The abortion medication mifepristone remains fully available in Vermont. That's after the U.S. Supreme Court on Friday placed a temporary hold on an appeals court ruling that restricted access to the drug nationwide.
But mifepristone’s future is still murky. Earlier this month, a federal judge in Texas took the unprecedented step of reversing the FDA approval of the drug from 23 years ago. Now, the Supreme Court will decide whether to keep mifepristone available as an appeal from the Biden administration plays out.
The Vermont Attorney General's Office has also joined a multi-state coalition trying to preserve access to the drug.
Vermont Public’s Jenn Jarecki spoke with Lucy Leriche, Vice President of Public Affairs for Planned Parenthood of Northern New England, to learn more about how the legal battle could impact abortion care here in Vermont. Their conversation below has been edited and condensed for clarity.
Jenn Jarecki: Medication is used to carry out the majority of abortions here in Vermont. Before we get into the court case, Lucy, can you explain for us what medical abortions are and why they're so common here?
Lucy Leriche: Sure. Basically, it's being able to have an abortion in the comfort of your own home with medications. It's a two-pill regimen. It starts with mifepristone. And then you take misoprostol. Mifepristone blocks the hormones that grow the pregnancy, and misoprostol eliminates the contents of your uterus.
So it's something that can be done in a controlled environment, on your own schedule without any kind of procedure. So it really has become the preferred method of abortion care. More than 70% of the abortions that Planned Parenthood of Northern New England does are medication abortion.
Lucy, I've been getting a little bit of whiplash following all the court rulings over this last week-plus. It looked like the drug was potentially going to be restricted completely, then just partially. And now it remains available, but that could change in the next day or two. Can you talk with us about the next movement we may see in this case from the Supreme Court?
Yeah, I mean, there are some parallel paths. You mentioned the Washington case. And the state of Vermont is working under the legal guidance of the Vermont Attorney General's office in keeping the two-pill protocol in place.
As the Supreme Court decides the fate of this drug, it could be drawn out, or we might find out in the fall. But you have good reason to feel like you have whiplash, because this has been a tumultuous and very confusing time.
And of course, we know there's a range of potential outcomes here. But broadly speaking, Lucy, how would restricting mifepristone impact access to abortion here in Vermont?
So if the state of Vermont ended up being subjected to a court decision — that would require us to give up the use, or ban the use in some way of mifepristone — in Vermont, at Planned Parenthood, we have a plan in place to switch to a misoprostol-only medication abortion. It is also still safe and effective. But I would consider it as like, the second tier of preference.
Could you explain in a little bit more depth why it's really not ideal to go down to a one-pill regimen, but why the two-pill regimen is so much more effective?
Sure. The two-pill regimen is really the gold standard and the best practice in medicine. It's 98-100% effective. There are severe complications in less than 1/3 of 1% of medication abortions using the two-pill regimen of mifepristone and misoprostol — so it's definitely the preferred option.
When you go to a misoprostol-only approach, it’s just a little less certain. The patient might take two doses, three doses, maybe even four doses. And if the abortion isn't successful, they may then have to go in clinic and get a procedural abortion to empty the contents of the uterus.
It's still incredibly safe, 95-98% safe and effective. But it might cause more gastrointestinal issues, more bleeding, more cramping. So it's not ideal, because the mifepristone and misoprostol together are just that much more safe and effective.
Lucy, do you know, would Vermonters be able to visit Canada for mifepristone, if the drug is deemed illegal here in the U.S.?
I think that as individual patients, we absolutely can do that.
Well, we've been talking a lot about the technical aspects of this issue. And I'm wondering, Lucy, if you can speak to how the legal back-and-forth over medical abortion access is impacting providers and inpatients emotionally here in Vermont.
I mean, it's incredibly stressful for everyone, and confusing. Patients are stressed already. And coming off of COVID and inflation, it's a lot. It's a lot for patients to have to endure, to feel confusion around whether or not they can access basic reproductive health care.
From the point of view of Planned Parenthood, I can say that it's incredibly disruptive and stressful. We meet every day, basically, to review the latest court ruling and determine how we're going to practice care, or whether or not the way we practice care has to be modified for that day. So yeah, it's incredibly difficult.
Because abortion is under attack, and gender-affirming care is under attack, health care providers are also watching their backs and watching their steps and thinking about, “Well, if I provide an abortion to a patient in Florida, can I go to Florida to see my parents over the holidays? Will that put me in danger? Or will I be risking, you know, some kind of legal consequences or harassment?” So it's — it's a whole different world.
To finish up: What will you be watching for, as this court case continues to unfold?
Well, I'm going to be looking for certainty in how we can move forward. And of course, we're all, we're looking for justice, and we're looking for victory on behalf of patients and health care providers, for people to access basic reproductive health care without political interference.
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