This week a Republican-appointed federal judge weighed whether to grant an injunction that could remove mifepristone, the drug used in most American abortions, from the market nationwide. And the hearing almost happened in secret.
US district court judge Matthew Kacsmaryk had initially planned to keep Wednesday’s hearing in the case – in which a group of rightwing anti-abortion groups are suing the FDA to reverse its 20-year-old approval of mifepristone – quiet. In a conference call with lawyers for the anti-choice groups and the Department of Justice, Kacsmaryk asked attorneys not to disclose the existence of the hearing (“This is not a gag order,” he said repeatedly), and said that the event would only be made public late on Tuesday to minimize popular awareness. “It may even be after business hours.” The judge’s courtroom in Amarillo, Texas, is hours away from any major city. It was only because of a press leak that the hearing was known to the public at all.
It was just one of many of the alarming irregularities in the lawsuit, in which Kacsmaryk seems poised to grant the plaintiffs’ wish and issue an injunction that will radically reduce access to abortion nationwide.
For one thing, the plaintiffs’ standing is exceptionally shaky: it’s not clear why the collection of abortion opponents – including one doctor, George Delgado, whose attempt to design an abortion-reversal clinical trial sent 25% of the test subjects to the hospital – have standing to sue the FDA. It’s especially unclear why they have standing to sue in Amarillo; the federal judicial district has become a popular venue for rightwing litigation in part because Kacsmaryk, an exceptionally conservative jurist willing to publish poorly reasoned, policy-driven opinions, is the only federal judge there.
For another thing, the plaintiffs’ requests are exceptionally far-reaching. The anti-abortion groups want Kacsmaryk to declare the FDA’s approval of mifepristone illegal, even though the drug has been available in the US, and proven to be safe, for more than 20 years, and even though a judicial reversal of FDA approval for a medication would be highly unusual and only dubiously legal. At the hearing on Wednesday, lawyers for the plaintiffs acknowledged that there was no precedent for the court to order the suspension of a long-approved medication. If Kacsmaryk approves the injunction – and all indications are that he will – the drug could become inaccessible nationwide, even in Democratic-controlled states where abortion is legal.
For another thing, the plaintiffs’ claims are so profoundly divorced from fact that it is difficult to believe that they are being made in good faith. The anti-abortion groups – including the doctor whose study sent women to the hospital – say that they are challenging the drug because they believe, falsely, that mifepristone is unsafe. Lawyers from the Alliance Defending Freedom, the rightwing legal outfit that is representing the plaintiffs and which is designated as a hate group by the Southern Poverty Law Center, pursued this idea on Wednesday in court. “How many more women have to die?” attorney Erik Baptist asked.
In fact, no one dies from mifepristone. One of the most aggressively studied and tested drugs in the world since its creation in France in 1987, mifepristone, which blocks the pregnancy hormone progesterone and stops a pregnancy from progressing, has been found effective and overwhelmingly safe; it has a lower rate of serious complications than Tylenol. One study found that “significant adverse outcomes” occurred in less than 1% (0.65%) of mifepristone patients; the most common of these was continued pregnancy.
What women do die from – died from in massive numbers before Roe, and will die from again, if medication abortion becomes unavailable - is illegal surgical abortions.
Since Dobbs, the abortion rights movement has correctly been aiming to de-stigmatize illegal, self-managed abortions, encouraging women to stock up on the pills in advance so that they have them if they need them. The idea was that women shouldn’t be scared to use the pills: mifepristone, taken together with the contraction-inducing drug misoprostol, is so overwhelmingly safe and effective that women who could access the pills could confidently and secretly manage their own abortions, even in ban states. But if medication abortion becomes inaccessible, women may attempt more dangerous methods to self-induce. This is the real reason anti-abortion groups are targeting mifepristone: not because it endangers women, but because it keeps them safe.
The injunction doesn’t necessarily have to end medication abortion in America as we know it. For one thing, there are already groups, both foreign and domestic, that are mailing abortion medication, including mifepristone, to all 50 states, regardless of local law. Women’s solidarity, inventiveness and determination will always outmatch punitive anti-abortion regimes. For another, an established misoprostol-only protocol for abortion has already been proven effective.
Some abortion providers have already signaled their intention to switch to misoprostol-only; the drug is available over the counter in Mexico. But though they are effective, misoprostol-only abortions are also significantly more painful than those conducted with mifepristone. For the anti-abortion groups in court, that’s likely part of the point.
Moira Donegan is a Guardian US columnist
