Challenges in Accessing Mifepristone for Miscarriage Management
Many women can’t access miscarriage drug because it’s also used for abortions. Such disruptions aren’t uncommon after miscarriage, which affects roughly 1 in 10 known pregnancies. For many, these challenges have served as a persistent reminder that they couldn’t access the drug mifepristone — the preferred method of care — to help the body pass the miscarriage.
Patients are, experts say, a little-recognized casualty of America’s fractious abortion wars. In other contexts, both mifepristone and misoprostol are used to voluntarily terminate pregnancies, and both medications are often called “abortion pills.” “There’s been this conflation of abortion and miscarriage management,” said Dr. Elise Boos, an assistant professor of obstetrics and gynecology at Vanderbilt University and a practicing OB-GYN. “There’s so much stigma and worry about the optics — and as a result, patients get suboptimal care for miscarriage.”
Medical Standards and Treatment Options
Miscarriage patients have three options for passing pregnancy tissue, which can cause hemorrhage or infection if not removed: medication, minor surgery or “expectant management” — waiting for the body to complete the process on its own. Since 2018, the American College of Obstetricians and Gynecologists has recommended a two-drug protocol of mifepristone and misoprostol for patients who elect the medication route.
Under this protocol, mifepristone is taken first, to “loosen” pregnancy tissue from the uterine wall, followed by misoprostol to expel the tissue. While misoprostol also is a safe and effective treatment on its own, physicians stress, it is markedly less effective than the two-drug combination — requiring follow-up surgery to complete the miscarriage in roughly 1 in 4 cases. A study published in July in the Journal of the American Medical Association found that between 2016 and 2020, just 1% of more than 22,000 patients nationwide who took medicine to help pass their miscarriages received the recommended two-drug protocol.
| Treatment Method | Effectiveness and Clinical Notes |
|---|---|
| Two-drug protocol (Mifepristone + Misoprostol) | Recommended by ACOG since 2018; mifepristone loosens tissue while misoprostol expels it. |
| Single-drug protocol (Misoprostol alone) | Markedly less effective; requires follow-up surgery in roughly 1 in 4 cases. |
| Usage Statistics (2016-2020) | Only 1% of patients received the recommended two-drug protocol. |
Regulatory and Political Barriers
Doctors and reproductive health advocates blame a thicket of overlapping cultural, political and regulatory factors for limiting patient access to mifepristone. While misoprostol is indicated for a wide range of medical uses, including labor induction and ulcer treatment, mifepristone is taken almost exclusively to induce abortions and manage miscarriages, the latter of which is an off-label use. The federal government regulates it tightly, as do most state governments. The drug remains widely unavailable to patients experiencing pregnancy loss — even in states that do not otherwise restrict abortion.
In the United States, mifepristone is typically only available at hospitals, health clinics and doctors’ offices that routinely provide abortions or that employ specialists in “complex family planning.” This is despite the fact that decades of federal data show that the drug only rarely causes serious side effects and is responsible for fewer deaths than Tylenol. The two-drug combination is just as safe as misoprostol alone. More than 90 countries have approved mifepristone since the late 1980s — including Canada, which since 2017 has permitted any physician or nurse practitioner to prescribe mifepristone and any pharmacist to dispense it.
The lack of access leaves tens of thousands of patients to face longer miscarriage processes and potential medical complications. As one patient noted, “It felt like that was the reason my miscarriage was dragging on and the reason I bled for so long.”