Since the fall of Roe v Wade in 2022, the use of mifepristone – a medication sometimes called the “abortion pill” – has been in jeopardy. Learn more about this medicine, the lawsuits targeting its use and the questions about its future. 

What is mifepristone?

Mifepristone is a medicine - commonly used with another medicine called misoprostol - for abortion. It works by blocking progesterone, a hormone needed for a pregnancy to continue. 

“Mifepristone is heavily studied and safe,” says Maria Rodriguez, M.D., M.P.H., an obstetrician-gynecologist and director of the OHSU Center for Reproductive Health Equity. “Abortion is one of the most common procedures in this country, and it’s something everyone may need access to at some point in their lifetime.” 

A brief history of mifepristone in the United States

2000-2007 

• After FDA approval in 2000, mifepristone was available in all 50 states, Washington D.C., Guam and Puerto Rico.  
• Only a doctor could prescribe mifepristone. Patients needed to have three medical visits. In some states, the doctor needed to be in the room with the patient when they took the pill. 

2016 

• The FDA approved use of mifepristone to end a pregnancy up to 70 days since the last menstrual period. 

2020 – 2021 

• Concerns for safe access to abortion care during the COVID-19 pandemic caused the American College of Obstetricians and Gynecologists (ACOG) to file a lawsuit to make mifepristone available in retail pharmacies and by mail. By the end of 2021, the FDA relaxed the in-person medical requirements. This paved the way for abortion care via telemedicine. Mifepristone still requires a prescription, but the pills could be sent by mail. 

2022 

• On June 24, 2022, the Supreme Court struck down Roe v Wade, ending nearly 50 years of federal protection for abortion care. 
• Since then, 21 states have either banned or restricted access to abortion care. 
• The day of the decision, OHSU issued a statement: Abortion is essential health care. Abortion remains unrestricted in Oregon and Washington. 

2023 

• In April 2023, a U.S. District Judge said that the original FDA approval process for mifepristone was flawed. A group of judges ruled to keep mifepristone legal, but to put in place restrictions that would: 
• Prohibit sending the medicine by mail.  
• Discontinue telemedicine appointments for abortion care.  
• Even in protected states, these changes require an in-person visit for abortions, creating access barriers such as transportation, travel costs and time away from work or childcare duties.  
• In response, another U.S. District Judge issued a ruling, arguing that the more “relaxed” access to mifepristone must remain. 
• The Supreme Court stepped in, putting a hold on the lower court decisions. As a result, mifepristone is still available via telemedicine and mail until the Supreme Court makes its decision.  

What’s ahead for mifepristone and abortion access?

The Supreme Court may choose to keep full or partial access to mifepristone. It could also ban access to mifepristone altogether by revoking its original FDA approval. This decision would make mifepristone unavailable in all 50 states. In states where abortion is legal, medical abortion could continue to be provided with misoprostol. However, this single-dose regimen is less effective and has more side effects than when it is used in combination with mifepristone. 

“We know Oregon has a long history of supporting reproductive rights, but this ruling will take place at the federal level,” says Rodriguez. “We want people to know that even if this ruling restricts access to mifepristone, we will continue to provide the care they need.”