Intended for healthcare professionals

Rapid response to:

Editor's Choice

Death and ill health by order of the Supreme Court

BMJ 2022; 377 doi: (Published 30 June 2022) Cite this as: BMJ 2022;377:o1600

Rapid Response:

Re: Death and ill health by order of the Supreme Court

Dear Editor
The Women’s Medicines Group of the International Society of Pharmacovigilance (ISoP) agrees with the BMJ Editor in Chief in strongly condemning the recent decision made by the US Supreme Court (SCOTUS) which overturns Roe v. Wade [1]. Around 36 million women will be denied access to abortion in their own State [2] with serious consequences for their health and implications for the safe use of drugs for this medical procedure in the USA.

Within hours of the SCOTUS leak on 2 May, internet searches for abortion medicines escalated [3], indicating that women (especially in states with restrictive reproductive rights) may now be forced to take matters into their own hands. While abortifacients such as mifepristone and misoprostol are effective and safe [4] and their use is endorsed by the World Health Organization [5], in most countries these medicines are prescription-only and their supply and use (in hospitals, clinics or community settings) are intended to be supervised by health professionals.

Women undergoing medical or surgical abortion deserve appropriate medical support. Although most procedures are uncomplicated, in some cases (for example, incomplete abortion or infection) life-saving treatment is required. The recent SCOTUS decision not only prevents millions of American women having the right to seek abortion and associated medical care, but also places health professionals in the unacceptable position of providing care outside the legal framework in which access to safe termination of pregnancy should normally be provided.

Other consequences of the SCOTUS decision include supply issues with drugs such as methotrexate, a drug used in medical abortion regimens in the USA before mifepristone was approved. Some American patients taking methotrexate for autoimmune conditions and cancers have already reported access problems [6]. It is also possible that women unable to have medically supervised abortions will illegally obtain drugs approved for the induction of full-term labour, which are unsuitable or unsafe for use as abortifacients. In addition to the safety concerns for women using these medicines for abortion, there may be consequential effects on supply to obstetric units in the USA.

We stand with the BMJ and other international medical professionals opposing the harmful and retrograde decision by SCOTUS to overturn Roe v. Wade. Millions of people worldwide have long since fought for access to safe abortion as a human, reproductive and medical right. In recent years there has been progress to protect women’s health in Latin American countries, Ireland and New Zealand. American women also deserve access to safe, medically supervised and legal abortion procedures.


1. Abbasi K. Death and ill health by order of the US Supreme Court. BMJ 2022;377:o1600
2. Shah S. What abortion safe haven States can do: Time; 2022 [Available from:
3. Poliak A, Satybaldiyeva N, Strathdee SA, et al. Internet searches for abortion medications following the leaked Supreme Court of the United States draft ruling. JAMA Internal Medicine 2022 doi: 10.1001/jamainternmed.2022.2998
4. Aiken ARA. Safety and effectiveness of self-managed medication abortion provided using online telemedicine in the United States: a population based study. Lancet Regional Health - Americas 2022 doi: 10.1016/j.lana.2022.100200
5. WHO. Abortion care guideline Geneva: World Health Organization; 2022 [Available from:
6. ACR. A message from the American College of Rheumatology: Twitter; 2022 [Available from:

Competing interests: No competing interests

13 July 2022
Mira Harrison-Woolrych
President, International Society of Pharmacovigilance
Professon Sam Rowlands
International Society of Pharmacovigilance (ISoP)
ISoP Secretariat Ltd; 140 Emmaunuel Road, London SW12 0HS