By LAURA UNGAR and MATTHEW PERRONE (Associated Press)

The U.S. Supreme Court will take up a case Tuesday that could impact how women get access to mifepristone, one of the two pills used in the most common type of abortion in the nation.

The central dispute in the case is whether the Food and Drug Administration overlooked serious safety problems when it made mifepristone easier to obtain, including through mail-order pharmacies.

Legal briefs filed with the court describe the pill’s safety in vastly different terms: Medical professionals call it “among the safest medications” ever approved by the FDA, while the Christian conservative group suing the agency attributes “tens of thousands” of “emergency complications” to the drug.

Earlier this year, a medical journal retracted two studies that claimed to show the harms of mifepristone. The studies were cited in the pivotal Texas court ruling that brought the matter before the Supreme Court. The publisher cited conflicts of interest by the authors and flaws in their research, although the studies’ lead author called the retractions a baseless attack.

Here’s what to know about the safety of mifepristone, which is typically used with misoprostol in a medication abortion.

What safety limits has the FDA imposed since 2000?

The FDA approved mifepristone in 2000 as a safe and effective way to end early pregnancies.

There are rare occasions when mifepristone can cause dangerous, excessive bleeding that requires emergency care. Because of that, the FDA imposed strict safety limits on who could prescribe and distribute it — only specially certified physicians and only as part of three mandatory in-person appointments with the patient getting the drug.

The doctors also had to be capable of performing emergency surgery to stop excess bleeding and an abortion procedure if the drug didn’t end the pregnancy.

Over the years, the FDA reaffirmed mifepristone’s safety and repeatedly eased restrictions, culminating in a 2021 decision doing away with any in-person requirements and allowing the pill to be sent through the mail.

How often are there serious problems?

Abortion opponents say the more lax restrictions resulted in many more “emergency complications.” But that argument lumps together women experiencing a range of issues with mifepristone — from the drug not working to people who may simply have questions or concerns but don’t require medical care.

OB-GYNs say a tiny fraction of patients suffer “major” or “serious” adverse events after taking mifepristone.

A legal brief by a group of medical organizations including the American College of Obstetricians and Gynecologists says: “When used in medication abortion, major adverse events — significant infection, excessive blood loss, or hospitalization — occur in less than 0.32% of patients, according to a highly regarded study with more than 50,000 patients.”

The definition that scientists generally use for serious adverse events includes blood transfusions, major surgery, hospital admissions and death, said Ushma Upadhyay, one of the authors of that 2015 study. She added: “The hospital admission is a catch-all for the very serious but more rare events such as major infection.”

The prescribing information included in the packaging for mifepristone tablets lists slightly different statistics for what it calls “serious adverse reactions.” It cites ranges for how frequently various complications occur: 0.03% to 0.5% for transfusion; 0.2% for sepsis and 0.04% to 0.6% for hospitalization related to medication abortions. The ranges reflect findings across various relevant studies, experts said.

Why do patients go to the emergency room?

Mifepristone’s labeling also lists a complication that most medical groups don’t consider a serious or major adverse event: ER visits, which ranged from 2.9% to 4.6%. The current FDA label lists going to the ER as an option if patients experience prolonged heavy bleeding, severe abdominal pain or a sustained fever.

But ER visits don’t always reflect big problems, doctors told The Associated Press.

Some people may go there after a medication abortion because they want to be checked out or have questions but don’t have a doctor, said Upadhyay, a professor at the University of California, San Francisco. Others, she said, “don’t want to go to their primary care provider about their abortion” because of stigma.

A study she co-authored in 2018 found that slightly more than half of patients who visited the ER because of abortions received only observational care. Some, Upadhyay said, “don’t receive any treatment.”

How effective is the pill?

Mifepristone results in a completed abortion 97.4% of the time, according to U.S. studies cited in the FDA label.

But in 2.6% of cases, a surgical intervention is needed. And 0.7% of the time, the pregnancy continues.

That’s compared to a procedural abortion in a clinic, where the chance of the procedure failing to end a pregnancy “is extremely, extremely low,” probably less than 0.1%, said Dr. Pratima Gupta, a board member for the American College of Obstetricians and Gynecologists.

“Any time a procedural abortion is done, the clinicians ensure that it was a complete abortion” by examining the tissue that is removed or performing an ultrasound during or after the procedure, she said.

Gupta, who has done abortion procedures for more than 20 years, said there are “very few complications from abortion — any kind of abortion, medication or procedural abortion.” A recent study suggests that’s just as true for medication abortions that happen in a clinic, a doctor’s office or at home with the help of telehealth.

How does mifepristone’s safety and effectiveness compare to other drugs?

The FDA makes drug approval decisions on a case-by-case basis, weighing effectiveness, safety and other factors.

No drug is 100% effective, and many common medications don’t work for a significant portion of patients.

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Antidepressants typically help between 40% and 60% of people with depression. New antibiotics approved by the FDA often resolve about 70% of infections.

Since 2000, roughly 6 million patients have taken mifepristone, according to the FDA. A 2021 review of agency records looking for deaths that were likely related to the drug identified 13, or .00027% of patients.

Medical organizations supporting mifepristone’s availability say the drug’s safety — given the rate of deaths — compares to “ibuprofen, which more than 30 million Americans take in any given day.”

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

An improvement project to increase accessibility for visitors has begun at William O’Brien State Park. The lower portion of the park surrounding Lake Alice, including the Riverside Group Camp, Riverway Campground and all areas east of Minnesota Highway 95 will be closed through early 2025.

The construction will add accessible campsites, a canoe and kayak launch, trail upgrades to better accommodate wheelchairs and other mobility devices and new restrooms and shower facilities.

The majority of the park will remain open during construction, including most of the park’s 17.4 miles of hiking trails, the main office and multiple of the campsites. In addition to the Riverway campground and group camp, other areas that will be closed include the Mondale Day Use Area, which encompasses the St. Croix River public water access and Lake Alice swimming beach.

“The Minnesota DNR is constantly working to make our state park system more accessible, and this project is a key advancement in our efforts to ensure Minnesotans of all abilities can enjoy our state’s outdoor experiences,” said Ann Pierce, director of the Minnesota Department of Natural Resources Parks and Trails Division, in a statement.

The project, in development for several years, is being funded primarily through state bonding funds, with additional money raised by the 2023  Get Out MORE (Modernize Outdoor Recreation Experiences) appropriation.

Construction updates will be available on the William O’Brien State Park webpage of the DNR website.

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FORT MYERS, Fla. — A year ago at this time, Royce Lewis watched as his Twins teammates packed up to head north without him, unable to join them. He already had been placed on the 60-day injured list as he made his way back from his second anterior cruciate ligament surgery, meaning the earliest he could return was late May.

Recent seasons had been marred by injuries, and 2023 starting out with months of rehab, as well. His first torn ACL wiped out the entire 2021 season, then Lewis played in 12 major-league games before injuring the same knee in mid-2022.

When he finally came back from his second surgery last season, he dealt with a couple more injuries, straining his oblique and then his hamstring. But in between injuries, when he was on the field, he flashed his immense potential. And now, fully healthy, he’s looking forward to his first full season as a major leaguer.

“I’m very excited to get going,” Lewis said. “I feel like you can’t play every game unless you start with No. 1, so that’s what I’m looking forward to doing (and) just being available for (Twins manager) Rocco (Baldelli) and the staff as much as possible.”

In the glimpses that the team got of Lewis last season, the Twins couldn’t have asked for much more.

And, well, the excitement around the uber-talented 24-year-old and what he might be able to accomplish during a full season is high.

“A full season of a productive and healthy Royce, it changes your offensive outlook, your offensive outcomes. It changes everything,” Baldelli said. “… I mean, it’s not a shock to hear that a full year of Royce Lewis means that our offense is probably going to do some really good things.”

Last year, Lewis, the first overall pick in the 2017 draft, hit 15 home runs in just 239 plate appearances — four of them grand slams. He added four more home runs in six playoff games, including two of Game 1 of the Wild Card Series, propelling the Twins to their first playoff series victory since 2002.

He hit .309 with a .372 on-base percentage and .548 slugging percentage. His finished the season with a 150 OPS+ (100 represents a league-average hitter). He quickly became a fan favorite, both for his talent and his positive, enthusiastic nature.

Perhaps the most impressive thing he’s seen him do, Baldelli said, is excel after coming back straight from injury with little almost no ramp-up time.

“He just kind of walks in the door and performs,” Baldelli said. “He’s a performer.”

And now he’s a performer with a position, solidifying himself as the Twins’ third baseman. Lewis was drafted as a shortstop, but with veteran star Carlos Correa entrenched there, the Twins briefly tried him in center field — where he was when he crashed into a wall and tore his ACL for the second time — in 2022 before he eventually settled in at third last year.

“That, for sure, feels way more established for me,” Lewis said of knowing he’ll play third base this season. “You’re just more comfortable going out to the same spot every day knowing where I’m going, not moving around during our … fungoes (where) you go to short, third, second, or even taking outfield stuff. It makes it way easier.”

But while he feels established at his position, he still doesn’t feel established as a major leaguer. Though he has looked every bit the star since he was first called up in 2022, he has, after all, played just 70 games in his career.

“I still look at it like I’ve got to fight to show them that I belong here, and just continue to earn a spot each and every day,” Lewis said.

And after spending so much time watching his teammates — either from afar or while sidelined by injury on the bench — his motivations are simple.

“I want to win, and I want to play in the big leagues every day possible,” Lewis said.

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