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Mifepristone, an abortion pill, also known as RU 486. (Photo by James Leynse/Corbis via Getty ... [+] Images)

Since last months leak of Justice Alitos draft majority opinion, which says that the Supreme Court has voted to overturn Roe v. Wade, the abortion wars have dominated the U.S. domestic news cycle.

Removing abortion as a constitutional right would, in Alitos words, return the issue of abortion to the peoples elected representatives. While this could mean Congress, its clear from a recent attempt to codify Roe v. Wade, the Democrats lack the votes to succeed. And so, it will be up to states to determine who has access to abortion services, and under which conditions.

Most of the discussion has focused on in-hospital or in-clinic abortion procedures. But, some Republican-led states may ban the abortion pill, even though the Food and Drug Administration (FDA) has approved it.

In 2000, the FDA approved Mifeprex (mifepristone) for medication abortion. Mifepristone is a drug that blocks progesterone, which is needed for a pregnancy to continue. When used in conjunction with misoprostol, mifepristone ends early pregnancies (up to 10 weeks following conception).

Mifepristone has been in use in Europe for nearly three decades with a minimal number of adverse events. And, the drug has had a similar safety record in the U.S since its approval in 2000. Between September 2000 and December 2018, just 24 of the 3.7 million women who had undergone medicated abortions have died.

Medication abortion accounts for about 42% of all abortions in the U.S. Notably, since 2000 a steady decline in abortions of all kinds has coincided with the availability of mifepristone.

While until now no state has banned medication abortions, Oklahomas Republican governor, Kevin Stitt, will soon sign legislation outlawing all abortions from the moment of fertilization. Presumably, this would include a prohibition of the use of mifepristone and misoprostol. Other states may follow suit.

But, its unclear whether states can prohibit the use of a medication the FDA has approved. The FDAs mandate is to review the safety and efficacy of therapeutics, diagnostics, and devices, based on clinical evidence. As such, the FDA is the federal authority on all pharmaceuticals distributed throughout the U.S., including mifepristone and misoprostol. On this basis, FDA approval of a drug would appear to preempt state action.

Furthermore, in December 2021 the FDA lifted a major restriction on access to abortion pills. It now allows patients to receive such pills by mail, rather than requiring women to obtain the medications in person from specially certified healthcare providers.

Some Republican-led states may, however, argue that they can ban abortion drugs because they have the authority to regulate the practice of medicine. Indeed, 19 states have already prohibited telemedicine visits for abortifacients. By claiming there are medical risks with abortion drugs governors and legislators who are opposed to abortion pills maintain the state as having a compelling interest in regulating them. Its uncertain how this will impact women being able to obtain out-of-state medications by mail.

The most obvious retort to this is, why dont states bother to regulate most other pharmaceuticals, as they all carry risk, including many with a far greater likelihood of adverse events than mifepristone?

And, the current line of reasoning echoes previous disingenuous appeals made in the autumn of 2020 by Senator Ted Cruz (R-TX) and 20 other Republican senators. They sent a letter to the FDA formally requesting that the agency remove Mifeprex from the market. The 21 senators claimed Mifeprex is deadly and an imminent hazard to the public health. Cruz tweeted Make no mistake, Mifeprex is a dangerous pill.

Once again, this begs the question, what is the relative safety risk for women associated with the use of mifepristone? As referenced above, the safety risk appears to be minimal. Here, Cruz and others resort to a red herring to deflect attention from their main concern; abortions of any kind and at any time during a pregnancy.

Rhetoric notwithstanding, the Senators letter wasnt in fact an appeal to the FDA based on clinical evidence regarding Mifeprexs safety. Rather, the letter objects to the use of Mifeprex because of what the senators view as an opportunistic ploy to expand access to abortion.

In the wake of the leaked draft decision by the Supreme Court on Roe v. Wade, the battle lines on abortion have hardened. As a result - and is invariably the case in a polarized U.S. - politics gets in the way of there ever being a shared common ground on which people with different perspectives on abortion could have factual discussions about Mifeprexs good relative risk profile and whether Mifeprexs availability is associated with more abortions. Regarding the latter, evidently this is not the case, as abortions of all kinds have been steadily decreasing for decades.

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Next Up In The Abortion Wars: Some Republican-Led States May Restrict Or Even Ban Access To Mifeprex, Used To End Early Pregnancy - Forbes