Idaho residents worry as access to mifepristone faces possible limitations

Some Idahoan residents and physicians worry about pregnancy care as state and federal officials consider mifepristone restrictions.

BOISE, Idaho — This story originally appeared in the Idaho Press. 

As state and federal officials have recently signaled a desire to restrict access to mifepristone — a drug used for abortion — some Idahoan residents and physicians are concerned about the future of dealing with pregnancy complications.

Kayla Smith, a former Nampa resident who joined a lawsuit against the state’s abortion bans, had been denied an abortion in Idaho when she received a fatal fetal diagnosis in 2022. She traveled to a University of Washington clinic where she took mifepristone and misoprostol to induce labor and meet her baby boy before he died shortly after the birth.

“He had several fatal anomalies,” Smith told the Idaho Press in a phone interview. “There was a potential for my life to be at risk because I did get severe preeclampsia with my oldest daughter Addison, but at the time, the law just went into effect two days prior. I don’t think physicians understood what they could or couldn’t do.”

Idaho doctors cannot by law prescribe mifepristone, which is used in conjunction with misoprostol, for elective abortions — doing so would be a felony crime, punishable by prison time, suspension of medical license, and a potential civil penalty of at least $20,000. Some top officials are considering restricting access to the abortion medication nationwide.

Food and Drug Administration Commissioner Marty Makary committed to reviewing the abortion drug mifepristone in a June 2 letter to Missouri Republican Sen. Josh Hawley, according to the letter Hawley posted on social media. The FDA first approved use of the drug in 2000.

Health and Human Services Secretary Robert F. Kennedy Jr. directed the agency to do a review last month, CBS News reported.

State lawmakers during this year’s legislative session proposed a bill that would have made both mifepristone and misoprostol a Schedule 4 controlled substance, in the same category as Xanax or Valium. The bill did not have a hearing or move forward.

Idaho Attorney General Raúl Labrador, along with the top lawyers from Kansas and Missouri, in 2024 sued the FDA to restrict access to mifepristone, while on June 5, New York, California, Massachusetts and New Jersey jointly filed a lawsuit against the FDA to expand access and remove some of the restrictions on it that are currently in place.

Labrador’s office did not respond to requests for comment on the case by press time.

Mifepristone is currently being used in Idaho for clinical uses other than elective abortions, such as to manage miscarriage or treat Cushing syndrome, which is caused by sustained high cortisol levels.

Boise-based OB-GYN Anne Feigner said that she will prescribe the drug to patients that decide to use it to move along the miscarriage process, which can take up to six weeks on its own.

“They typically complete their miscarriage faster and with fewer complications,” Feigner said of using the medication in an interview.

The use of the medication can reduce risk of an emergency room visit; the need for the surgical procedure dilation and curettage (D&C) or dilation and evacuation (D&E), which remove tissue from the uterus; or complications related to bleeding, she said.

The other drug in the series, misoprostol, is also commonly used to induce labor in a stillbirth or for postpartum hemorrhaging, Feigner said.

Restricting access could mean delays for health care providers and their patients, sometimes in emergency situations.

“Midwives who deliver babies at home in the community or birth centers, or rural emergency rooms or rural labor and deliveries … dealing with hemorrhage from early pregnancy loss would not have access to a drug that is very safe, very effective, because they would have then take it out of a pharmacy essentially to administer it to the patient,” Feigner said.

Food and Drug Administration Commissioner Marty Makary speaks as Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, left, listens during an event at White House on May 22, 2025, in Washington.

Idaho’s abortion felony ban allows for the removal of a dead fetus. The American Academy of Family Physicians and American College of Obstetricians and Gynecologists recommend the two-medicine series of mifepristone and misoprostol to induce labor for early pregnancy loss, which the FDA recommends for up to 70 days gestation.

Feigner said she’s heard from patients in Idaho who have trouble getting the medication from some pharmacists even for legal uses because of concerns about the laws. A Boise woman in early 2024 told the Idaho Statesman that she and her husband were denied a prescription for the medication to aid her miscarriage.

The Idaho Board of Pharmacy has not received concerns about the medication, board spokesman Bob McLaughlin told the Idaho Press in an email, and it has not issued guidance related to it.

In Smith’s situation, her baby had fetal cardiac activity, which can often be detected just under six weeks of pregnancy, so its use was not legal under Idaho’s laws. She and her husband opted to induce labor so that they could meet their son, whom they had named Brooks. So they travel out of state.

Without the medication, she may have required a caesarean section, as she did when she had her first child. The risk of uterine rupture can go up with each caesarean section.

“This was the safest way, hoping to avoid a C-section as well for me, because we knew that our son wasn’t going to survive,” Smith said. “It’s major abdominal surgery and so to have to go through that again, which I had already had one, and to potentially have to do that again was very risky.”

If nationwide restrictions on the medication had been in place at the time, Smith could only guess how her situation may have been different.

“We may not have been able to meet our son,” Smith said. “We might have had to go and get a D&E procedure, which was really risky for me. I don’t know, I may have had to stay pregnant. It’s just really nuanced, right? It just limits access across the board tremendously.”

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