'You might have thought that after the Supreme Court overturned Roe v Wade nearly two years ago, anti-abortion rights groups would be satisfied. After all, they had been working for decades to topple the precedent. This was the big one they were after. What else was there to overturn?

OutFront tonight, breaking news and what is now the most consequential ruling since the Supreme Court overturned Roe versus Wade.

Turns out there was quite a bit more.

A Trump appointed federal judge has just suspended the FDA's approval for a widely used abortion drug. That means the drug, called mifepristone, could soon be banned nationwide, even in states where abortion remains legal.

It's been nearly a year since that ruling about a super popular abortion pill. Well, now, on Tuesday, the Supreme Court is going to hear oral arguments in this case. And some advocates say the eventual decision could be even more seismic for women across the country. My guest this week is CNN medical correspondent Meg Tirrell. We're going to break down what the science says about medication abortion, and check in on how recent rulings are impacting women from Idaho to Alabama from CNN, this is One Thing I'm David Rind.

So, Meg, what is happening at the Supreme Court this week?

So the court is taking up its real first major abortion case since it overturned Roe v Wade with the Dobbs decision in the summer of 2022. The court is going to hear oral arguments about a drug called mifepristone, which is part of a regimen used for medication abortion.

So when we hear medication abortion, this specific drug is a big part of that.

This is one of two medicines that are part of this regimen, which is incredibly widely used for abortion. Mifepristone is the first drug, and the second drug is misoprostol, and mifepristone is the drug at the heart of this case.

And so how did this end up at the Supreme Court?

'So essentially, a group of doctors challenged the FDA's approval of mifepristone. The drug was originally approved in 2000. Essentially, they said there were no safety issues that the FDA didn't appropriately consider. Over time, the FDA expanded how the drug could be used. So in 2016, they expanded the gestational limit for using the drug from seven weeks of pregnancy to up to ten weeks of pregnancy. Over time, they also made it easier to access the drug through telehealth. So originally, you had to have three in-person visits with a doctor to be able to get access to medication abortion. During Covid, they changed the rules so that you could get access to medication abortion through telehealth. And then, they sort of solidified that, going out of the pandemic. So instead of having to go to a doctor, you can now do this through telehealth.

So this had been a thing. But then gradually there are all these approvals and it's making it more available to people through telehealth and things like that.

Yes. And since it's become much more available, we've actually seen it become a bigger and bigger proportion of how people access abortion in the United States. A new study just came out showing that medication abortions are 63% of all abortions that happen in the United States, and we just got new data on how many abortions happened per year in the US. In 2023, it was more than a million. So you're talking about more than 600,000 people using this regimen for medication abortion.

Let me just tell you a little bit about what this judge said in this long opinion. He said that the FDA entirely failed to consider an important aspect of the problem by omitting any evaluation of the psychological effects of the drug or an evaluation of the long term medical consequences of the drug.

So essentially, what happened is that a district judge in Texas agreed with the plaintiffs. And that would have essentially made Mr. Preston's approval in 2000 go away. But that ruling was stayed. And an appeals process happened. And the appeals court essentially said the 2000 approval is too long ago now. But we agree that you can roll back the regulations around this drug to where they were before the 2016 expansion started. So you're going back to you seven weeks gestation. You're going back to not being able to access mifepristone through, telehealth. And that is going up to the Supreme Court.

Interesting. So that would kick it back to this time period where it was kind of less available. And then as a result, it just wouldn't be as accessible to people.

Yeah. And I've talked with, doctors about this. I was talking with Doctor Dan Grossman at UCSF who's a researcher in this space, and he was saying it's really the telehealth aspect of this. First of all, we've seen that really expand access to this over time. But also, you know, that could be the part that really goes away and is a big, impact because doctors typically have the ability to prescribe something off label. So even if you're changing the gestational limit to seven weeks from ten weeks, doctors could still prescribe the drug off label. The other thing to know is that misoprostol, which is the other medicine that's part of this regimen. It can work by itself, but the gold standard is to use the two drugs together to have a safer and better outcome. The other thing that I think is really freaking out the medical community about the Supreme Court's decision about mifepristone is that it's really unprecedented to see a judicial challenge to an FDA decision about a drug. And if the Supreme Court agrees with the district judge that the FDA was wrong here. Does this open up a huge window for anybody to challenge any FDA approval based on ideological grounds? I mean, no, I know that the pharmaceutical industry is very worried about this, and I think people in general are wondering what happens to drug approvals.

They're like, this is the realm of scientists and health professionals, and the judicial angle shouldn't have anything to do with that.

Yes. And the window that I've heard, talked about a lot is does this open up ideological challenges to vaccine approvals, for example.

Hmhm, so this summer, it'll be two years since Roe v Wade was overturned and the landscape of abortion access in this country has been totally changed. Since then, you've been looking into kind of what that looks like up close. So what do you find?

So we're seeing more abortions happening. You're seeing a number of states that have banned abortions completely. You don't see abortions happening or at least being recorded through the data. But abortions overall went up 10% in 2023. But in states neighboring, states that have totally banned abortion, you saw a much bigger increase because people are going out of state.

So you guys are Jon and Jen Adkins?

Yep.

We went out to Idaho, a state with an almost total ban on abortion, very few exceptions. And we met a mom named Jen Adkins, and her husband John.

Tell me about, you know, you guys living in Idaho? Like, how long have you been here?

Our whole lives, basically. Both of us were born and raised. Jon's actually a sixth generation Idaho, and.

They're very proud to live in this state. But they had a really traumatic experience, when they had essentially their second pregnancy. So they already had, a little boy and they were pregnant with their second baby.

As soon as that ultrasound technician put that wand on my stomach and I saw the baby on the screen, I knew something was wrong. I saw that the baby was covered in fluid.

And at 12 weeks during routine ultrasound, Jen found out that the baby was very unlikely to survive to term and that because of the what was going on with the baby, there were health risks to Jen as well.

All of which can be prevented by terminating the pregnancy. So I asked the question, you know, then then what's our what's our option here? And they said, well, because you're in the state of Idaho, we cannot provide a termination for you. We cannot provide an abortion.

And she said it was essentially sort of telegraphed to her that they would potentially recommend a termination, but they couldn't provide one for her or direct her to any place she could get that in Idaho.

So I was handed a piece of paper basically under the desk that had a list of clinics that I could potentially call and from, you know, all the surrounding states. And, I was sent home to grieve and mourn and call around to see if we could get an appointment, out of state.

Wow.

And so she was essentially in this situation where they basically had to travel, out of state. They were in Boise or outside Boise. They had to travel to Portland, Oregon.

The the clinic staff kind of had to go through their, the motions that they legally have to go through. So, you know, they in triage, they asked me, have you considered other options like adoption or, parenting this child? And I just broke down because, of course we did. Of course we wanted to parent this child. And, I just it was so hard to, to explain to them because they didn't they didn't know me from anyone else. And it's it feels like an inappropriate place to be having a procedure like I was, because I was grieving and I was a bereaved parent, and, I wasn't there just because I didn't want to be pregnant. I wanted to be pregnant. I wanted to have this baby.

And this was a traumatic experience for them in many ways, a wanted pregnancy that turned out not to be viable.

It's like there's stress of that. But then there's the added stress of having to find money to travel and go elsewhere and get this procedure done.

Yeah. And so we also talked with doctors in the state of Idaho who are challenging the abortion laws. They're part of lawsuits. Who told us now on the first prenatal visit with expecting patients instead of just talking about, like, here's what you eat and here's the prenatal vitamins you need to take. They also say by LifeFlight insurance, in case you have a complication and you have to be helicoptered or flown to another state where you can get abortion care.

Now, if you thought Dobbs was just about abortion, boy, do I have some news for you.

Of course. Then there's what happened in Alabama.

Yeah, this has been in the news recently, but this isn't necessarily about abortion but about IVF. So can't catch us up like what happened there.

Yeah. So essentially it comes back to an idea known as fetal personhood.

The Alabama Supreme Court ruling that frozen embryos created through IVF are children. Babies, quote, "kept alive in a cryogenic nursery while they awaited implantation."

And under a law in Alabama that dates back to the 1800s, I think it's 1872, the unlawful death of a minor act. The Alabama state Supreme Court ruled that frozen embryos are unborn children and are protected by this law. And so what this led to essentially, this decision led to several fertility clinics in Alabama shutting down because they didn't know what they could be held liable for in the practice of IVF. What was your reaction when this the news of the Supreme Court decision came out?

You know, this news has been a huge shock to all of us. A week ago, our practice made the devastating decision to have to halt IVF treatments.

And we went down there and talked with people who'd built their families using IVF.

So we've had to make terrible phone calls to patients who have, been planning, their treatments for weeks and months.

And we talked with doctors who said it really robbed them of the best part of their job, which is getting to tell a person or a family that they're pregnant.

The people here are the men and women in Alabama who have infertility. They should not have to go across state lines to get treatment. That's that's unacceptable. I don't know that anyone should view that as a solution.

So there was a huge uproar about this both in Alabama and nationally. And the state legislature stepped in very quickly and passed a law that enabled most of the fertility clinics to start operating again. But it didn't reverse the decision of the state Supreme Court around that fetal personhood idea. It essentially carved out protection for IVF providers and families. And so there are still a lot of questions that people have about whether we're going to see this come up again.

That's kind of what I wanted to get at. Like as we approach two years with the overturning of Row and all these challenges to various parts of reproductive health, like where does this end up? I guess as we look at all the knock on effects that we see and all these stories that you've been talking about.

The concern I've been hearing from people in this community, specifically with the mifepristone case it's not that medication abortion itself is going to go away, but one of the things Doctor Dan Grossman from UCSF was telling me is that does this open a window? If the Supreme Court agrees with the appeals court and rolls back some of the accessibility of this, does it open a window for states to go after even people who are using medication, abortion, really criminalizing people who are using it? That's been sort of a place where we've seen the law stop.

Kind of like where we've seen those those laws that would criminalize somebody who helped a person get an abortion out of state or something like that.

Yes, exactly. Those we've started to see more of, but typically we haven't necessarily seen the pregnant person themself be the subject of enforcement. And that is a place a lot of people are talking about this potentially going.

Really interesting. Meg, Thank you.

Thank you.

One Thing is a production of CNN Audio. This episode was produced by Paola Ortiz and me, David Rind, our senior producer is Faiz Jamil. Our supervising producer is Greg Peppers. Matt Dempsey is our production manager. Dan Dzula is our technical director, and Steve Lickteig is the executive producer of CNN Audio. We get support from Haley Thomas, Alex Manasseri, Robert Mathers, John Dianora, Lenni Steinhart, Jamus Andrest, Nicole Pesaru, and Lisa Namerow. Special thanks to Katie Hinman. And remember, if you like the show, the easiest, best way to spread the word. Just tell a friend. Tell a family member. Tell them where to find us. We appreciate it.