Access to reproductive healthcare, especially for those seeking medication abortion for management of miscarriage or termination of pregnancy, has become a highly politicized issue, distracting from its critical importance in reproductive healthcare. With looming threats to mifepristone (Mifeprex) dispensing, it’s more crucial than ever that we examine how emergency departments (EDs) can play a key role in ensuring safe, timely access to care, particularly in rural or remote areas.
Mifepristone, a medication FDA approved more than two decades ago, is important in the management of both medication abortion and miscarriage. It works by blocking the hormone progesterone, which is necessary to continue a pregnancy. Its approval for pregnancy termination and its use in treating miscarriages has revolutionized care for patients in the U.S. In 2021, the FDA increased access to mifepristone by removing an in-person dispensing requirement, allowing patients to receive mifepristone at a pharmacy or through the mail after a telemedicine visit, and improving access for patients in rural settings or locations with little or no access to local reproductive healthcare providers.
Yet, the future of this crucial medication is under threat. Anti-abortion advocates have made repeated attempts to restrict access to mifepristone, including potentially rolling back its authorization for dispensing by mail or without an in-person visit. While President Donald Trump hasn’t yet issued executive orders related to mifepristone in the U.S., the administration has already reinstated a policy cutting off funding to international organizations that provide legal abortion information, referrals, or services. This could be indicative of more restrictions to come, and the impact on rural, low-income, and marginalized populations would be devastating. The prospect of forcing patients to travel long distances, take time off work, or incur unnecessary expenses to visit a physician’s office for mifepristone could exacerbate the healthcare disparities that already disproportionately affect these groups.
While EDs haven’t historically prescribed medication abortion for elective termination, they are uniquely positioned to fill this looming access gap in healthcare deserts. They can support patients seeking treatment for miscarriage as well as those seeking medication abortion — consistent with the legal landscape of state laws.
In cases where a patient experiences an early miscarriage, mifepristone can be prescribed and/or dispensed from an ED to help expel the pregnancy tissue and prevent further complications, reducing the need for invasive procedures. This care is legal in all 50 states, but new abortion laws have led to constraints and reports of delayed or denied miscarriage care.
In the case of medication abortion, this same medication offers a safe, non-surgical option that can be administered within the first few weeks of pregnancy. And existing research suggests it is feasible for EDs to initiate medication abortion. While this care is prohibited in many states and impractical in others (due to 24-hour waiting periods or cumbersome bureaucratic requirements), I estimate it would be possible in more than 20 states with less restrictive abortion laws. By ensuring that emergency physicians can prescribe this medication and have the ability to dispense it effectively where it is legal and supported, we can give patients who live in areas with limited access to other types of providers the compassionate, timely care they deserve.
Current legal threats come at a time when cultural conversations around reproductive rights are intensifying. “The Pitt,” an ED-based drama airing on Max, includes a storyline about the administration of medication abortion by emergency medicine providers — a practice that may seem simple on its face but is implemented infrequently across the country. With public opinion on abortion becoming increasingly politicized, it’s essential to understand the real-world process of obtaining medications like mifepristone. With the possibility of additional restrictions related to the Comstock Act or the roll back of authorization for telehealth prescribing, EDs can be an essential access point for mifepristone prescribing and dispensing, giving patients more options.
In light of these challenges, we must advocate for the preservation of broad mifepristone access, and encourage EDs, especially those in healthcare deserts, to play a role in expanding access. Any move to roll back access to this critical medication will not only undermine individuals’ right to make their own healthcare decisions but also impose unnecessary burdens on those already struggling to navigate an often fragmented and inefficient healthcare system.
The case for mifepristone access in EDs is clear: it concerns patient care, safety, and autonomy. As we continue to face the shifting landscape of reproductive rights, we must ensure that healthcare providers, particularly those in emergency settings in rural areas, are empowered to offer the best care possible for all patients in need — no matter the circumstance.
Dara Kass, MD, is a practicing emergency medicine physician, and formerly a regional director at HHS. Her research and policy interests include the expansion of reproductive healthcare and the intersection of federal and state policies in supporting healthcare access and funding.
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