After a tense few weeks during which U.S. courts twice revoked and reinstated telehealth access to the abortion pill mifepristone, the drug remains available without an in-office appointment—for now. But doctors and policy experts worry that uncertainty and any future rollback in access will make things harder for people seeking to end a pregnancy and place added pressure on the health care system.

Since 2022, when the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization overturned the right to abortion enshrined in Roe v. Wade, antiabortion proponents have focused on mifepristone. They claim, despite a wealth of evidence to the contrary, that the drug is unsafe. First approved in the U.S. in 2000, mifepristone is currently used here in combination with the drug misoprostol up to 10 weeks into a pregnancy.

Overwhelming scientific evidence shows that mifepristone is safe and effective, whether the drug is dispensed via telehealth or at an in-person doctor’s visit. “It is incredibly safe; it is one of the most well-studied drugs in reproductive health care,” says Tejasvi Gowda, an obstetrician-gynecologist in Maryland who is also a fellow at Physicians for Reproductive Health, a nonprofit advocacy group. Just more than a quarter of all U.S. abortions currently rely on mifepristone that is prescribed virtually. If the telehealth option is taken away, providers and patients will face tough choices, experts say. In-person care will be much harder to access for some people and inconvenient for the rest. Other patients and providers will likely switch to misoprostol-only abortion, a regimen used before mifepristone’s approval in 2000 that is still safe and effective but could cause more complications than the combination regimen.

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Before the start of the COVID pandemic, the U.S. Food and Drug Administration mandated that providers could only prescribe mifepristone after an in-person appointment. That requirement was tied to the FDA’s Risk Evaluation and Mitigation Strategy (REMS) program, which is usually applied only to medications with unusual safety concerns. Mifepristone’s REMS restrictions “have always been political,” says Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute, a research and policy organization that supports reproductive health and rights. “It was never about the safety and efficacy of the drug.”

But when the COVID pandemic shattered normal health care operations, the FDA temporarily removed that in-person requirement; the change was made permanent in 2023. At that time, Ushma Upadhyay, a public health scientist at the University of California, San Francisco, began studying the safety and efficacy of telehealth abortion medication, eventually gathering data from more than 6,000 patients. Of those individuals, 98 percent needed no additional care for their abortion. Only 0.25 percent (15 people) had a serious complication, such as needing a blood transfusion or hospital stay; no deaths were reported. Today an appointment for a medication abortion unfolds in the same way, whether it’s in person or online.

Without the telehealth option, some people will struggle to be able to attend an appointment. In addition, telehealth medication is the only safe abortion access for many people who live in states that ban or restrict abortion and can’t travel out of state. Since the fall of Roe v. Wade in 2022, 13 states have placed essentially a total ban on abortion, while four others have banned almost all abortions starting at six weeks of gestation.

And misoprostol-only prescriptions could make abortions slightly more complicated. “The majority of side effects from medication abortion happen because of the misoprostol,” says Rachel Jensen, an ob-gyn and fellow at the American College of Obstetricians and Gynecologists (ACOG). When used without mifepristone, a higher dose of misoprostol must be used. It simply is not considered “standard of care” in modern medicine, she and Gowda both emphasize.

The switch could also create new burdens on the health care system, Upadhyay says. Although providers used misoprostol on its own before mifepristone was approved, “it will be new to many providers,” and they will need to update their protocols, she notes. She also worries that providers will need longer to teach patients how to manage the process and that more patients may end up choosing to visit an urgent care or emergency room to ensure their bleeding is normal.

Although mifepristone access currently remains intact, Upadhyay says she’s worried that the chaos in headlines is already affecting abortion access. “There’s fear, and I think that this fear is causing providers to be ultraconservative, even though there’s nothing being enforced right now,” she says.

Experts know the latest ruling is only a temporary reprieve. “The [Supreme] Court, sooner or later, is going to weigh in on mifepristone,” says Mary Ziegler, a professor of law at the University of California, Davis, and an expert on the history of abortion policy. Furthermore, the FDA is conducting its own review of mifepristone’s safety, a process that experts fear will rely on junk science to declare the pill unsafe.

Ob-gyns and reproductive rights advocates say they will respond to whatever unfolds. “We’re used to facing those barriers and are ready to do what we need to do to be able to take care of patients in safe and legal ways,” Jensen says.

Gowda agrees. “People will always find a way to get abortion care,” she says, “and we will always be there to help them.”