The Bloody History of Mifepristone

This month marks a critical juncture in the ongoing fight against abortion in the United States. As Walgreens and CVS begin dispensing mifepristone (Mifeprex ®) in many of their retail pharmacy locations—and before the Supreme Court considers reinstating restrictions on the same—we must pause to consider mifepristone’s brutal history and raise awareness of rapidly changing laws and politics governing its use. We must also underscore the need to pray for an end to its bloody reign.

Chemical abortifacients account for roughly 53 percent of all abortions in the United States annually, the vast majority of which utilize mifepristone as the primary agent. Mifepristone is a chemical abortifacient and is currently available as an oral tablet taken concurrently with another drug called misoprostol, indicated for “termination of intrauterine pregnancy,” typically through 10 weeks gestation. The drug works by blocking the effects of progesterone, a hormone necessary for maintaining the integrity of a woman’s uterus. 

Without progesterone, the uterus can no longer support a growing baby, thereby starving the human life of oxygen and nutrients. Following administration, the mother experiences cramping and bleeding and the eventual expulsion of the aborted child from the birth canal. The drug misoprostol is then administered buccally, sublingually, or vaginally 24-48 hours later to further induce uterine contractions. Mifepristone and misoprostol account for 98 percent of chemical abortions annually in the United States.

Known previously by its more suitably ominous name RU-486, mifepristone was first developed in France in the 1980s, where it was approved for use in 1988. The U.K., China, and Sweden followed soon after. A year after France approved mifepristone, the drug was banned in the United States, where it remained so until 1993 when the Clinton Administration ordered the Department of Health and Human Services to begin investigating the drug for use in chemical abortions. Mifepristone was ultimately approved for use by the Food & Drug Administration (FDA) in 2000 under the brand name Mifeprex ® for termination of pregnancy through seven weeks, which would be increased to 10 weeks in 2016. A generic product was ultimately approved in 2019.    

From 2000 until 2021, mifepristone was only available in clinics, medical offices, and hospitals. In April of 2021, the FDA began allowing mifepristone to be prescribed online and mailed to patients on a temporary basis, a change that was made permanent in the same year. In 2023, the FDA began allowing pharmacies to go through a certification process to begin dispensing mifepristone from retail pharmacy locations. 

In August 2023, the Fifth U.S. Circuit Court of Appeals ruled to invalidate the FDA’s actions to loosen restrictions on the drug, a decision that was stayed by the Supreme Court until they hear arguments later this month. The stay also blocked a decision by U.S. District Court Judge Matthew Kacsmaryk to suspend mifepristone’s approval. The Supreme Court’s ruling, expected by June, will affect whether restrictions dating back to 2016 are reinstated on the drug—but not whether the drug’s approval is revoked.  

On the surface of most legal challenges to the availability of mifepristone are a number of legitimate and grave concerns about the safety of the drug for the women who take it, including serious and fatal infections and bleeding, to say nothing of the psychological damage that comes from killing your own child. Mifepristone itself poses grave heath concerns to women, and any attempt to facilitate casual access to the drug is wholly irresponsible from a patient safety perspective. 

This point has been supported by various studies, although the increasingly partisan landscape of scientific literature yielded a retraction by Sage Publishing in early February of three separate studies, two of which demonstrated the potential harms of mifepristone. These studies had been cited in both Matthew Kacsmaryk’s decision as well as that of the Fifth U.S. Circuit Court of Appeals. This politically motivated move highlights the desperation of abortion advocates in the post-Dobbs landscape.  

If concerns about the health of women taking mifepristone are on the surface of legal challenges, then at their heart is concern for the lives of these Holy Innocents that are being taken. We needn’t pretend otherwise. As is the case with heartbeat bills, measures to partially restrict the use of abortifacients do not go far enough, though they are a tool that we can and should leverage to save as many lives as possible while we fight the larger war to systematically ban these chemicals and draconian procedures. Debate will always be present when we discuss safety concerns; people will continue to lie to themselves, and data will always be corrupted and abused. With regard to outright abortion bans, nothing will suffice except a conversion of hearts, a road which begins with prayer.

In the time since its initial approval, mifepristone has been responsible for the deaths of millions of unborn children. It is currently estimated that 930,000 abortions occur annually in the United States. With mifepristone currently accounting for nearly 53 percent of total abortions in the United States, the drug is responsible for close to a half million murdered children per year, and the number is growing. Mifepristone use has been exploding over the past few years, and with the advent of telemedicine prescriptions and retail pharmacy dispensing, we can only expect those numbers to continue to climb as ease of access grows exponentially. 

Catholic President Joe Biden recently stated: 

With major retail pharmacy chains newly certified to dispense medication abortion, many women will soon have the option to pick up their prescription at a local, certified pharmacy—just as they would for any other medication. I encourage all pharmacies that want to pursue this option to seek certification.

Among the many incendiary statements in the press release, what stood out to me perhaps the most was President Biden’s use of the word “medication,” as did his comparison to “any other medication.” We must not allow people to normalize the use of this drug, to allow it to lose its stigma as oral contraception and “the morning after pill” have. Mifepristone’s name should evoke horror and deserves a place in the gutter. 

What’s more, I would argue that mifepristone, in the context of its use as an abortifacient, isn’t a medication at all. Legitimate uses aside, the right to be called a medication is forfeited the second a drug is used not only without the goal of improved health but with the intent to actively take life. We don’t call heroin a medication, nor do we award that title to mustard gas, or the lethal injection, for that matter.       

The various oaths, duties, responsibilities, and moral obligations of healthcare professionals are aimed at improving the healthcare outcomes of patients. To be pressured to prescribe and dispense a drug intended to take the life of a child is not only morally repugnant, it is a grave dereliction of the healthcare worker’s sworn duties. The Hippocratic Oath, as classically formulated, says as much. 

In my work as a pharmacist, I am tasked with ensuring that medications are prescribed appropriately and that dosages are calculated correctly, all to maximize both efficacy and patient safety. How can either task be performed in the case of an abortifacient? There are two patients, not one, and mifepristone is a non-medication designed to do maximum harm to one of them. 

As retail pharmacies begin dispensing mifepristone this month, and as we prepare for the Supreme Court to hear arguments on March 26th on the reinstatement of restrictions on the drug, we must understand the battle facing us and know what is at stake. We must join in prayer. We must fight hard against the normalization and destigmatization of chemical abortions, and we must stop the use of mifepristone before its use climbs even higher.  

We must pray and petition the first Holy Innocents, those glorified patrons of the pro-life cause, for the protection of unborn babies everywhere. The souls of the modern-day Holy Innocents whose lives have been taken by the drug cry out to us. Their blood is on the hands of millions of Americans. We must come together and examine mifepristone’s bloody past to ensure that it has no future.