Mifepristone: A Tool for Reproductive Freedom
By Priya Pandey and Angélica Díaz Nuñez
The Supreme Court’s recent decision to keep mifepristone available and accessible means that a crucial way for people, particularly young people, to access reproductive care remains legal and protected.
Even before the Dobbs decision, barriers such as parental involvement laws, the Title X Domestic Gag Rule, and the Hyde Amendment severely curtailed access to abortion. These legal and policy restrictions disproportionately affected young people, who often struggle with financial constraints, logistical barriers like being able to travel to distant service sites, and the stigma surrounding abortion. That stigma further hinders their ability to seek necessary health care and advocate for reproductive rights amidst a hostile legislative climate aimed at limiting abortion access nationwide.
While abortion bans and restrictions affect all people seeking reproductive care, young people face additional logistical and legal hurdles. For example, legislators in Idaho, a state that has already banned abortion, recently became the first state to criminalize assisting someone under age 18 in traveling out of state to get a wanted abortion. Abortion restrictions and bans do not just impact young people who are pregnant or seeking abortions. They also influence their decisions about voting and where to live, study, and work, as well as their ability to manage their reproductive futures. Additionally, these restrictions may significantly affect the mental health of young people.
In 2022, 58 percent of adolescents seeking abortion care chose to have a medication abortion. Nearly a quarter of adolescents chose which health center to go to because it offered the option of medication abortion, while 40 percent selected it based on proximity and 26 percent for the ability to receive care as soon as possible.
The accessibility of mifepristone has been enhanced by FDA policies that permit telehealth prescriptions and mail delivery to patients, as well as its availability in major pharmacy chains and prescriptions from nurses and other health professionals. However, state abortion bans, specific bans on telehealth for medication abortion, and requirements for in-person dispensation of mifepristone and in-person visits will continue to restrict access in many states.
As a result, mifepristone accounted for nearly two-thirds of all abortions performed in the United States last year. Despite state laws aimed at restricting this medication, statistics indicate that individuals in those states still obtain it through mail deliveries, as state authorities have limited oversight over shipments handled by the U.S. Postal Service. This ease of access, coupled with comprehensive information on its safe use, underscores mifepristone’s crucial role in empowering young people to manage their reproductive futures and assert their bodily autonomy.
Mifepristone is safe and effective, and has been used by more than 5 million people in the U.S. for both medication abortion and miscarriage care since it was approved by the FDA in 2000. The ability to access mifepristone helps ensure that young people can make private medical decisions in a timely manner and expands access to reproductive health services, which are under dire threat in this country.
Because of their age, financial circumstances, and other unique challenges, young people face distinct challenges in accessing reproductive care that the Dobbs decision has only exacerbated. As a result, they may not always feel empowered to make the choices they desire about their reproductive health care. These choices do not exist in a vacuum; they are informed by an individual’s hopes, dreams, fears, and desires, as well as the present reality of their life. Protecting access to medication abortion, and the ability to self-manage an abortion procedure at home, is a critical part of guaranteeing the reproductive rights of young people.
To be able to make these choices in an informed and supportive way, young people need to be able to understand what options they have and these options need to be available and accessible to them. Young people deserve to get the medicine they need, and providers should be able to provide that medicine easily and without unnecessary interference from courts or politicians. While the Supreme Court decision is encouraging, there is still much work to be done by advocates and voters to ensure that access to mifepristone is not further stifled by state policies. Mifepristone will remain on the market and accessible in states where abortion is legal. However, the attack on medication abortion could continue; the case at the center of the Court’s ruling will be sent back down to federal district court judge Matthew Kacsmaryk, who has already allowed Kansas, Missouri, and Idaho to intervene in the case.
Every public elected official at every level of government must do everything in their power to help protect access to abortion and reproductive health care. Young people deserve to live in a world that supports their hopes and dreams and allows them to make the decisions that are in line with what they want for themselves and their bodily autonomy. We need to ensure abortion care is not just legal, but accessible, affordable, and confidential.
