St. Louis doctor: Restricting access to mifepristone would endanger patients



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For the past few weeks, we have watched with anxiety as American healthcare takes a backseat to American politics. We watched this play out on Friday, April 7, when Federal Judge Matthew Kacsmaryk sided with the conservative Christian legal advocacy group, Alliance Defending Freedom, and issued an injunction on the FDA’s 2000 approval of mifepristone.

After two weeks of multiple rulings, on April 21, the U.S. Supreme Court ruled that mifepristone would remain available without further restrictions until the issue is fully litigated and works its way through the courts.

As healthcare providers, we have temporarily exhaled. For now, our patients will still have access to this safe and effective medication, used in combination with misoprostol for over 50% of abortions under 10-weeks gestation in the United States. Overturning the FDA approval of mifepristone would impact tens of thousands of pregnant people across our country.

After the initial ruling, Erik Baptist, senior legal counsel for Alliance Defending Freedom, stated that “this is a significant victory for …. the health and safety of women and girls.” Contrary to his statement, Mifeprex has been used safely and effectively for over 20 years. Its approval and safety are based on numerous medical studies, and it is successful in 95-98% of cases depending on gestational age. The risk of serious complications from the two-drug protocol (mifepristone and misoprostol) is less than 0.3%.

By comparison, the risk of serious complications from a surgical abortion is about 0.4%, and the risk of serious complications in childbirth is 1.3%. Despite this safety record, Mifepristone is also subject to “REMS,” risk evaluation and mitigation strategy. REMS requires pharmacies and physicians who carry and prescribe this drug to become certified. No such requirement is in place for penicillin or Viagra, even though a person is four times more likely to die as a reaction to penicillin, and nearly 10 times more likely to die as a reaction to Viagra, than to die from taking mifepristone.

Tylenol, available over the counter, is also not subject to REMS, even though it can cause severe liver damage when taken in excess. The REMS mandates on mifepristone limit access to medication abortion, despite its proven safety compared to pregnancy and these commonly used medications.

If Kacsmaryk’s ruling goes into effect, mifepristone will no longer be available anywhere in the United States. As a result, the only option for medication abortions will be to use the drug misoprostol alone. The misoprostol-only regimen, already used in some other countries, has a significantly lower success rate of 80%. In some cases, this means the pregnancy continues. In others, this results in complications such as an incomplete abortion, hemorrhaging, or sepsis at a higher rate than the two-drug regimen with mifepristone.

The lower success rate and higher complication rate will drive more women to have surgical abortions, significantly increasing wait times, exhausting already stressed resources, and delaying some first-trimester abortions to the second trimester, where the risks are higher. This will also deepen economic inequality as patients without means to travel for in-person care will be disproportionately affected, continuing the cycle of poverty.

As a Jewish woman, I am proud that most in the Jewish community stand with pregnant people in support of their autonomy and agency over personal healthcare decisions. Judaism teaches that a fetus is not an individual until it is born and outside the womb. The Talmud says that existing life takes precedence over potential life, so the life of the fetus may be sacrificed to save the life of the mother.

Over time these teachings have evolved. For example, most Jews believe that pregnant people must have absolute autonomy over their own bodies, while some Jews believe that Judaism permits, and indeed mandates, abortion if the mother’s physical or mental health is at serious risk. In all branches of Judaism, complete abortion bans are contrary to Jewish law. But I believe that pregnant people must possess complete autonomy and agency to choose abortion without explanations or exceptions.

As we celebrate Mother’s Day, we should remember that parenthood should be a choice. To truly be free, those who may be pregnant must be able to make their own healthcare decisions, without having to justify their choice to satisfy the moral construct of others. Autonomy must be absolute, and I pray that, as Jews, we continue unfettered support of the individual right to choose when and if to be pregnant. Removing, or further restricting, access to this safe and effective drug will limit autonomy and harm patients, something that I find unacceptable as a physician and a Jew.

MO Healthcare Professionals for Reproductive Rights demands that our elected officials restore abortion access in Missouri. MO healthcare professionals can support abortion access here and community members here.

Dr. Jennifer Smith earned her medical degree from Washington University and completed her residency in obstetrics and gynecology at Barnes Jewish Hospital. She is in private practice with Consultants in Women’s Healthcare at Missouri Baptist Hospital and is a cofounder of Missouri Healthcare Professionals for Reproductive Rights.