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They Took Away Roe and Now They Are Coming for Abortion Pills

A federal judge just banned mifepristone in a staggering attack on reproductive rights.

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(Photo by Allison Bailey/NurPhoto)

On April 7, a federal judge in Texas issued a preliminary ruling invalidating FDA approval of mifepristone, an abortion pill. The ruling will take effect by seven days, which allows for time for the decision to be appealed. Less than an hour later, a Washington judge issued a ruling contradicting the Texas decision, ordering the FDA to maintain mifepristone availability in states where abortion is still legal. These conflicting orders will likely escalate the case to the Supreme Court. If the Texas ruling is upheld, it will make it more difficult for patients to get abortions even in states where it is currently legal. Although there are alternative, less effective medication abortion regimens available, this is yet another major attack on abortion rights and on bodily autonomy. We cannot rely on the courts to defend our rights; it is essential to build a movement to fight for free, safe and legal abortion. 

Banning Mifepristone 

Back in November of 2022, anti-abortion groups filed a lawsuit, Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration, that sought to repeal the FDA’s approval of mifepristone for medication abortions. They argue that the FDA did not sufficiently review the scientific evidence around mifepristone when they approved it, and that the agency has since ignored potential safety risks. Yesterday, the Trump-appointed ultra-conservative U.S. District Judge Matthew Kacsmaryk ruled that the FDA improperly approved mifepristone for use in medical abortion. This means that it would no longer be legal to dispense even in states where abortion is legal. 

According to The Guttmacher Institute, since 2020, medication abortions have accounted for more than half of abortions in the United States. Mifepristone is the first pill taken during a medication abortion, as it works to block progesterone, a hormone necessary for continued pregnancy growth. The claims that mifepristone’s safety hasn’t been adequately reviewed is patently false. The safety profile of mifepristone has been studied rigorously since it was approved by the FDA to terminate pregnancies over twenty years ago. From 2000 to June 2022, the FDA reports the deaths of only 28 individuals out of approximately 5.6 million people who took mifepristone. However, they note that these deaths “cannot with certainty be causally attributed to mifepristone because of information gaps about patient health status, clinical management of the patient, concurrent drug use, and other possible medical or surgical treatments and conditions.” Not only is Mifepristone very safe, but when taken together with Misoprostol, it has an efficacy rate of approximately 94 to 98 percent. 

Misoprostol is the second pill administered for a medication abortion, sometimes with multiple doses, to expel the pregnancy tissue from the uterus. It is less strictly regulated than mifepristone due to its use for other medical conditions like stomach ulcers. In places where mifepristone might not be available, health care workers turn to a misoprostol-only regimen to terminate pregnancies. However, using misoprostol alone is not as effective and can lead to more side effects like vomiting, fever, and diarrhea. 

If the Texas decision stands, some providers, like Planned Parenthood, will likely use a misoprostol only regimen for medication abortions. In that sense, medication abortions will continue to be widely used in states where abortion is still legal. While a misoprostol-only regimen is safe, the fact that it is less effective could mean an increase in patients with continuing pregnancies that need access to surgical abortion procedures. Left Voice spoke with an anonymous abortion provider in California who said, “Already my clinic is planning to stop offering medication abortion to out-of-state patients if mifepristone is banned due to higher likelihood that the medication fails. Due to these types of policies, out-of-state patients will be forced into having surgical abortions.” Instead of pushing patients into unwanted surgical procedures, clinics and medical providers need to challenge the courts by continuing to provide safe, evidence-based medical care. 

Attacks on Reproductive Care 

Since SCOTUS overturned Roe v. Wade on June 24, 2022, abortion rights have been left to the fate of individual states. As a result, thirteen states have essentially banned abortion, and eight states’ bans are still pending, forcing people to travel to other states for reproductive care.  This essentially means that low-income people, especially immigrants and people of color, struggle the most to access abortion. Meanwhile, healthcare workers in abortion haven states have been inundated with patients from across the country since Roe v. Wade was overturned. In Colorado, abortion workers saw an increase in the amount of abortion patients, likely due to many traveling from out-of-state. This surge of patients further strains an already crumbling healthcare infrastructure, which will mean a significant increase in wait times for patients who need time-sensitive abortion care. 

The SCOTUS is an unelected, undemocratic political body. Justices are appointed by the senate, not the people, and can stay as long as they want. Despite being a so-called “democratic” institution, they decide the rules that govern our everyday lives without actually involving the people in the decision-making or law implementation. While almost two-thirds of people in the United States think that pregnant people should be able to choose whether they want to terminate a pregnancy, only one-third of Supreme Court justices do. In addition to the SCOTUS, local courts similarly enact legislation autocratically. Kacsmaryk’s mifepristone decision is the most recent of his undemocratic rulings, including striking down a program for teenagers to access birth control without parental consent and federal rules that prohibited health care providers from discriminating against transgender patients.

While working class people struggle to access a basic health care service, members of SCOTUS are taking lavish vacations paid for by GOP mega donors. Justice Clarence Thomas has accepted luxurious trips from Texas billionaire and GOP donor Harlan Crow for the past two decades. The disdain that  wealthy SCOTUS members and politicians have towards people who need access to life-saving health care is not surprising, but it should motivate working-class people to demand the abolition of the court and other institutions of oppression. 

Pro-choice activists and organizations have turned to slogans such as “Abortion Pills Forever” to counter the overturning of Roe v. Wade. Of course, abortion pills are safe and effective, and we do want abortion pills forever. However, abortion pills do not and will not counter the increasing right wing attack on bodily autonomy and on our basic rights. On one hand, it is clear that even with websites like PlanCPills.Org, there are many barriers working-class people, low-income people, and immigrants undergo to access abortion pills. Simply put, not everyone has access to this information. 

Further, the sentiment that we should not be alarmed and that abortion pills are enough doesn’t account for the unrelenting anti-abortion agenda to cease mifepristone dispersion and attack abortion access everywhere. On March 17, Wyoming passed a law to make it illegal to dispense mifepristone, punishable for up to six months in prison and a fine of up to $9,000 for any healthcare providers who dispense the medication to patients. Idaho, which has banned abortion entirely except in cases of rape or incest, recently passed a bill that criminalizes anyone who helps a minor leave the state to access abortion care. Other states like South Carolina have drafted more extreme laws like the Prenatal Equal Protection Act. Although this act is unlikely to pass, it would criminalize pregnant people and include the death penalty. In addition to state laws, chain pharmacies are bending to the threats of anti-abortion groups. Pharmacies like Walgreens have decided not to dispense mifepristone even in states where it would be legal to do so. The right-wing courts are coming for abortion pills as well. They came for mife. They will come for miso. Our rights are not safe. 

The Democrats promised to codify Roe into law in election cycle after election cycle. In the 2022 midterms, abortion rights meant a relatively good result for the Democratic Party, despite skyrocketing inflation. However, the Democrats, who passed the Hyde Amendment and who see our rights as nothing by an electoral token, are our enemies in this struggle. 

Abortion pills are one important strategy for ensuring safe abortions. However, we need a broader fight for free, safe, legal abortion on demand.  We need to look to the examples of Argentina, Mexico, Ireland, and Chile, where abortion rights were won in the streets. Our own force as the working class and mobilizations using working class methods are the only ways to protect, reinstate, and even expand abortion rights. Healthcare workers should defy the law and we should build a movement to protest alongside them. We should organize our schools and workplaces to go to protests and unite this struggle for abortion rights with the strugggle for trans rights, for bodily autonomy and against all of the attacks by the far right. We demand free, safe, legal medical and surgical abortions for anyone who needs or wants one.

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K.S. Mehta

K.S. Mehta is a research assistant in New York City.

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