On Friday, federal Judge Matthew Kacsmaryk handed down a decision further restricting abortion access nationwide by suspending the Food and Drug Administration’s approval of mifepristone, the most common and safe pill used for medication abortion. Another ruling, from a federal judge in Washington state, ordered the F.D.A. to make no changes affecting the drug’s availability. This sets up a clash in the courts. The judge in Texas has stayed his order for seven days to allow the F.D.A. to appeal.
The same antiabortion extremists that worked to reverse Roe v. Wade are behind this Texas lawsuit, Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration. With appeals, it now will move to the U.S. 5th Circuit Court of Appeals in New Orleans and then to the Supreme Court. If the ruling is not overturned, it will result in a harmful restriction to abortion access even for people in “blue” or “safe haven” states. Mifepristone, taken with misoprostol, is now used in more than half of all abortions in the U.S.
Since the Dobbs v. Jackson Women’s Health Organization decision in June, 13 states have banned most abortion procedures and 26 clinics have closed, including the four in Texas managed by Whole Woman’s Health. With the latest ruling in Texas, abortion care could be disrupted more than it already has been.
Whole Woman’s Health clinics were early adopters of the mifepristone-misoprostol regimen for medication abortion. It is a safe and effective medication for our patients, and after its approval by the FDA in 2000, it quickly became the most popular option for abortion care nationwide. Over the course of two decades, we have provided thousands of patients with these abortion pills and have seen the benefits and effectiveness of the combination regimen.
As this case over mifepristone continues through the upper courts, there remains an option for people to use misoprostol alone. Misoprostol can be safely used on its own to end a pregnancy with an 85% to 90% efficacy rate (the mifepristone-misoprostol regimen has a 99.6% efficacy rate.) “Miso-alone” protocols have been used effectively around the world for decades but are most often used in countries where abortion is restricted or banned, and where people don’t have access to mifepristone. Whole Woman’s Health will continue providing mifepristone abortions unless directed otherwise by the FDA.
The risk of losing the most effective method, the mifepristone-misoprostol regimen, is unacceptable for patients who deserve access to safe abortions without having to resort to workarounds. Unfortunately, when abortion is involved, science is often set aside while the political agenda of a small minority of Americans is weaponized, harming those who are or who will become pregnant by restricting their options.
This Texas ruling also forces expert healthcare workers to offer a less-effective method of medication abortion that might not be as comfortable for their patients. Providing compassionate abortion care is what we do, and navigating the ever-changing abortion-care landscape has become part of our daily lives. But without mifepristone, the experience of abortion with pills will not be the same for our patients. Misoprostol-only abortion care involves more side effects, including increased bleeding, cramping, nausea, as well as potential vomiting and diarrhea. The regimen also involves more pills over a longer period of time.
In the aftermath of another ruling designed to eradicate access to abortion care, I no longer recognize the abortion landscape that I first started in over 30 years ago. This attempt to ban medication abortion shows what many of us in the reproductive health, rights and justice fields have been saying for years: that antiabortion extremists won’t stop their war against bodily autonomy just because Roe was overturned. And they aren’t going to stop now.
But abortion providers and our allies are not backing down. We know that abortion bans do not reduce the need for abortion care in our communities. We may be more restricted in what we can prescribe in the way of medication abortion, but we will continue to provide the best care legally allowed, with compassion, wherever we can for as long as we can.
We are continuing our work to build a world beyond Roe, beyond Dobbs and beyond Friday’s decision in Texas. Abortion seekers deserve to have all options when it comes to their health, and we remain steadfast in our commitment to providing their care.
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ABOUT THE WRITER
Amy Hagstrom Miller is president and chief executive of Whole Woman’s Health Alliance.
