Judge overturns state’s mandate to check for dangerous ectopic pregnancy before giving abortion pill

Last week, a federal judge struck down a provision in a North Carolina law requiring doctors to verify that a pregnancy is in the uterus — and therefore not ectopic — before prescribing the abortion pill, while also restoring a 2023 law stating that abortions after 12 weeks must be committed in a hospital.

The two provisions had been challenged by Planned Parenthood South Atlantic and Dr. Beverly Gray, and both were temporarily blocked by U.S. District Judge Catherine Eagles last year. In her Friday ruling, Eagles vacated her previous ruling that had blocked the hospital requirement, noting “the plaintiffs have not negated every conceivable basis the General Assembly may have had for enacting the hospitalization requirement.”

However, her decision to strike down the portion of the law ensuring that women do not have an ectopic pregnancy before they receive the abortion pill puts these women at risk.

The abortion pill has been found to have a number of complications if taken while the woman has an ectopic pregnancy, which occurs when the new human being (blastocyst) implants outside of the uterus, most commonly in the fallopian tubes. An ectopic pregnancy is a life-threatening condition that requires emergency treatment — treatment a woman may not receive if she takes the abortion pill, as many of the dangerous complications of an ectopic pregnancy can mimic side effects of taking the abortion pill.

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In defending the provision prior to Eagles’ ruling, North Carolina lawmakers highlighted some of the risks.

“As the leading cause of maternal mortality in the first trimester, ectopic pregnancies must be identified and treated before they rupture,” they argued. “The North Carolina General Assembly addressed this danger by requiring doctors to document an intrauterine pregnancy (IUP) prior to giving women drugs that can mask the symptoms of a life-threatening rupture. The U.S. Food and Drug Administration (FDA) has also addressed this risk by including a warning on mifepristone’s label that a prescriber must ‘exclude [an ectopic pregnancy] before treatment.’ Codifying FDA’s warning into law is rational.”

A case study released earlier this year revealed that a 24-year-old Irish woman nearly died after she experienced a life-threatening ruptured ectopic pregnancy after she was given the abortion pill, while a 2019 case report out of India showed a woman died after taking the abortion pill regimen while unwittingly experiencing an ectopic pregnancy.

Eagles, however, disagreed with the data that the abortion pill is dangerous for ectopic pregnancies, and found that as written, the provision was “unconstitutionally vague” and that it “violates the plaintiffs’ constitutional due process rights.”

House Speaker Tim Moore and Senate leader Phil Berger, who both defended the state law after Attorney General Josh Stein refused to, did not respond to requests for comment after the court’s ruling.

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