At least for now, people seeking abortions in Michigan can still get mifepristone, one of two drugs commonly used in medication abortions.
That’s despite the legal confusion set in motion Friday, when a Texas judge ruled to suspend the FDA’s approval of the drug, which it first authorized back in 2000. But the judge said the order wouldn’t go into effect for seven days, in order to give the U.S. Department of Justice time to appeal.
The same day, a judge in Washington issued a contradictory ruling, ordering the FDA not to make any changes to mifepristone’s availability. That case was brought by several states, including Michigan. On Monday, the federal government asked the appeals court to put the Texas ruling on hold. The case is likely headed for the U.S. Supreme Court.
In the meantime, Dr. Sarah Wallett said she’s going to keep offering patients mifepristone for as long as she can.
“There is no question that mifepristone is safe and effective,” said Wallett, the chief medical operating officer for Planned Parenthood of Michigan. “All of the medical evidence, all of the major medical organizations, all the providers, myself included, believe that this is the best option for people who choose medication abortion. I want to make sure that people don't question those facts because of this lawsuit. The lawsuit is politically motivated. It is designed to prevent people from accessing health care or prevent people from accessing abortion.”
For now, the Texas ruling isn’t in effect, said Leah Litman, professor at the University of Michigan Law School.
“Now, in the event the ruling does go into effect, there is considerable uncertainty about what exactly that would mean. Nothing in the ruling requires the Food and Drug Administration to go out and try to remove all the mifepristone out there from the shelves. Nothing about the ruling requires the Food and Drug Administration to begin issuing penalties or beginning enforcement proceedings against doctors who prescribe mifepristone. And I think many people are hoping that the Biden administration, of course, would do no such thing,” Litman said Monday on Michigan Radio’s Stateside.
But the current confusion is no accident, she said. “That uncertainty, and really the chaos, is part of why the anti-abortion plaintiffs in the Texas case sought this ruling.”
Meanwhile, groups that oppose abortion rights are celebrating the Texas ruling, including groups in Michigan.
“The ruling that came out of Texas was based on the historic documents submitted to the court showing that the FDA unlawfully approved the abortion pill in the year 2000,” said Genevieve Marnon, legislative director for Right to Life of Michigan. “I think Michiganders and Americans alike expect the FDA to be a nonpolitical, unbiased body that protects Americans and Michiganders by approving safe and effective drugs. That’s not the process that took place with the abortion pill.”
Decades of research have shown both types of abortion pills, mifepristone and misoprostol, are safe to use. Taken in combination, the pills are used in more than half of all abortions nationally. They’re also used to help pregnant women who’ve experienced miscarriages, said Dr. Lisa Harris, a professor and the associate chair of obstetrics and gynecology at the University of Michigan.
“And if mifepristone were to become unavailable, we wouldn't be able to use it in either of those settings,” she said. “So this broadly affects many, many people, even people who think they would never be faced with an abortion decision.”
What happens in Michigan if mifepristone isn’t available?
Even if the FDA’s approval of mifepristone is struck down, patients would still be able to get safe, legal abortions in Michigan. They would have two options: have a surgical abortion or go the pill route using misoprostol alone. But that’s slightly less effective than using the two drugs combined.
“It's more like 85-95% effective, rather than 95-99% effective,” Harris said. “And it involves more hours of nausea and vomiting and other side effects. So we will still be able to provide medication treatment for miscarriage and abortion care, but we won't be able to use the regimen that is the most effective.”
Harris predicts fewer patients would opt for medication abortions, especially if they’re traveling from states where abortion is illegal.
“A lot of people might say, ‘Well, I don't want this substandard regimen. I don't want to have any uncertainty about it. I can't come back if it doesn't work.’ …And that would be fine for people to make that decision, except that we don't have the infrastructure right now to ramp up procedural care. …We don't have a way to suddenly, overnight, replace that medication care with surgical care.”
That could mean longer wait times, Wallett said.
“If a lot more patients choose procedural abortion, it would be hard to see them all. Our health centers are designed right now for about 50% of our patients, or a little bit more, to choose medication abortion. Procedural abortions in a health center take different resources. They take different staffing. They take more time in a health center, just because of the nature of what's happening.”
For those who did still opt for medication abortions using misoprostol alone, there would be a greater risk of having an incomplete abortion.
“Perhaps about 20% of the time, the medications wouldn't work,” she said. “And the pregnancy may be partially expelled, but not completely, or it may not be expelled at all. And someone would need to be able to figure that out, and they would need to seek care to complete the process.”
Medication abortion patients can check to make sure the abortion was successful by getting a blood test, or taking a pregnancy test several weeks later.
“What I would worry about is that someone wouldn't know that, or they would wait too long to recognize they had an ongoing pregnancy,” Wallet said. “...And that means additional procedures in our health center as well. If you have more failed medication abortions, and then people want a procedure to finish the process, that's additional procedures that will happen, even if they aren't choosing a procedural abortion from the get go.”
