SARAH MCCAMMON, HOST:
It took Larissa Adams and her husband a long time to get pregnant. And when she did, she had a miscarriage.
LARISSA ADAMS: And we thought that was going to be the end of it and that we would get pregnant again. And what ended up happening was that we spent the next four or five years getting pregnant regularly and then miscarriage after miscarriage after miscarriage.
MCCAMMON: Her doctors needed to intervene to complete each miscarriage. Adams would take mifepristone and misoprostol, the two drugs that are used together for miscarriage management and for abortions. After a number of miscarriages, Adams was able to conceive a single viable embryo through IVF.
ADAMS: By sheer luck - I don't know. I've always wondered. I'm like, are we the luckiest people in the world or have the worst luck? But it stuck, and now we have a 3-year-old, and she's totally healthy.
MCCAMMON: NPR's Selena Simmons-Duffin and Becky Sullivan spoke to a number of people about why they took mifepristone. Some said mifepristone gave them a sense of control, like Michelle Brown, who found out she was pregnant while planning her wedding. She says she was a little bit panicked at first.
MICHELLE BROWN: But then, after doing more reading and thinking, we were - we then got pretty excited, actually, about the pregnancy. And then we found out that it was not working out.
MCCAMMON: Brown had started to miscarry. Her doctor had suggested waiting for the bleeding to begin. Brown was living in New Orleans at the time and working at a university about an hour away. Her commute took her across long bridges over swamps and lakes, areas where it would be hard to pull over.
BROWN: Every time I had to commute to and from my university, I just had all of this, like, dread, essentially, because I was, like, really afraid. Like, what if it happens now - right? - like, the cramping and the bleeding.
MCCAMMON: Brown went back to her doctor to get mifepristone and misoprostol and took them in the comfort of her home with her fiance by her side. Since then, they've married and they now have two kids.
Dawn - we're only using her first name because she fears family and professional repercussions - had an extremely complicated first pregnancy. She had severe preeclampsia, a condition with symptoms that include high blood pressure and can endanger both the mother and the fetus. Her daughter was born premature at 29 weeks and spent months in neonatal intensive care. Dawn ended up quitting her job.
DAWN: You know, I spent most of my time in that year, like, trying to keep her alive, taking her to different doctor and specialist appointments.
MCCAMMON: She learned that she was pregnant again when her daughter was less than a year old.
DAWN: I knew in that moment that it would be physically, emotionally, mentally, like, devastating.
MCCAMMON: It was an agonizing decision, but Dawn decided to get a medication abortion at Planned Parenthood.
DAWN: Honestly, I feel like it saved my life. I really feel that way.
MCCAMMON: These are just some of the stories of those who wrote to NPR giving their perspective on mifepristone. Mifepristone is at the center of a court case that could make its way to the Supreme Court, and here's why. Last November, a group of abortion-rights opponents sued the Food and Drug Administration, arguing that the FDA should never have approved the medication more than 20 years ago. And now they're seeking to take the drug off the market nationwide. The lawsuit also challenges recent rule changes from the FDA that have expanded access to mifepristone, including allowing abortion pills to be dispensed by mail.
Recently, attorneys gathered in New Orleans at the 5th Circuit Court of Appeals to argue the case. Here's Deputy Assistant Attorney General Sarah Harrington, who's representing the FDA. She took questions from Judge Cory Wilson about whether FDA's changes - the ones that made prescription mifepristone available through mail-order pharmacies - causes more problems. For instance, if someone's abortion is not complete after 14 days...
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SARAH HARRINGTON: Those people will go back to their doctor and discuss with their doctor...
CORY WILSON: Not if they didn't get it from a doctor. I mean, the FDA's relaxed the requirement that the provider even be...
HARRINGTON: They'll go back to their provider and discuss with their provider...
WILSON: Nurse? Midwife?
HARRINGTON: Yes. And discuss with their provider the next step. But even in that small population...
WILSON: Mail-order pharmacy?
HARRINGTON: Mail-order pharmacy is not the prescriber.
MCCAMMON: The U.S. Supreme Court has put a hold on any changes to access to mifepristone for a period of time as the case plays out. So currently, the drug remains available in states where abortion is legal. This comes in the aftermath of the overturning of Roe v. Wade last year, and many people are worried about ongoing efforts to restrict abortion and other reproductive rights. Meanwhile, one U.S. senator is trying to make it easier for people to prevent unwanted pregnancies in the first place.
PATTY MURRAY: It is a health care decision. It is an economic decision for women, and women want and have the right to make this decision on their own.
MCCAMMON: That's Washington Senator Patty Murray. Birth control pills could soon be available over the counter after a Food and Drug Administration advisory panel recently recommended allowing them to be sold without a prescription. More than 100 countries allow access to birth control pills over the counter. The U.S. is not one of them. And Washington Senator Patty Murray says it's important that they not only be available but also affordable. When and if that day comes, Murray wants to require insurance companies to cover the pills free of charge. She introduced legislation to that effect a few days ago. Senator Murray joins us now. Welcome to the program.
MURRAY: Thank you. Good to talk to you all.
MCCAMMON: As you know, we are coming up on the one-year anniversary next month of the Supreme Court decision that overturned Roe v. Wade. Many states since then have implemented abortion bans, and there have been more proposed in recent months. How is that reality shaping the conversation around birth control?
MURRAY: Well, it's having a tremendous impact. Women in many states today, because of the decision by the Supreme Court, are really worried about their access to be able to have birth control pill as a way of making sure they don't become pregnant because in their states, they won't have access to abortion care. I disagree wholeheartedly with the Supreme Court decision. We need to make sure that over-the-counter birth control is available.
The FDA, which is the agency that approves drugs, now has an advisory board with 17 members that unanimously has said that birth control should be available over the counter. So you don't have to go to a doctor. You don't have to get a prescription. You can just go to your pharmacy and purchase it. They have to go before the full FDA, and we are awaiting that decision with bated breath. But because they had a 17-to-nothing advisory board, we are hopeful that will occur and occur soon. That is a great step forward for women today to be able to make their own health care choices.
MCCAMMON: Yeah. I want to break this down a little bit. You talked about the FDA process. So just remind us exactly where things stand right now with over-the-counter birth control.
MURRAY: Well, FDA has a process to approve drugs that go on the shelves in drugstores everywhere for all of us to purchase. And that standard is that it is safe and it has efficacy, meaning that if you take it, it's safe to take and that it works. So they have an advisory board that looks at any requests that come to them. And some of the birth control manufacturers have brought forward a proposal to have these over the counter. Their experts, their scientists, their researchers all look at this and do an in-depth decision and then vote on whether FDA should consider having it over the counter. That first step, the experts advisory panel, has now voted 17 to nothing that that should be available over the counter. The next step is FDA has to take it up as the full FDA, make that decision. And we are really hoping that that comes sometime by the end of this summer.
MCCAMMON: And help me understand a little bit more how your bill would work. I think a lot of people may assume that health insurance automatically covers birth control. The Affordable Care Act - Obamacare, as it's known - already requires many insurers - most insurers, really - to cover contraception. Why is your bill necessary?
MURRAY: Well, under the ACA, we said that insurance companies had to pay for all birth control for women without a co-pay so that women could afford it. Now that we are seeing that it may become available over the counter, we want to make sure that insurers still pay for it because it is costly, and it is part of your health care coverage. So it isn't just prescription only so that women can afford it.
Look, this is a great step if FDA approves this and women can go to the drugstore and purchase it without having to have a doctor's appointment or anything else. But it will only be available for some women if it is not covered by insurance. The cost can be prohibitive. So we're making sure that it falls within that category of this is what insurance companies have to pay.
MCCAMMON: We are seeing daily right now how difficult it is for Congress to make any headway on critical issues. Do you think this bill, quite frankly, has any chance of becoming law?
MURRAY: Well, I think we're all aware of what Congress is right now, and it will be an uphill battle. But if they follow the science and we listen to the FDA and we look at the decades of precedence and research, there really is no denying that the birth control pill is safe and it's effective. American people know that. They overwhelmingly support birth control being accessible and affordable, and I hope that Congress listens.
MCCAMMON: You have some Democratic co-sponsors for this legislation, but what are you hearing from your Republican colleagues? Are you sensing support for that argument that now, in a post-Roe v. Wade environment, is the time to make birth control more accessible?
MURRAY: Well, I would like to tell you that the rhetoric matches the reality of how many of these members of Congress are doing in terms of the post-Roe world and following the words that they say. So far, I'll just tell you the reality. We do not have any members - Republican members supporting this right now. So speak up. Speak out. Let them know. I don't think this is a partisan issue.
MCCAMMON: And just one last question. Why is access to birth control pills over the counter important when there are - you know, there are already other options like condoms that are available over the counter and many other options available through health care providers? What do you see as the impact of this kind of access?
MURRAY: Access for birth control, as every woman and most men understand, is extremely important for families, for women to be able to make the health care choices that work for them. It is a health care decision. It is an economic decision for women. And women want and have the right to make this decision on their own. That's why birth control is so important. It's why it's so important that it's easily accessible, and it's so important that it is affordable so all women, no matter where they live or how much money they have, affordability is not a deterrence for them to get the basic health care that they deserve.
MCCAMMON: Washington Senator Patty Murray, thank you so much for your time.
MURRAY: Thank you.
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