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How Pennsylvania providers will pivot if an abortion drug gets banned

The drug misoprostol sits on a gynecological table.
Victor R. Caivano
The drug misoprostol sits on a gynecological table at Casa Fusa, a health center in Buenos Aires, Argentina, Friday, Jan. 22, 2021.

The 5th U.S. Circuit Court of Appeals will hear oral arguments on Wednesday in a case that asks whether a medication used for abortion can remain on the market; the eventual outcome has implications for providers and patients across the country — including western Pennsylvania.

More than half of abortions in the U.S. are done with medication; the most common protocol uses a two-pill regimen. The federal court case centers on the first of these drugs — mifepristone — which blocks progesterone, a hormone needed for pregnancy to continue. The Alliance for Hippocratic Medicine is attempting to get mifepristone pulled from the market in a lawsuit against the U.S. Food and Drug Administration: The plaintiff contends that the federal agency erred when it approved mifepristone back in September 2000 during the final months of the Clinton Administration.

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Even if Alliance for Hippocratic Medicine wins its court case, medication abortions will continue because people can still end a pregnancy if they take additional doses of the second drug used in most medication abortions. Misoprostol has several uses, such as the treatment of stomach ulcers and prevention of postpartum bleeding; with abortion, it stimulates the uterus to expel the pregnancy. The World Health Organization endorses the single-drug protocol as an alternative method for medication abortions as research shows it is safe and effective.

Sydney Etheredge, CEO of Planned Parenthood of Western Pennsylvania, says, for the last five or six months, clinic staff has been planning for the possibility they might need to switch to a misoprostol-only protocol for patients seeking medication abortions. This work includes drafting new education materials, retraining staff and forming new workflow plans.

Etheredge took over as head of Pittsburgh’s Planned Parenthood affiliate the month after the U.S. Supreme Court heard oral arguments in the case that would result in the overturning of Roe v. Wade, a ruling that had ensured a right to an abortion for nearly 50 years. As she watches yet another case that may upend reproductive health care move through the federal court system, her goal is to be prepared as possible, whatever the outcome: “It is so important to continue care and to make it seamless for our patients.”

Drawbacks of a misoprostol-only abortion

Choosing a medication abortion allows a person to terminate their pregnancy within the privacy of their own home. It can be more cost-effective for those who need to travel to an abortion provider, as a surgical abortion takes more time at the clinic and might require an overnight stay nearby to recover from the procedure.

However, patients will experience more heavy bleeding and cramping with a misoprostol-only protocol compared to those who also took mifepristone; plus, its success rate is slightly lower than the two-pill regimen.

Even if abortion providers can continue caring for patients with the two-pill regimen, Susan J. Frietsche of the Women’s Law Project warns there will be more attacks on abortion access in the coming years. “What we’re seeing play out in the 5th Circuit is not the end of the story.”

When Roe was struck down, says Frietsche, it created a whole new area of federal and state law that is still being written.

Sarah Boden covers health and science for 90.5 WESA. Before coming to Pittsburgh in November 2017, she was a reporter for Iowa Public Radio. As a contributor to the NPR-Kaiser Health News Member Station Reporting Project on Health Care in the States, Sarah's print and audio reporting frequently appears on NPR and KFF Health News.