Today the Supreme Court of the United States heard oral arguments in a consequential case that threatens to curb access to medication abortion across the country.

A central difficulty within the case is the protection of the drug mifepristone, the primary in a two-pill routine used to induce an abortion. The drug blocks a hormone wanted for being pregnant and has been accredited by the US Food and Drug Administration since 2000.

That FDA approval is being challenged by a coalition of antiabortion docs and activists, the Alliance for Hippocratic Medicine, which is asking for the tablet to be faraway from the market. The group has alleged that mifepristone is harmful to sufferers, citing a 2021 study that discovered greater charges of emergency room visits following treatment abortion. However, that study was retracted in February after an impartial overview discovered issues with how the authors analyzed and introduced the information.

During Tuesday’s arguments, a significant line of questioning from justices was about ER visits following mifepristone use and whether or not the FDA’s loosening of rules on the drug lately has resulted in a rise in these visits.

“I think ER visits are definitely the wrong measure when looking at safety,” says Michael Belmonte, an ob-gyn and fellow on the American College of Obstetricians and Gynecologists. “It’s important to recognize that the vast majority of people that go to the emergency room are going just for reassurance rather than a true safety concern.”

Belmonte says the extra vital measure is critical antagonistic occasions, that are extraordinarily uncommon with treatment abortion. “Adverse events happen with any medication or procedure and, quite frankly, the adverse events that occur with these medications are extremely rare in comparison to things that we use every day,” he says.

Significant antagonistic occasions embrace hospital admission, blood transfusion, an infection, and demise. A 2013 peer-reviewed study discovered that, amongst 233,805 treatment abortions offered in 2009 and 2010, these important antagonistic occasions or outcomes have been reported in 1,530 instances, lower than 1 p.c.

“Many women might go [to the ER] because they’re experiencing heavy bleeding, which mimics a miscarriage, and they might just need to know whether or not they’re having a complication,” mentioned US Solicitor General Elizabeth Prelogar, who’s defending the FDA, in oral arguments on Tuesday.

Belmonte says it’s price noting that the abortion tablet routine is supposed to trigger bleeding and cramping. While these results could also be troubling to some sufferers, it’s a operate of the treatment and an indication that it’s working. “Mifepristone really just prepares the uterus for evacuation, and so, inherently, mifepristone alone doesn’t tend to cause any bleeding, cramping, or other side effects,” he says. Misoprostol, the second drug utilized in a drugs abortion, is what causes bleeding and cramping.

Ushma Upadhyay, a public well being social scientist on the UC San Francisco who research treatment abortion, says many sufferers who go to an emergency division after a drugs abortion are alarmed by the bleeding the treatment causes, however that doesn’t imply they’re experiencing a critical antagonistic occasion. “When people have a medication abortion they’re experiencing it alone, and they don’t have a provider with them to ask questions,” she says. “People are going to the ER to understand whether the bleeding that they’re experiencing is normal and to assess whether the medications worked.”