Access to abortion medication could be thrown into jeopardy following conflicting rulings from judges in Texas and Washington. But Democrats in Michigan are still fighting to keep it protected.
MICHIGAN—Recent federal court rulings have created an uncertain future for the legality and access of mifepristone, a drug used in medication-assisted abortions. But for now, the drug is still legal in Michigan—and it can still be relied on by Michiganders as a safe option for abortion.
Here’s what you need to know about the situation:
What is Medication Abortion?
Medication abortion is a two-dose regimen of pills that work together to induce an abortion. The two medicines, called mifepristone and misoprostol, can only be prescribed by doctors to induce abortions, and only for pregnancies that are less than 10 weeks along.
The medications are not available over the counter, and are only prescribed to patients following a meeting with their physician, an examination (including a possible ultrasound), and lab testing. Patients are also required to receive detailed information about the procedure, as well as other prenatal and parenting resources—should they decide to change their minds.
Taken alone, either drug can induce an abortion, though medical experts have said the dual-drug approach has had a slightly higher rate of effectiveness in ending pregnancies.
What’s the Problem?
Access to mifepristone plunged into uncertainty last week after two different US District Court judges from other sides of the country issued conflicting rulings on the legality of the medication.
On Friday, Trump-appointed US District Judge Matthew Kacsmaryk, of Texas, ordered the FDA to suspend its decades-old approval of mifepristone for use in medication abortions. Less than an hour later, Obama-appointed US District Court Judge Thomas Rice, of Washington, ordered the FDA to instead maintain the status quo, and permit the continued use of the drug in 17 states—including Michigan—which had filed a lawsuit to protect access in their states.
For now, women in Michigan—and the 16 other states that protect abortion rights—have full access to the medication. The Texas ruling has been put on hold for one week so federal officials can file a challenge, and President Joe Biden’s administration has vowed to fight back.
The nation’s top health official said the ruling threatening mifepristone availability was “not America,” and he also didn’t rule out defying the judge’s order, if necessary, to protect access.
“We want the courts to overturn this reckless decision,” Xavier Becerra, Biden’s health secretary, told CNN on Sunday. “We want, yes, that women continue to have access to a drug that’s proven itself safe. Millions of women have used this drug around the world.”
Gov. Gretchen Whitmer and Democratic lawmakers have also stood up against the decision.
“Despite this ruling, I want to be clear: abortion, including medication abortion, remains safe and legal in the state of Michigan,” Whitmer said in a statement. “We must continue using every tool in our toolboxes to fight back against these relentless assaults on reproductive health care.”
Attorney General Dana Nessel was “deeply disappointed” to see the ruling from Texas, and said the final decision ought to instead be decided by the US Supreme Court. In the meantime, her “top” priority is to safeguard the health, safety and well-being of Michigan residents, she said.
“Michigan will remain a safe haven for women in our region whose home state access to reproductive healthcare has been curbed by this ruling,” Nessel said in a statement.
The conflicting rulings will likely push the issue to the conservative-leaning US Supreme Court, which last year overturned Roe v. Wade and curtailed reproductive freedoms across the country.
Abortion clinics and doctors, however, have a plan, should mifepristone be pulled from the market: They’ll just use misoprostol by itself, which is still effective in ending pregnancies.
Officials at Planned Parenthood of Michigan said this week that they’re actively evaluating their office protocols, and preparing for the potential change in practice at their clinics in Michigan.
“Planned Parenthood of Michigan will continue to provide safe and legal medication abortion to everyone who relies on us for care,” said President and CEO Paula Thornton-Greer. “Access to the highest standard of medical care is a human right. The judge’s decision to ignore medical science and attempt to remove mifepristone from the market could rob millions of Americans of that right—even in states with protections for abortion access. Our patients deserve better.”
The Texas ruling, as it stands, however, could still carry dire ramifications for any other FDA-approved drug—like insulin or new Alzheimer’s drugs—namely because it seeks to upend the entire FDA approval process, allowing judges to insert their preferences and personal opinions over those of medical professionals, Becerra explained to CNN on Sunday evening.
The Cabinet secretary added: “What you saw by that one judge in that one court, in that one state, that’s not America. America goes by the evidence. America does what’s fair. America does what is transparent and we can show that what we do is for the right reasons.”
Over 300 biotech and pharmaceutical executives, including Pfizer CEO Albert Bourla, signed an open letter on Monday calling for the reversal of the decision in Texas. They argued that the ruling “puts the entire industry at risk” and undermines the FDA’s authority to approve drugs.
Ovid Therapeutics CEO Jeremy Levin told Reuters that the recent ruling, as it stands, could also eventually “open the possibility to the banning of vaccines and contraception for women.”
Is Abortion Medication Safe?
Decades of medical research vouches for the efficacy and safety of medication abortion.
Mifepristone was approved in 2000 by the US Food and Drug Administration, and is sold under the brands Mifeprex and Korlym. It has been used by millions of women over the past 23 years, and complications from mifepristone occur at a lower rate than that seen with wisdom teeth removal, colonoscopies and other routine medical procedures, medical groups have noted.
One 2015 study of 30,000 women found medication abortion successfully ended pregnancy 99.6% of the time—about the same rate as surgical abortions. A 2012 study of 45,000 medication abortions found only 0.3% of led to side effects that required hospitalization.
Dr. Halley Crissman, a board certified OB/GYN and the associate medical director of Planned Parenthood of Michigan, told The ‘Gander last year that medication, compared to surgery, offers women “a bit more autonomy” over exactly when and where they decide to have an abortion.
Medical officials also believe that access to medication abortion has increased choice for women, and helped them feel empowered to manage their abortion care “in the way that feels safest and most aligned with their comfort or their desires,” Crissman explained.
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