The focus on mifepristone, a pill that is used to manage miscarriages and is also part of a two-pill series of drugs for abortions used widely in the United States, began on April 7 when Judge Matthew Kacsmaryk, a U.S. District Court judge in Texas, ruled to stop distribution of the pill while a lawsuit challenging its Food and Drug Administration safety approval continues.
More than half of abortions performed in the U.S. are done using medication. Mifepristone has been approved by the FDA for use in the U.S. since 2000 and has been used in Europe for even longer. It has a 96% efficacy rate, with less than 1% of use resulting in any complications.
The lawsuit that Kacsmaryk, a Trump Administration appointee, ruled on was initially filed by the Alliance for Hippocratic Medicine, a group of anti-abortion health care providers. The group sued the FDA, claiming the agency has not done its due diligence to respond to safety concerns, and had failed to protect women and girls from the pill. Within an hour of Kacsmaryk’s ruling, Judge Thomas O. Rice, a U.S. District Court judge in Washington, ordered the opposite —asking authorities to keep the pill available, at least in 17 Democratic-controlled states that also sued over the issue.
Then, on Friday, U.S. Supreme Court Justice Samuel Alito placed a hold on any changes to distribution or proposed restrictions, allowing the Supreme Court until April 19 to determine the legal challenges.
But despite the legal back-and-forth, advocates and physicians in the Gulf South said outlawing the pill wouldn’t change much for people living in states with total abortion bans.
Robin Marty, the operations director for the West Alabama Women’s Center, said a mifepristone ban would barely change daily operations at the Women’s Center since abortions have been illegal in Alabama since last June. Advocates in Mississippi said not only are they not providing mifepristone, but they point to legislation that’s gaining popularity in some states, like Texas, that would make it illegal for providers to even talk about abortion pills.
This legislation, Marty said, could lead to a bigger divide between states with abortion access and those without.
“All [the mifepristone lawsuit] really is, is it’s distracting all of the liberal places that are supposed to be supporting us into watching their own backs,” Marty said. “I hope that when it's done, they remember that we're still here. They may have had their victory, and everything's still the same for them, but we are still in so much trouble and we need them.”
Marty said her center used to provide abortion care — but that changed after Roe v. Wade was overturned last summer. Now, it provides birth control, HIV treatments and care for transgender people in Alabama. Remaining open as an after-care facility was most important to their team, Marty said.
“We're finding a way to take care of all the things that were just as hard for people to access as abortion was,” Marty said. “We're committed to existing as a place where people who do end up terminating their own pregnancies, because we know they will, can come and make sure that they did it safely.”
From a state with abortion protections, Dr. Jennifer Lincoln, an OB-GYN based in Oregon and the executive director of Mayday.Health, is working diligently to get abortion pill education to those in states with bans. She said it’s hard to really know what the courts will decide, but pregnant people seeking abortions should not give up yet.
Through Mayday.Health, Lincoln aims to help people find abortion pills online. She recently helped spearhead a campaign that sent traveling billboards advertising the nonprofit’s services to college towns in 14 states with abortion bans, including Montgomery, Alabama, New Orleans and Baton Rouge, Louisiana, and Jackson, Mississippi.
“The workarounds are out there and they exist, and we're thankful for that, but we at Mayday also completely acknowledge that this will affect the people who are already the hardest hit,” Lincoln said.
Those workarounds for abortion pills online can cost hundreds of dollars, and can sometimes take weeks to arrive — crucial time in an already narrow window for a medication abortion. If mifepristone does become banned, patients may have to take a misoprostol-only regimen, which is similarly safe, but more painful due to additional side effects.
Lincoln said, though she’s not a lawyer, it’s clear to her that banning mifepristone is less of a healthcare move and more of a political one. And while the Supreme Court could make a decision soon in the conflicting rulings, Lincoln said abortion opponents will not stop with mifepristone.
“Those who want to take the choice for abortion away from us cannot stomach the idea that we can use abortion pills to take back our control,” Lincoln said. “That's why they're going after this. They will very soon be coming for emergency contraception and hormonal contraception. This is part of a plan of reproductive control.”
This story was produced by the Gulf States Newsroom, a collaboration between Mississippi Public Broadcasting, WBHM in Alabama, WWNO and WRKF in Louisiana and NPR. Support for reproductive health coverage comes from The Commonwealth Fund.
