The Right Is Frothing Over a New Medication Abortion Study

Yahoo

31-01-2025

When people talk about 'the abortion pill,' they typically mean mifepristone, the first drug in the FDA-approved medication abortion regimen. Conservatives are currently lobbying both federal courts and the Trump administration to roll back access to mifepristone and make it functionally inaccessible—if not get it withdrawn from the market altogether. If more restrictions take effect, many abortion providers have said they'll switch to abortions using only the second medication in the protocol, misoprostol, which causes uterine contractions.
With all that in mind, it was intriguing to see a study published last week that suggested that a different FDA-approved drug could possibly stand in for mifepristone: ulipristal acetate, the active ingredient in the prescription-only emergency contraceptive Ella. (Ella is the brand name for a 30 milligram ulipristal pill used to delay ovulation and prevent pregnancy.) Yes, that's right, a birth control ingredient being researched for abortion.
For the study, researchers in Mexico City enrolled 133 women who were up to nine weeks' pregnant and seeking abortions. The women took 60 milligrams of ulipristal, followed 24 hours later by 800 micrograms of misoprostol. All but four of the women ended their pregnancies without further intervention, for a completion rate of 97 percent. (Those four received a procedure or additional medication to complete the abortion.) That efficacy rate is similar to the gold-standard regimen of mifepristone plus misoprostol, though there were no comparison groups in this proof-of-concept study.
Conservatives have long wanted to redefine emergency contraception not as birth control but as abortion, based on a medically and legally inaccurate belief that pregnancy begins at fertilization. (It actually begins when an embryo implants in the uterus.) The Project 2025 playbook for a second Trump term called out Ella by name to be excluded from the Affordable Care Act's mandatory contraception coverage as a 'potential abortifacient,' so this research could put an even bigger target on the drug. After all, Project 2025 declares that 'abortion pills pose the single greatest threat to unborn children in a post-Roe world.'
As you might expect, anti-abortion groups were practically giddy about the news. Students for Life told The New York Times in response: 'The pro-life movement should be vindicated. We've been arguing for years that Ella acts as an abortifacient.' The American Association of Pro-Life Obstetricians and Gynecologists gave a similarly misleading comment to The Atlantic: 'Abortion advocates have long denied Ella's potential to end an embryo's life, but this study contradicts that narrative.'
These statements aren't true. 'Ella' is only the 30 milligram dose, and the study participants got twice that amount. Importantly, they also took misoprostol, which is a very effective abortion-inducing drug on its own and is used around the world in the face of abortion bans, said Daniel Grossman, an ob-gyn and researcher at the University of California, San Francisco. (Grossman was not involved in the study but did write an accompanying editorial.)
Misoprostol makes the cervix open and causes uterine contractions, inducing a miscarriage. It's the commonality in every medication abortion protocol that's been frequently used or seriously studied—it's taken alongside mifepristone, methotrexate, letrozole, or, again, on its own, Grossman said. 'Misoprostol is doing the bulk of the work of causing a medication abortion, regardless of the regimen,' he said. 'Misoprostol on its own, unlike mifepristone on its own, is an effective abortion-inducing regimen, and it is one that's recommended by the World Health Organization.' Misoprostol-only abortions can be more than 93 percent effective with repeated doses, compared to between 50 and 60 percent effectiveness of mifepristone alone, he said.
As Angel Foster, a health science professor at the University of Ottawa, told The Atlantic in 2022, 'We talk about mifepristone as 'the abortion pill,' but I think it's more appropriate to think of it as a pre-treatment or an adjunct therapy. Because it's really the misoprostol that's doing the lion's share of the work.'
Grossman said the study is well designed, but it's not enough for health care providers to change what they prescribe for medication abortions. And there are several things the research doesn't prove: It does not show that this regimen is any more effective than misoprostol alone or that taking ulipristal by itself at any dose affects an established pregnancy.
The research suggests it's possible—but not certain—that ulipristal could be another pretreatment, but conservative groups are fanning bad-faith flames to suit their larger agenda, which is to attack birth control. 'We know that contraception has been in the crosshairs of the anti-abortion movement for a long time,' Grossman said. 'They don't just say that ulipristal is an abortifacient, many of them say that all hormonal contraceptive methods can cause an abortion.'
Using this study to restrict access to the 30 milligram brand-name drug would not be evidence-based. But then again, neither are conservative claims that birth control is an abortifacient. 'We still don't have any evidence that Ella causes an abortion, so those attacks are misapplying the results of this study,' Grossman said.
Still, he's worried that, 'particularly in the current political environment,' the birth control method could become harder to get, which would harm people who need it. Over-the-counter emergency contraception (levonorgestrel) is effective for up to three days after unprotected sex and is less effective for people over 155 pounds. Ella can be used for up to five days, and it remains effective for people with larger body sizes.
Aside from possible changes to insurance coverage and other restrictions like outright bans, Grossman worries there could be a chilling effect on pharmacies in states with abortion bans willing to stock the drug and pharmacists willing to dispense it. 'It's really critically important that we maintain access to this medication,' he said.
If, in the coming weeks and months, Republicans do succeed in requiring three in-person visits to get mifepristone, that nationwide rollback will be enraging and jarring. But this new research underscores a key point: In many ways, misoprostol is the real abortion pill, first discovered by Latin American activists, and it's fairly easy to get in the United States. It's FDA-approved to treat ulcers, and it's already in most pharmacies because it doesn't have onerous restrictions like mifepristone does. Aside from telemedicine providers, there are community networks that help people access pills outside the medical system: Activist groups mail free mifepristone and misoprostol to people in the U.S., including from Mexico.
'It's very difficult to restrict the movement of pills,' Grossman said. 'Increasing restrictions on abortion generally have resulted in a lot of changes in terms of people taking abortion care into their own hands and figuring out how to access these medications—and self-managing that abortion on their own with support from lay experts or clinicians or both.'
That's another point of emphasis: Conservatives can try to ban abortion, but they cannot stop it.