Brittany House speaks to demonstrators in front of the Supreme Court, which is hearing arguments related to FDA v. Alliance for Hippocratic Medicine, on Tuesday in Washington. (Tom Brenner for The Washington Post)
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Brittany House stood in front of the Supreme Court on Tuesday morning, surrounded by hundreds of abortion rights advocates cheering her on. As the justices heard arguments over restricting access to mifepristone, House shared how abortion pills changed her life.

More than a decade ago, House learned she was pregnant. She was 21 and had just graduated from Howard University with a bachelor of science in biology and chemistry. She wasn’t ready to be a mother. She met with a doctor at a Planned Parenthood center in the District and was provided with a prescription for a medication abortion.

“Mife and miso provided me with greater autonomy to have my abortion,” House, now 33, said, referring to mifepristone and misoprostol — the prescription medications most commonly used as part of a two-drug regimen for abortion. “I was comfortable, and I was able to go through the process on my own terms.”

Less than two years after the Supreme Court overturned Roe v. Wade, the justices are considering whether to limit access to mifepristone, a medication used in more than 60 percent of U.S. abortions and shown in multiple studies to be overwhelmingly safe. During nearly two hours of oral argument, the Supreme Court seemed unlikely to limit mifepristone. The high court will issue its ruling it by the end of this term, probably in late June or early July.

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House joined hundreds of abortion rights advocates rallying outside the Supreme Court on Tuesday, all united in their belief that medication abortion should remain legal and accessible. There were other women with medication abortion stories of their own, some taking the microphone and others content with being one of many in the crowd. There were nurses who have driven women hundreds of miles to access a surgical abortion, aspiring gynecologists, a grandmother who had an abortion decades ago and people worried about the future of reproductive care.

While there were protesters who did not support abortion rights, citing personal stories of adoption, being conceived from rape and their own Christian beliefs, there were many more rallying in favor of access to abortion.

The protesters stood behind bike racks separating the court’s marble steps from those rallying on the sidewalks, a typical measure taken by law enforcement ahead of protests. Capitol Police officers on bikes were stationed on the opposite side of the street as protesters held signs with “mife + miso” written inside a purple heart. This case, abortion rights advocates said, was a reminder that access to abortion care is at stake for everyone, not just those living in states that have restricted abortion.

Earlier Tuesday, dozens of protesters with the Women’s March organization walked to First Street and Constitution Avenue NE, chanting, “Our body, our choice!” before encountering a handful of antiabortion activists yelling, “Abortion is murder!” The two sides traded chants and waved signs as abortion rights advocates coalesced near the intersection. Capitol Police officers blocked the group from disrupting traffic.

A small group of abortion rights advocates, including Rachel O’Leary Carmona, the executive director of the Women’s March, then blocked a nearby walkway, leading to arrests. Capitol Police spokesman Tim Barber said about 13 people were arrested under a D.C. code that prohibits crowding, obstructing or incommoding, which is often cited in the arrest of protesters.

Outside the high court, Aid Access, the largest telehealth clinic mailing pills into antiabortion states, used machines that it dubbed “Roe-bots” to dispense doses of mifepristone — hoping to convey that abortion pills will remain available regardless of how the high court rules.

The “bots” were controlled remotely by abortion providers in Democrat-led states with “shield laws,” new legislation that has allowed U.S.-based doctors to mail pills into antiabortion states without fear that they could be prosecuted. Antiabortion advocates and politicians have so far done little to try to target shield law providers, despite the growing numbers of pills flowing into states with bans.

Aid Access, based in Europe, is mailing approximately 6,000 doses of abortion pills into states where abortion is banned every month, according to founder Rebecca Gomperts. The organization started mailing pills into the United States in 2018, relying initially on European doctors to prescribe pills and pharmacies in India to mail them.

“This is a way of saying, ‘No matter what the Supreme Court decides, the pills will be here,’” Gomperts said, referring to her commitment to mailing pills into antiabortion states. “We’re not in the 1800s anymore.”

Several antiabortion activists outside the court Tuesday morning said they were hoping the justices would bring up and ask questions about a long-dormant law from 1873 — the Comstock Act — which prohibits the mailing of “obscene” materials, including those used for abortions.

Casey Casias, 22, traveled from Amarillo, Tex., the city where the case was first heard by Judge Matthew J. Kacsmaryk, with his wife to express his support for the antiabortion cause. Casias carried a sign that said the Comstock law “plainly forecloses mail-order abortion in the present,” a quote from Kacsmaryk’s ruling issued nearly a year ago.

“This is a law that has already been established,” Casias said.

Casias and his wife, Jade Casias, said they were proud to be from the same city as Kacsmaryk.

“He stands up for our Amarillo values,” Jade Casias said, adding that she and her husband are committed to supporting life “in and outside of the womb” and are hoping to foster children in the future.

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What is mifepristone?
Mifepristone is one of two drugs that work together to terminate a pregnancy, and is approved by the U.S. Food and Drug Administration through 10 weeks gestation. Mifepristone was first approved for use in France in 1988, and approved in the U.S. in 2000.
How a medication abortion works
A patient first takes mifepristone as a single pill, which blocks the hormone progesterone, preventing a pregnancy from progressing. About 24 hours later, the patient typically takes a four-pill dose of misoprostol to prompt contractions that expel the embryo or fetus.
Safety
A large body of research shows mifepristone is safe and effective. The American College of Obstetricians and Gynecologists analyzed hundreds of published studies, and found "serious side effects occur in less than 1% of patients, and major adverse events — significant infection, blood loss, or hospitalization — occur in less than 0.3%.”
Mifepristone and abortion access
Mifepristone is used in more than half of U.S. abortions, according to the Guttmacher Institute, a group that supports abortion rights. If mifepristone is taken off the market, abortion providers will have to provide only surgical abortions, or use a medication abortion regimen that includes only misoprostol.
Misoprostol-only medication abortion
A misoprostol-only abortion requires three doses of four pills each. While misoprostol is widely used on its own to perform abortions around the world, studies show it is less effective than the two-step regimen, and usually causes more cramping and potential side effects, including diarrhea, fever and chills.
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Lindsay London also traveled from Amarillo, Tex., to make her voice heard outside the Supreme Court on Tuesday. London, a nurse with the Amarillo Reproductive Freedom Alliance, a coalition supporting abortion access and reproductive rights in the Texas panhandle, said she has driven women to Albuquerque and Denver to receive a surgical abortion.

London, 42, said she provides resources for people to obtain mifepristone, which is often the safest and most accessible option for people whose abortion care clinics have closed down.

“I’m thinking of the young people in our community who are raised in Texas without access to comprehensive sex education, who aren’t given the tools to prevent pregnancy and who are now being put in a situation where they’ll be forced to give birth,” she said while facing the Supreme Court. “I’m thinking about the impact on their futures, their economic viability, their dreams, their hopes, their goals.”

Although Tuesday’s arguments inside the court focused on mifepristone, Kimberly Inez McGuire told the crowd how she needed to take misoprostol after a miscarriage last month. While dealing with the emotions of her pregnancy loss, she said it was important that accessing the medication she needed was not difficult. McGuire, a single mother and the executive director of Unite for Reproductive & Gender Equity, fears antiabortion activists will target misoprostol next.

McGuire said she worries about what kind of reproductive health care will be available to her 2-year-old daughter and her nieces living in Texas.

“Whether it’s pregnancy loss, abortion, miscarriage care, we should all be able to get the medications we need. To deny that to someone is an offense to human dignity,” said McGuire, 39, of Silver Spring, Md. “This is about fighting for a better world for myself, for my family, for the people that I love.”

U.S. abortion access, reproductive rights

Tracking abortion access in the United States: Since the Supreme Court struck down Roe v. Wade, the legality of abortion has been left to individual states. The Washington Post is tracking states where abortion is legal, banned or under threat.

Abortion pills: The Supreme Court seemed unlikely to limit access to the abortion pill mifepristone. Here’s what’s at stake in the case and some key moments from oral arguments. For now, full access to mifepristone will remain in place. Here’s how mifepristone is used and where you can legally access the abortion pill.

New study: The number of women using abortion pills to end their pregnancies on their own without the direct involvement of a U.S.-based medical provider rose sharply in the months after the Supreme Court eliminated a constitutional right to abortion, according to new research.

Abortion and the 2024 election: Voters in a dozen states in 2024 could decide the fate of abortion rights with constitutional amendments on the ballot in a pivotal election year. The Biden administration announced new steps intended to ensure access to contraception, abortion medication and emergency abortions at hospitals. Here’s what the moves on reproductive health mean for consumers. See where the 2024 presidential candidates stand on abortion bans.