Maura Healey took action in recent weeks to try to preserve access to mifepristone in Massachusetts. She asked UMass Amherst to stockpile 15,000 doses of mifepristone. She also signed an executive order, affirming that mifepristone is covered under a 2022 state law that protects abortion providers and their patients from out-of-state legal action.

“This is good news, but it shouldn’t have gotten to this point,” Gov. Maura Healey wrote on Twitter in reaction to the Supreme Court’s order. “And it’s far from over.”

Kristie Monast, the executive director of HealthQ that operates three clinics in Massachusetts, said she’s grateful for the leadership in Massachusetts. But she added that the onslaught of challenges to abortion access, through state-level bans and lawsuits, have been emotionally draining and “traumatizing.”

“For us as an abortion-providing community, it feels like the last year has definitely been being on the defense,” she said. “The last year and a half have been really exhausting. And we’re also working in a health care system where I think we’re already exhausted.”

Some providers are also stockpiling pills, given that legal access could be up in the air in the future. Julia Kehoe, president and CEO of Health Imperatives, which serves low-income populations at clinics in Hyannis, Martha’s Vineyard, Nantucket, Brockton, New Bedford, Plymouth and Wareham, said they have ordered enough mifepristone to last about a year.

“We ordered it one day and had it in hand the next,” she said.

Health Imperatives is getting ready start offering medication abortion at all of its clinics in July. Kehoe said Massachusetts leaders’ actions the past few weeks to protect mifepristone have been “groundbreaking,” but uncertainty remains.

“We’re still extremely concerned and disturbed about what could happen in the future, but we’re cautiously optimistic that this is a sign that the Supreme Court may not tolerate such an egregious abuse of the judicial process,” she said.

Planned Parenthood League of Massachusetts interim President and CEO Ellen Frank said the organization is “proud to be the leading provider of this care in Massachusetts.”

“Medication abortion is essential health care that helps patients to manage their abortion safely, on their own terms,” Frank said in an emailed statement. “Planned Parenthood League of Massachusetts is and will continue to do everything we can to ensure patients can access abortion care with as few barriers as possible.”

Carol Rose, the executive director of the ACLU of Massachusetts, put out a statement welcoming the Supreme Court decision, but noting is not the end.

“This is very welcome news, but it’s frightening to think that Americans came within hours of losing access to a medication that is used in most abortions in this country and has been used for decades by millions of people to safely end a pregnancy or treat a miscarriage,” Rose wrote.