When Roe v. Wade was overturned last year, many touted medication abortion—a nonsurgical procedure that involves taking a pill called mifepristone to stop the pregnancy from progressing, followed by a pill called misoprostol to empty the uterus—as a potential saving grace for those seeking abortions in states that would no longer provide in-person surgical procedures.

As of 2022, medication abortions accounted for more than half of all US abortions, but recently new restrictions around mifepristone have imperiled access and raised questions about the future of the drug. Below, find a guide to what’s going on with the legality of medication abortions in the US.

Why is medication abortion under attack right now?

Wildly enough, the outcome of one Texas lawsuit could end up affecting the availability of medication abortions across the country. Last November, the Alliance for Defending Freedom, a conservative Christian legal advocacy group, filed a lawsuit against the FDA on behalf of the Alliance for Hippocratic Medicine, a coalition of physicians who oppose abortion, alleging that the FDA’s procedures for approving the drugs were out of date. Should Trump-appointed US District Judge Matthew Kacsmaryk rule in favor of the plaintiffs, he could “grant an emergency injunction that would revoke the FDA’s approval of mifepristone nationwide,” according to Newsweek, affecting nearly 65 million women of reproductive age. Kacsmaryk is due to make his decision by February 24. 

Why would the approval of mifepristone—but not misoprostol—be reversed?

While mifepristone has been FDA approved since 2000, misoprostol’s use for a variety of conditions (including the prevention of stomach ulcers, labor induction, and postpartum bleeding) makes it less of a target for the anti-choice plaintiffs behind the lawsuit.

Can a medication abortion happen without mifepristone?

While it is possible to obtain an abortion using only misoprostol, the mifepristone-misoprostol combination is considered to be the most safe and effective route, with success rates over 95%. A misoprostol-only abortion regimen, on the other hand, has a success rate of about 80 to 85%.

What are the potential negative outcomes of banning mifepristone?

New York Attorney General Letitia James argued in a letter written on behalf of 21 states and the District of Columbia that banning mifepristone could result in an “unprecedented spike” in maternal mortality and make it more difficult for clinics that provide abortions to provide other potentially lifesaving reproductive care due to an increased demand for surgical abortion services. “With increased demand for abortion care produces delays in accessing other forms of care at those facilities, the result will inevitably be higher rates of unintended pregnancy and sexually transmitted infections,” James wrote.

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