What would it mean in Arizona if mifepristone access is restricted?

Experts have said that mifepristone, part of a two-drug regimen, has a record of safety and efficacy in more than two decades of use. Photo by Chris Coduto | Getty Images for UltraViolet

Half of abortions performed in Arizona are medication abortions, but a ruling from the U.S. Supreme Court expected later this year could roll back federal approval of the most commonly used medication, further decimating reproductive health care in the Grand Canyon State. 

On Tuesday, the high court heard arguments in Food and Drug Administration v. Alliance for Hippocratic Medicine, during which Scottsdale-based anti-abortion legal firm Alliance Defending Freedom urged the justices to revert the use of mifepristone back to its pre-2016 regimen

Mifepristone is a pill used in conjunction with misoprostol to induce an abortion. The drug has been approved by the FDA for over two decades, and has been deemed safe and effective by an equally long body of research conducted by the federal agency and independent researchers. In 2016, the FDA began updating its guidance of the drug to make it more accessible, including by extending the time period it can be used from seven to 10 weeks of gestation. 

In Arizona, that expanded access saw the drug steadily increase in use by women seeking to terminate their pregnancy, quickly making up half of all abortions performed in the state. 

Data visualization made with Flourish

Even after the U.S. Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization in 2022 eliminated the constitutional right to an abortion and enshrined a 15-week gestational ban in Arizona, medication procedures continued to be obtained. That year, which otherwise saw a precipitous plunge in overall procedures due to clinics shuttering amid legal uncertainty, medication abortions outnumbered surgical procedures. 

The vast majority of medication abortions performed in Arizona in 2022 were the result of mifepristone and misoprostol: Only 26 medication abortions provided that year were induced by medications other than the popular two-drug regimen. Misoprostol is the second most commonly used regimen, and can be used by itself, but has been found to be less effective alone. The drug is most often used by itself when mifepristone is not available, and it has been approved for use up to 11 weeks of gestation. 

Data visualization made with Flourish

Reproductive rights advocates have criticized the challenge against mifepristone as the latest effort to cut off access to abortion care. If the high court rules to rescind mifepristone’s certification, Arizona women — who are already dealing with a gestational ban — will face even greater barriers. State law currently allows surgical abortions up to 15 weeks, with exceptions afterwards for life-threatening cases, but the procedures are far more invasive and expensive than medication abortions. Rolling back mifepristone access back to the 7-week regimen would further limit the options available to women, especially when most pregnancies aren’t identified until at least five weeks of gestation. Arizonans seeking an abortion also have to contend with a scarcity of clinics: There are only nine abortion providers in the state and most of them concentrated in Maricopa County. 

One state-level case has the potential to ban virtually all abortions and render the debate around mifepristone moot. The Arizona Supreme Court has yet to rule on whether a Civil-War era law from 1864 that bans all abortions except for those to save the woman’s life and punishes doctors with 2 to 5 years in prison should be the law of the land instead of the state’s current 15-week abortion ban.  

Arizona Democrats blasted the challenge against mifepristone. Abortion has become a focus of the 2024 election cycle as efforts to restrict access to the procedure persist across the country in the wake of Dobbs. Democrats have sought to underscore their party’s support for reproductive rights in the hopes of mobilizing voter support to cement control in Congress and flip state legislatures blue, including in Arizona where Republicans hold a one-vote majority in each legislative chamber. 

Gov. Katie Hobbs, a vocal abortion access advocate who joined an amicus brief in support of mifepristone earlier this year, called on the high court to dismiss the challenge. 

“Mifepristone is a safe, widely used option for reproductive healthcare, and restricting access could threaten the health of millions of Arizona women,” she said in an emailed statement. “Washington D.C. judges should not be dictating the kind of care that Arizonans are allowed to receive. I am proud to join the effort to protect access to Mifepristone and I hope the Supreme Court will do the right thing and end this attack on our basic rights.”

Jen Cox, senior advisor for the Biden-Harris campaign in Arizona, added that the presidential election is more important than ever for deciding the future of abortion across the country. Former president Donald Trump, who is seeking to recapture the White House, nominated the judges responsible for the fall of Roe, and his allies have signaled an intent to use the Comstock Act, a 151-year-old law prohibiting the mailing of abortion drugs, to ban abortions nationwide.  

“From appointing the judge who ruled to ban abortion medication, to nominating the justices who cast the deciding votes to overturn Roe v. Wade, to promising a national abortion ban if he’s reelected, Trump and his extreme agenda pose an existential threat to our reproductive rights,” Cox said in an emailed statement. 

The U.S. Supreme Court is expected to issue its opinion in the case against mifepristone in early summer.

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