A Doctor’s Warning From the Front Lines of Reproductive Care
An Asheville physician says the fight over Mifepristone is not fundamentally about medicine — but about politics, geography, and whether patients still control their own healthcare decisions.
When anti-abortion attorneys argue in court that Mifepristone is dangerous, Dr. Bhaskari Burra says her clinical experience tells a very different story.
“Anecdotally, I’ve never had anybody experience any adverse effects from mifepristone or any untoward side effects that we weren’t expecting or unexplained complications from taking mifepristone,” Dr. Burra said.
Burra, a maternal fetal medicine physician in Asheville and fellow with Physicians for Reproductive Health, recently joined an amicus brief urging the U.S. Supreme Court to block a Fifth Circuit ruling that would sharply restrict remote access to mifepristone, the medication commonly used in abortion and miscarriage management.
Drawing on firsthand experiences from OB-GYNs, maternal-fetal medicine specialists, and family medicine physicians across the country, the brief emphasizes that telehealth evaluations are medically sound and that doctors are fully capable of screening patients remotely for rare complications, such as ectopic pregnancy.
Beyond the legal arguments, the filing centers heavily on the human consequences of restricting access to medication abortion and miscarriage care. Physicians describe patients in rural communities traveling hours for medically unnecessary visits, women experiencing severe pregnancy complications or mental health crises, and families navigating devastating fetal diagnoses while facing additional bureaucratic hurdles.
The brief argues that forcing in-person dispensing of Mifepristone would deepen racial and economic inequities in healthcare, particularly for Black women, Indigenous women, low-income patients, and people living far from abortion providers. Throughout the filing, doctors frame patient autonomy — including the ability to choose where and how to manage a pregnancy loss or abortion — as a core principle of ethical medical care.
During an interview this week, Burra described the effort to limit telehealth access as politically driven rather than rooted in legitimate medical concerns.
In her own practice, Burra said she primarily prescribes mifepristone for miscarriage management and second-trimester abortion procedures involving severe fetal anomalies or pregnancy loss. She said she has never personally encountered unexplained complications tied to the medication and emphasized that its safety profile is extraordinarily strong compared to many routinely prescribed drugs.
The legal battle now before the Supreme Court centers on FDA rules that allow patients to receive mifepristone through telehealth visits and mailed prescriptions, policies that were loosened during the COVID-19 pandemic and later made permanent. The case has become one of the most consequential abortion disputes since Dobbs v. Jackson Women’s Health Organization overturned Roe v. Wade.
Burra said the consequences are especially significant in rural regions like western North Carolina, where patients often live hours away from specialized medical care. Her health system serves as the primary provider of high-risk obstetric care across much of the mountainous region, including parts of Tennessee and Georgia. For many patients, she explained, mandatory in-person visits create major logistical and financial burdens, requiring multiple long-distance trips within just a few days.
Those travel requirements can translate into lost wages, difficulties arranging child care, and delayed medical treatment. In some cases, she said, patients may ultimately abandon care altogether because the barriers become overwhelming.
“So for folks who have to travel a long distance, not having to do that just to seek the care that is medically necessary is a big deal,” Burra said.
Burra also pushed back against arguments that telehealth abortion care creates unique dangers because doctors cannot reliably detect ectopic pregnancies remotely. She said physicians are trained to identify warning signs through symptoms, medical history, and patient counseling, and she argued that claims about widespread danger are often exaggerated by anti-abortion activists and crisis pregnancy centers seeking to increase barriers to abortion access.
“That it is actually more of a scare tactic by folks who are trying to limit Mifepristone access,” Dr. Burra said.
Professional organizations, including The American College of Obstetricians and Gynecologists and the Society of Family Planning, she noted, do not require ultrasounds in every case before prescribing mifepristone.
Much of Burra’s work involves patients receiving devastating diagnoses involving fetal anomalies or pregnancy loss later in pregnancy. In those moments, she said, state abortion restrictions often intensify trauma by forcing patients through medically unnecessary waiting periods, repeated travel, and mandatory counseling documents that she described as emotionally harmful and medically inaccurate.
The emotional toll extends beyond patients themselves. Burra said many physicians increasingly feel trapped between medical ethics and political mandates imposed by lawmakers with little understanding of reproductive healthcare.
Before moving to North Carolina, Burra trained in Texas and Louisiana, where restrictive abortion laws had already reshaped reproductive healthcare long before Dobbs. She said those policies ultimately influenced her own decision not to return to Texas to practice medicine. According to Burra, many OB-GYNs are now leaving states with the harshest abortion bans, creating growing shortages in places that already struggle with access to maternal healthcare.
She warned that the burdens of abortion restrictions fall disproportionately on Black women, Indigenous women, low-income patients, and others already facing systemic barriers in healthcare. Those same communities, she noted, are also disproportionately affected by America’s worsening maternal mortality crisis.
At the core of the debate, Burra said, is patient autonomy — the belief that patients should retain meaningful control over how they experience abortion care or miscarriage management when multiple medically safe options exist. For some patients, medication abortion allows them to avoid procedures they may associate with prior trauma. For others, telehealth care may be the only realistic option because of distance, finances, or family obligations.
Burra argued that removing access to telehealth abortion care would deepen already severe inequities in reproductive medicine and further isolate vulnerable patients from care.
She said she hopes the public — and the Supreme Court itself — listens more closely to physicians and patients who directly experience the realities of reproductive healthcare, rather than to political rhetoric surrounding abortion.
“There are many, many medical conditions that are not acknowledged by folks who are making the law because they don’t understand the nuances of medical care that pregnancy would exacerbate or worsen their health,” Burra said.
Book Teaser: My book, Given No Choice: A History of Abortion Rights, traces the long history of abortion restrictions in America and the physicians, patients, and activists who fought them. From the criminal abortion era before Roe to today’s telehealth battles over Mifepristone, the struggle over reproductive autonomy has repeatedly reshaped medicine, law, and women’s lives.