Sami Alloy was “elated” when she found out she was pregnant in 2018 after four years of trying for a baby with her partner.
But after an early six-week scan, she was told by her IVF medical team that there was “no developing foetus”, and she would need to manage the pregnancy loss.
“Because I was working on trying to conceive and manage my fertility, they didn’t want to do a procedural abortion [removing tissue, performed by a trained provider] because they didn’t want to risk any scraping in my uterus,” the 42-year-old from Oregon told i. “It was possible that my body would have just expelled the tissue on its own, but it’s possible I could have developed an infection or a failure of the uterus to detach all the tissue which could lead to sepsis, fertility loss, or death.”
Instead, her team prescribed her mifepristone and misoprostol, a combination of medicines referred to as the “abortion pill” or a “medical abortion”, which ends a pregnancy. Mifepristone blocks the body’s progesterone, stopping the pregnancy developing, and misoprostol causes cramping and bleeding to empty the uterus. The prescription pill is approved in the US until 10 weeks of pregnancy.
While Ms Alloy views her experience as pregnancy loss management, the process was “exactly the same” as someone intentionally ending a pregnancy with medicine.
Following her medical abortion, Ms Alloy quickly became pregnant again and gave birth to her child later in the year, which she attributes in part to her access to mifepristone.
More than five million US women have used mifepristone to terminate pregnancies and in 2023, 63 per cent of abortions in America were medical. In the UK, 86 per cent of abortions from January to June 2022 were medical – the latest statistics available. The method has been shown by numerous studies to be a safe way to end an early pregnancy.
When Chris Smith, from Seattle, found out she was pregnant in 2020, she didn’t believe it was “meant to be”.
Life didn’t feel stable. She and her two daughters had just had to vacate their rental property. Finances were tight, the family didn’t have reliable healthcare or dental care and the world was in the middle of a pandemic.
“There were a lot of unknowns,” the 43-year-old told i. “It was terrifying.”
At around eight weeks pregnant, Ms Smith chose to end the pregnancy with medicine.
As a volunteer abortion doula, she had access to mifepristone and misoprostol, and was able to manage her abortion at home without having to take days off work.
“I feel a lot of gratitude for the privilege of being in a situation when I didn’t have to think twice,” she said.
The use of mifepristone could soon be severely restricted. Late last month, the US Supreme Court considered the fate of the drug in its first abortion case since it overturned Roe v Wade nearly two years ago.
The Alliance for Hippocratic Medicine, an umbrella group of anti-abortion doctors and activists, argue that the Food and Drug Administration (FDS) did not adequately study the safety risks of mifepristone before approving it for sale in 2000, claiming that doctors have had to treat patients who suffered complications from it.
The FDA and drugmaker Danco say that the challengers aren’t harmed by the prescribing rules, and that the FDA followed correct procedure and scientific evidence in making decisions.
If the court rules against the FDA, abortion access for thousands could be affected, as it would roll back the expansion of access since 2016, when the FDA loosened restrictions on mifepristone’s use.
“The case is unprecedented,” said Carrie Baker, Professor of the Study of Women and Gender at Smith College. “It’s outrageous. It’s factually incorrect, legally incorrect, and the only reason it has happened is because these antidemocratic forces are jury rigging our whole system to serve a Christian nationalist agenda that is hostile to sexuality, women, and abortion.”
She told i that 16 per cent of US abortions are now arranged through telemedicine, a number that is “significantly increasing”, and these are most at risk.
Access to the abortion pill through telemedicine has skyrocketed from 2021, when the FDA lifted a requirement for in-person provision, allowing healthcare providers and online pharmacies to mail mifepristone to patients.
Organisations calling for reproductive freedom expect a huge impact if the Supreme Court restricts access.
“This ban scares me most because restricting access to this drug will harm patients, particularly patients of colour, LGBTQ+ people, immigrants, rural and low-income patients, and people who travel long distances for care,” Ryan MacDonald, of Pro-Choice Washington, told i. “We actively work to pass laws that reduce barriers to care, and this ban will certainly make things more challenging.”
Ms Smith said that a move towards a ban would be “scary” for people in similar positions to hers.
While Ms Alloy was able to access a medical abortion through a clinic, and Ms Smith through her work, they are both worried about how the case could impact people who don’t have access to a clinic and depend on telemedicine.
“You should have access to these medications because they are essential healthcare,” Ms Alloy said. “I’m absolutely infuriated that the right to access medication abortion is up for debate.”
Without mifepristone, Ms Alloy said people could be forced to choose procedural abortions, which may impact future fertility, or risk infection from letting the tissue come out naturally.
She’s already heard of people criminalised for choosing a medical abortion, and fears that with more restricted access to mifepristone, criminalisation will increase.
“We’re looking at these incredibly high stakes,” she said. “The anti-abortion movement will stop at nothing to criminalise people for their pregnancy outcomes, to strip us of our basic human rights, and keep on with these test cases and policies until they receive a national total ban on abortion. It’s worrying.”
Professor Baker said the “underground abortion pill network” in the United States will not back down.
“It is very robust and growing,” she concluded, saying that over 26,000 people had accessed abortions through the network since Roe v Wade was overturned in 2022. “That will continue. Whatever the court does will have no impact on that.”
Professor Baker thinks the case will be dismissed when it is heard in June, but says anti-abortion groups are “not going to give up.”
“They’re going to continue to try to use the courts, executive branch, and legislative branch,” she said. “It’s like throwing spaghetti at a wall. They’ll throw and hopefully something will stick, even if it’s ridiculous.”
