Supreme Court reinstates restrictions on abortion pill

From Politico:

The Supreme Court on Tuesday night granted the Trump administration’s request to reinstate federal rules requiring people seeking medication abortions to obtain the pills in-person from a medical provider.

The court’s 6-3 decision along ideological lines halted a lower court ruling that waived the Food and Drug Administration rules to allow abortion pills to be distributed by mail during the Covid-19 pandemic.

Women Deserve Better Expert and American Association of Pro-Life Obstetricians and Gynecologists board member Dr. Ingrid Skop, an OB-GYN who has practiced in San Antonio for more than 25 years, issued the following statement:

“Abortion advocates have dishonestly attempted to leverage the COVID pandemic to permit unsupervised medical abortions. They sued the FDA to remove REMS restrictions on mifepristone, and in July a district judge agreed, allowing unsupervised use. Tuesday night, SCOTUS wisely blocked that judicial activism and upheld the medically sound restrictions that require adequate training of abortion providers, informed consent for women, accurate estimation of gestational age, documentation of intrauterine pregnancy, Rh status determination, and immunoglobulin administration if indicated. Without this supervision, women are at risk for medical abandonment if they have a complication, coercion, high failure rates if gestational age is beyond the 10 week cutoff, ruptured ectopic pregnancies, and isoimmunization, which could result in neonatal death or brain damage in future pregnancies. To use the pandemic as an excuse for poor quality medical care shows blatant disregard for the health of women, and these recommendations would consume precious emergency resources that need to be conserved during this time of crisis.”

Dr. Skop further explains:

A trend of mounting concern is occurring in abortion provision. Whereas once abortion advocates claimed they wanted abortion to be “safe, legal and rare,” now they favor immediate access and convenience, regardless of whether it might be more dangerous for a woman. The COVID-19 pandemic has fully exposed this dangerous agenda, as abortion advocates have leveraged the crisis to argue that all restrictions governing the use of medical abortion be removed, allowing women to access these drugs without a physical examination, ultrasound, or laboratory evaluation.(1) This would allow on-line, telemedicine and mail order provision, and ultimately, distribution over the counter without a prescription. “Do it yourself” abortions are being aggressively promoted to women.

It is important to understand the risks unique to medical abortion, which now comprise 39% of U.S. abortions. Two medications are utilized. Mifepristone blocks progesterone receptors in the uterus, cutting off hormonal support and causing fetal death. Due to the potential for serious complications, mifepristone has been regulated by the FDA’s Risk Evaluation and Mitigation Strategy (REMS) for the past twenty years. Misoprostol is given 24 to 48 hours later, inducing contractions that expel the pregnancy tissue.

Both medications suppress the immune system, increasing the risk of infection. Mifepristone also inhibits contraction of uterine blood vessels, predisposing to hemorrhage. If pregnancy tissue is not completely expelled, surgery is usually required. Even when the pills work as intended, the average woman will experience 9 to 16 days of bleeding, and 8% will bleed for more than a month.

While biased studies based on poor quality data published by the abortion industry report low complication rates of medical abortion, better-quality systematic reviews and records-linkage studies demonstrate high failure rates, often requiring surgery or hospitalization. Ongoing pregnancy, hemorrhage, infection, or incomplete evacuation of pregnancy tissue occur in 5-8% of women.(2) Complications are four times as frequent with medical compared to surgical abortion, occurring in as many as one out of five women.(3) 

There are significant risks to women if the REMS restrictions are no longer required. REMS…

  1. Requires a provider to intentionally register to prescribe mifepristone. Without this requirement, all health care providers and pharmacists will be pressured to provide these life-ending drugs.
  2. Requires provider training and standardized patient consent ensure that both are aware of the unique risks of medical abortion.
  3. Requires mifepristone to be dispensed directly to the woman seeking abortion. This prevents reproductive coercion and illicit use by others who may benefit from the loss of her baby.(4)
  4. Requires accurate assessment of the duration of pregnancy because underestimation of gestational age leads to far higher failure rates.
  5. Requires documentation of intrauterine pregnancy because mifepristone has no effect on an ectopic pregnancy, which can rupture, causing catastrophic bleeding or death.(5)
  6. Requires evaluation of a woman’s blood Rh status and provision of Rhogam immunoprophylaxis if indicated. This will prevent a mother from mounting an immune response to her future unborn children. If Rhogam is not given when indicated, and isoimmunization (mother’s antibody formation against her unborn child) occurs, 14% of untreated infants will be stillborn and half will suffer neonatal death or brain injury.(6)
  7. Finally, a provider is required to provide surgical intervention when medical abortion fails. Without a physician-patient relationship or proximity to emergency care, a woman experiencing these common complications finds herself abandoned and at high risk for adverse events.

It is apparent that unrestricted mifepristone use is not “compassionate medical care,” as abortion advocates allege, but rather, a “chemical coat-hanger.” Surely, women deserve better than this.


  1. Raymond E., et al. (2020). No test medication abortion: A sample protocol for increasing access during a pandemic and beyond. Contraception, 101(6), 361-366. doi: 10.1016/j.contraception.2020.04.005.
  2. Raymond E., et al. (2013). First trimester medical abortion with mifepristone 200 mg and misoprostol. Contraception, 87(1), 26-37. doi: 10.1016/j.contraception.2012.06.011; Mentula M., et al. (2011). Immediate adverse events after second trimester medical termination of pregnancy: Results of a nationwide registry study. Human Reproduction, 26(4), 937-942. doi: 10.1093/humrep/der016.
  3. Niinimäki M., et al. (2009). Immediate Complications After Medical Compared with Surgical Termination of Pregnancy. Obstetrics & Gynecology, 114(4),795-804. doi: 10.1097/AOG.0b013e3181b5ccf9.
  4. “Ethical Principles for Abortion Care,” National Abortion Federation, accessed September 27, 2019,; Megan Hall et al., “Associations between Intimate Partner Violence and Termination of Pregnancy: A Systematic Review and Meta-Analysis,” PLOS Medicine. 2014;11(1):e1001581. doi:10.1371/journal.pmed.1001581. accessed September 24, 2019.
  5. American College of Obstetricians and Gynecologists. (2018). Practice Bulletin 193: Tubal ectopic pregnancy. Obstetrics & Gynecology, 131(3), 613-615. doi: 10.1097/AOG.0000000000002559.
  6. American College of Obstetricians and Gynecologists. (2017). Practice Bulletin 181: Prevention of Rh D Alloimmunization. Obstetrics & Gynecology 130(2),481-483.