Clinics want patients to know medication abortion remains available in Georgia for now

A patient prepares to take the first of two combination pills, mifepristone, for a medication abortion during a visit to a clinic in Kansas City, Kan., on Wednesday, Oct. 12, 2022. A federal appeals court has ruled that the abortion pill mifepristone can still be used for now but reduced the period of pregnancy when the drug can be taken and said it could not be dispensed by mail. (AP Photo/Charlie Riedel, File)

New limits on a widely used abortion medication could have dangerous implications for reproductive health care in Georgia. That’s the message from some OB-GYN physicians and advocates in the state after a week of federal court rulings that would restrict the drug’s use and distribution.

On Friday, the United States Supreme Court temporarily blocked those restrictions while the court case plays out. 

They’re on hold until 11:59 p.m. Wednesday.

More than half of all pregnancy terminations in the country are medication abortions, using a two-drug protocol of mifepristone and misoprostol.

Mifepristone is also commonly used to treat early pregnancy loss.

“Very similar to the reasons that the people give for choosing medication versus surgical abortion, they might choose the same for early pregnancy loss management when they have a miscarriage,” said Emory University professor of gynecology and obstetrics Dr. Carrie Cwiak.

She is also a plaintiff in a state lawsuit challenging Georgia’s abortion law H.B. 481, which bans abortions, including medication abortions, after around six weeks of pregnancy, when cardiac activity is detected in the womb. 

The two-drug mifepristone and misoprostol regimen is standard for the medication management of miscarriage in the U.S. 

“The mifepristone-misoprostol regimen is superior. So it is more effective, has less side effects and therefore therefore it’s favored in situations where you have access to mifepristone. But there are healthcare providers that are already using misoprostol-only regimens, where they don’t have ready access to mifepristone, because it is still 85% effective, so highly effective,” Cwiak said. “And we can give medications to help mitigate the side effects of the regimen.”

It’s still unclear whether potential restrictions on the use of mifepristone for abortion would also limit its use for miscarriage treatment. 

The FDA approved mifepristone more than two decades ago. 

This week, New Orleans appeals court judges rolled back policy changes in effect after 2016 that made the medication easier to get — lengthening the gestational period when mifepristone is used from seven weeks to 10 weeks, and allowing it to be sent by mail. 

The appeals court ruling would again prohibit it from being sent by mail.

Cwiak said the additional restrictions would limit telemedicine care that more and more patients are relying on in Georgia, especially during the COVID-19 pandemic.

“And so if there’s a patient who doesn’t have risk factors for ectopic pregnancy, doesn’t have symptoms that are concerning, has a very clear last menstrual period that makes the clinical dating of the pregnancy very straightforward and certainly has no other contrary indications, then they can be provided mifepristone safely via telemedicine because in those instances an ultrasound is not required, laboratory testing is not required, an exam is not required,” she said. 

Anti-abortion groups applauded the ruling that would tighten the restrictions around medication abortion.

Meanwhile, clinics around Georgia that provide abortion services are watching the ongoing legal battles closely. 

Feminist Women’s Health Center, an Atlanta clinic that is also a plaintiff in the challenge over Georgia’s abortion law, said it plans to continue providing medication abortion in compliance with the FDA, and state and federal laws. 

“Decades of research tell us that the pill is a safe option for abortion care, just as the FDA has already determined. Feminist Women’s Health Center will continue offering medication and surgical abortion care, and we will continue to educate our communities on all available options,” executive director Kwajelyn Jackson said. 

Planned Parenthood Southeast said in a statement if plans to continue providing medication abortion “with regard to Georgia’s six weeks or gestational cardiac activity abortion restriction.”

In March, the Georgia Supreme Court heard oral arguments in the lawsuit challenging H.B 481. Justices are expected to rule in the case soon.