State, federal abortion rules prevent many women from accessing crucial miscarriage drug
Doctors and reproductive health advocates blame a thicket of overlapping cultural, political and regulatory factors for limiting patient access to mifepristone.
Decades of federal data show that the drug only rarely causes serious side effects and is responsible for fewer deaths than Tylenol. The two-drug combination is just as safe as misoprostol alone.
More than 90 countries have approved mifepristone since the late 1980s — including Canada, which since 2017 has permitted any physician or nurse practitioner to prescribe mifepristone and any pharmacist to dispense it.
In the United States, however, mifepristone is typically only available at hospitals, health clinics and doctors’ offices that routinely provide abortions or that employ specialists in “complex family planning,” a branch of gynecology focused on abortion, contraception and miscarriage management.
Some retail pharmacies also have begun to stock the drug since January of this year, when the Food and Drug Administration loosened some long-standing restrictions, said Abby Long, a spokesperson for Danco Laboratories, which manufactures mifepristone under the name brand Mifeprex.
But the names of those pharmacies are confidential, and few have chosen to publicize the fact that they carry the drug, Long said. Both CVS and Walgreens, the country’s largest pharmacy chains, have applied for permission to dispense mifepristone, but neither has been certified yet.
Clinics that stock mifepristone also represent a small and seldom advertised subset of health care providers, said Dr. Michael Belmonte, a practicing OB-GYN in Washington, D.C., and a fellow at the American College of Obstetricians and Gynecologists. Such facilities may be inaccessible to patients living in rural or low-income communities. There also is no publicly available list of clinics, offices or pharmacies that provide mifepristone, said Belmonte.
“Typically, it’s on the individual physician to understand their community,” Belmonte said. “Even for me as a complex family planning specialist, I understand how complicated that is — and it’s only more complicated, unnecessarily so, for a general OB-GYN or someone in family practice.”
Some miscarriage patients also may balk at turning to a clinic or health center better known for performing abortions. Federal law further requires that all patients who receive mifepristone sign a form acknowledging their desire to end their pregnancy, even if they’ve experienced a miscarriage.
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State abortion bans also impede miscarriage care, medical groups have said. Since the Supreme Court overturned Roe v. Wade last year, 14 states have banned abortion, some with explicit allowances for treatment that saves the life of the person giving birth or that eases miscarriage. But not all state laws make that distinction, said Alina Salganicoff, the director for women’s health policy at KFF, and many are written in confusing, nonmedical language that doctors struggle to interpret in real-life situations.
In Louisiana, for instance, doctors asked the state Department of Health to clarify whether the state’s near-total abortion ban extends to the treatment of miscarriages, ectopic pregnancies and other pregnancy complications. As currently written, state law requires physicians to confirm a miscarriage by ultrasound before beginning treatment. Republican legislators voted down a proposed bill in May that would have granted physicians more discretion when making care decisions.
“There’s a difference between the legal status of mifepristone for miscarriage care in states that are extremely hostile to abortion and the understandable concerns that providers might have given the hostility of that climate,” said Julia Kaye, a senior staff attorney with the American Civil Liberty Union’s Reproductive Freedom Project.
Kaye points, in particular, to letters that more than 20 Republican state attorneys general sent to major pharmacy chains earlier this year, threatening legal action against providers that dispensed or administered mifepristone, with no allowances for miscarriage care.