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How a SCOTUS ruling on mifepristone might disrupt abortion care in Pa.

Anti-abortion advocates celebrate outside the Supreme Court in Washington on June 24, 2022, following the court's decision to end constitutional protections for abortion that had been in place nearly 50 years.
Steve Helber
Anti-abortion advocates celebrate outside the Supreme Court in Washington on June 24, 2022, following the court's decision to end constitutional protections for abortion that had been in place nearly 50 years.

More than half of abortions in Pennsylvania are medication abortions that use a two-pill regimen.

Pennsylvania is one of the states where patients can get a medication abortion via telehealth appointment, which means they don't have to travel as far to receive care.

Dr. Sarah Horvath, vice chair for research in the department of obstetrics and gynecology at Penn State's College of Medicine, says some patients who are sexual assault survivors find medication abortions less invasive.

“Those patients in particular may have a really hard time having a procedure through a speculum,” said Horvath, referring to the small metal instrument that clinicians insert into the vagina in order to see the cervix. “That could be something that's very retraumatizing for them, that can bring up PTSD and really be problematic.”

But a case that was heard last week by the U.S. Supreme Court threatens widespread access to medication abortion — including in Pennsylvania where abortion is legal up until 24 weeks of pregnancy. The justices are expected to issue a ruling this summer.

How does a medication abortion work?

In Pennsylvania, only physicians can provide abortion care. So after receiving pre-abortion counseling and a 24-hour waiting period — which are both state-mandated — a patient takes a medication called mifepristone.

Mifepristone blocks the hormone progesterone. This causes the tissue that lines the walls of the uterus to detach. Then, 6-8 hours after taking the mifepristone, the patient takes the second medication: Misoprostol. Misoprostol causes contractions, which pushes the pregnancy out.

Doctors in Pennsylvania do not have to physically dispense either medication, so patients can be prescribed the pills using telehealth.

Up to how many weeks gestation can a patient use medication for an abortion?

Guidelines from the Food and Drug Administration say that patients can take mifepristone, the first drug prescribed in a medication abortion, at up to 10 weeks of gestation. However, some physicians in Pennsylvania prescribe mifepristone off-label past this mark: Doing so is backed up by research and is in line with the World Health Organization, which says patients can self-administer the two-pill regimen up until the 12th week of pregnancy.

How might the SCOTUS case upend access to medication abortion in Pennsylvania?

The legal arguments surrounding the case are complex, but it essentially hinges on access to mifepristone. It’s possible that the court will prohibit the use of the drug after seven weeks of pregnancy. Justices could rule that clinicians have to be in-person when the mifepristone is dispensed — that could end the use of telehealth abortion care, even in states like Pennsylvania where abortion is legal.

Penn State’s Sarah Horvath notes other medications that she prescribes to patients don’t have these same restrictions.

“Folks who don’t have the time to talk off work, who don’t have the gas money to travel are going to feel the consequences more than people who have better access, who have better resources,” said Horvath.

Are telehealth abortions less safe than in-person care for patients?

A recent study from researchers at the University of California, San Francisco found that, “telehealth medication abortion is effective, safe and comparable to published rates of in-person medication abortion care.”

Of the more than 6,000 patients who received abortion care via telemedicine, 99.7% had no serious adverse events. And 97.7% of these patients didn’t need any additional follow-up care after ending their pregnancies.

Sarah Boden