The Supreme Court doesn’t belong in your medicine cabinet

The silence from corporate America amid new attacks on women’s reproductive health care has been deafening. As the federal courts consider whether to override the FDA’s judgment on first-trimester abortion pills, it’s time for health care leaders to speak out about the repercussions of taking away medical sovereignty from 40 million women.

January 2023 marked 50 years since Roe vs. Wade gave Americans the freedom to make difficult, deeply personal medical decisions about their pregnancies based on their unique life circumstances, including potential risks to maternal health.

It took the newly constituted U.S. Supreme Court less than two years to eviscerate that right as it fast-tracked Roe’s reversal with insufficient regard for how their ruling would impact maternal health and clear disregard for the right of women to decide what happens to their bodies.

In erasing a half-century of precedent, Justice Samuel Alito’s majority opinion gave the right to choose to state legislators, who are 81% male and 71% white. As a result, those with unplanned pregnancies, including victims of rape and incest, may now be compelled in 12 states to carry their fetus to term under penalty of law. Such a mandate is medically perilous and, in my view, morally unconscionable.

As attorneys wage the next round of battles over reproductive rights in federal court, at stake is whether the FDA remains the arbiter of what medications are safe, effective, and legal for Americans to take.

Since 2000, the FDA has allowed women to take mifepristone and misoprostol in combination to medically terminate a pregnancy during its first 10 weeks. This window is well within the first trimester, when survival outside of the uterus is medically impossible and viability is still many months away. Even the federal abortion ban proposed by Congressional conservatives seeks to ban abortions only after 15 weeks.

Last month, acting on a mountain of evidence showing that mifepristone and misoprostol can be safely and effectively administered via telehealth, the FDA issued new regulations enabling the certification of retail pharmacies to dispense these medications.

Those rules followed the FDA’s decision to implement new labeling for emergency contraceptive medications clarifying that the morning-after pill is not abortive. The pill “will not work if a person is already pregnant,” the FDA states. “[It] prevents pregnancy by acting on ovulation, which occurs well before implantation.”

In both cases, the FDA made its determinations based on the best available medical science, consistent with its mission as the agency “responsible for protecting the public health.” The FDA’s leaders acted as responsible public health officials should.

The health implications of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization demand a bigger microscope. Nearly half of pregnancies in the U.S. are unplanned, according to the CDC. Meanwhile, there are more deaths related to pregnancy and childbirth in the U.S. than in any other high-income country. Individuals with underlying conditions like heart disease and pulmonary hypertension are at heightened risk of pregnancy complications that could threaten their health or their lives. In other cases, such as placenta accreta, the pregnancy itself can threaten a mother’s life.

Rape victims may also face heightened risks. Abhorrently, nearly 3 million American women and girls have experienced a rape-related pregnancy. Teenagers and girls forced to give birth are at an elevated risk of eclampsia, which can lead to seizures or death, and potentially fatal systemic infections.

Individuals diagnosed with cancer or other diseases may wish to terminate a pregnancy to begin treatment. Their right to do so could determine whether they live or die.

For many reasons, carrying a pregnancy to term can be a medically complicated event. The Supreme Court ruling ignored overwhelming public opinion that such a profound choice should be an individual’s to make in consultation with a doctor. Even in deep-red states like Kentucky, Kansas and Montana, clear majorities have voted for abortion rights in every voter referendum held since Roe’s reversal.

The most restrictive abortion bans are primarily in southern states, which have large Black and Hispanic populations. Were states able to outlaw medication abortion, it would disproportionately impact women of color, who may have greater barriers traveling out of state for abortion care due to economic inequities.

The ongoing litigation may ultimately be settled by the Supreme Court. A question every American should ask: Is there room for Samuel Alito and Clarence Thomas in your medicine cabinet?

As the new Supreme Court majority weighs the dismantling of a half-century of progress, CEOs, C-suite executives and other leaders in the health care sector should do our duty: Put patients before politics on reproductive health care, defend the FDA’s jurisdiction, and publicly support the right of pregnant women to make their own medical decisions.

Paul J. Hastings is the CEO of Nkarta Therapeutics in South San Francisco. The opinions expressed here are his and do not necessarily reflect those of Nkarta.