Abortion rights groups, funds and providers have been left to grapple with the uncertain future of medication abortion after a pair of competing federal court rulings Friday.
Melissa Fowler, chief program officer at the National Abortion Federation, said a ruling in Texas to halt FDA approval of mifepristone is “sowing chaos and confusion for abortion seekers.” Fowler emphasized the safety and effectiveness of mifepristone, which has been long hailed as safe by federal regulators and medical associations.
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The chaotic legal landscape is expected to rapidly change over the next week. But for now “nothing changes at all with respect to the availability of mifepristone,” said Andrew Beck, senior staff attorney with the ACLU’s reproductive freedom project.
But what comes next is unclear.
In the meantime, abortion providers and advocates across the nation have reported another round of confusion and frustration.
BACKGROUND:Who is Judge Matthew Kacsmaryk and why was the abortion pill case in his court?
Want an abortion?:Here are options for pregnant people if mifepristone is suspended
FRIDAY:Dueling federal rulings plunge future of abortion pill into legal uncertainty
“We have patients coming in for abortion services in our clinics today, so we had to know quickly what this meant for us,” said Andrea Ferrigno, corporate vice president for Whole Woman’s Health, a network of abortion clinics. “For patients, this is just another level of frustration, stress and confusion during an already stressful time.”
Whole Woman’s Health, which offers care in Minnesota, Virginia, Maryland, Indiana, New Mexico and Illinois, is among several abortion providers who told USA TODAY they would continue offering mifepristone for the time being. If clinics eventually lose access to the drug, many providers, including Whole Woman’s Health, said they would pivot to misoprostol-only care. Some have also said they may open more appointments for in-clinic, procedural abortions.
In the U.S., mifepristone is typically taken with misoprostol in a two-step regimen. But misoprostol-only methods have been used globally for years and is largely considered to be safe and effective. Still, studies show misoprostol-only methods are less effective than the two-step regimen.
Here’s what is happening around the nation in the wake of Friday’s legal news:
Alabama
As Alabama enforced a total abortion ban that includes medication abortion,
Kelsea McLain, deputy director at the abortion fund Yellowhammer Fund, said their work involves helping people learn how to safely self-manage abortions using medication, access medications through clinics or by mail, and understand the legal risks they are taking on when they do so.
As they wait for more clarity, McLain said this work remains largely unchanged. But if they lose mifepristone access down the line, the results will be devastating, she said.
“From an Alabama standpoint, if we lose mifepristone, we’ve then lost almost everything,” she said.
Colorado
Cobalt Abortion Fund in Colorado said the Texas ruling “endangers anyone who needs an abortion.” In a statement, the organization said it has already seen a flood of out-of-state patients seeking abortion care.
“Access to abortion care should not depend on politics, and definitely not from a single judge installed on a party line vote in Amarillo, Texas,” the organization said.
Florida
Earlier this week, the Florida Senate passed a bill that bans most abortions after six weeks of pregnancy. The measure is expected to be approved by the House and signed by Gov. Ron DeSantis before becoming law.
With a six-week ban likely on the horizon, McKenna Kelley, board member at Tampa Bay Abortion Fund, said losing mifepristone access “would be pretty uniquely devastating.”
“With this six-week ban likely to pass the House and go into effect and with the potential of no more access to mifepristone, I struggle to wrap my head around what that would mean for us,” she said. “That means someone would have effectively four weeks from their missed period to realize they’re pregnant, schedule an appointment, get that appointment, go to their consultation, go to their second abortion appointment, which would have to be procedural.”
“I can only imagine that it would essentially eradicate what little tiny bit of access we have in Florida,” she added.
Maine, New England
Planned Parenthood of Northern New England will continue to offer medication abortion to patients as the appeal process moves forward, said acting CEO Nicole Clegg.
“This ruling is outrageous and should make clear to everyone that people opposed to abortion will not stop until abortion is banned everywhere, including here in Maine,” she said. “Private medical decisions should be made by patients and their providers, not politicians and judges.”
Maryland
Lynn McCann-Yeh, co-director at the Baltimore Abortion Fund, called the lawsuit part of a “pattern used by the anti-abortion movement since the overturning of Roe v. Wade to sow confusion over what the law says abortion abortion rights.”
“The chaos, confusion and misinformation is not just a byproduct of this situation,” she said. “It was intentional. Confusion and chaos creates yet another roadblock for people trying to access abortion.”
McCann-Yeh said she worries about how losing mifepristone access might affect Maryland, which has among the strongest legal protections for abortion access nationwide and is a “critical access point on the eastern seaboard.” As out-of-state patients travel to states like Maryland for care, she said it has already led to longer wait times for abortions. This will only be exacerbated as the Texas ruling threatens to limit options for care by removing mifepristone, McCann-Yeh said.
Michigan
Michigan, which voted last year to enshrine abortion rights into its state constitution, has already seen a large influx of patients from neighboring states after the overturning of Roe v. Wade, said Michele Heisler, medical director at Physicians for Human Rights and a professor of internal medicine and of public health at the University of Michigan.
If procedural abortions become the only option without mifepristone access, this will just get worse, she said.
“Our health system is already being overwhelmed by patients,” she said.
“This is just going to put more of a burden on providers and add stress for patients who may already be in very vulnerable situations,” she added. “These kinds of efforts to limit medical care cause severe psychological harm and trauma.”
New York
Dr. Gopika Krishna, an OB/GYN in New York and a fellow at Physicians for Reproductive Health, said her team is already discussing how to talk patients through the confusing legal status of mifepristone while considering misoprostol-only regimens or more appointments for in-clinic, procedural abortions if mifepristone is eventually pulled off market. For now, she will continue to offer mifepristone, she said.
Krishna said she is thankful to work in a state with strong protections for abortion access but frustrated that “even in places where patients thought their abortion rights are protected, a ruling like this create this environment of confusion.”
“This level of confusion has no place in health care,” she said. “It’s my job to use medical evidence to give the safest, most effective options for my patients. The fact that a single judge in Texas may be limiting my ability to do that is extremely frustrating and disappointing.”
Texas
In Texas, where U.S. District Judge Matthew Kacsmaryk issued the ruling seeking to revoke FDA approval of mifepristone, abortions rights groups decried the decision, saying it could have severe consequences on people’s ability to access abortion and miscarriage care.
“Mifepristone, a drug the FDA approved more than 20 years ago and is safer than Tylenol, may not be available to those who need it within a week,” said Shaunna Thomas, co-founder and executive director of UltraViolet, a group that protested against the lawsuit ahead of a hearing last month. “This ruling is unacceptable, dangerous, and unprecedented.”
A protest was planned for Saturday in Austin, Texas, and the Women’s March also said it is planning national protests.
High maternal mortality rates in Texas and existing abortion bans have already “created an extremely dangerous environment for pregnant people” in the state, said Marsha Jones, executive director of the Afiya Center, a Texas-based reproductive justice organization.
“Access to Mifepristone from surrounding states and overseas has been a lifeline for pregnant Texans seeking abortion or those at high risk for complications,” she said. “We need to keep telling Texas legislators that we want to make our own private medical decisions, instead of leaving them in the hands of judges.”
Washington
The abortion rights group Pro-Choice Washington blasted the Texas ruling as “a blatant distortion of the legal and public health system” that “creates even more fear and confusion.”
Meanwhile, Washington state has also purchased a three-year supply of 30,000 doses of the generic version of mifepristone in anticipation of limits to its availability.
Wyoming
As her team prepares to open Wyoming’s only full-service clinic to provide surgical and medication abortions, Julie Burkhart, president and founder of Wellspring Health Access, said Kacsmaryk’s decision “jeopardizes this most basic form of care for millions of people.”
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She said limiting mifepristone access will only exacerbate existing abortion deserts in the Midwest, Mountain West and the South, where she plans to open the clinic in Casper, Wyoming.
“That’s why we at Wellspring Health Access are committed to this fight – because everyone deserves access to safe abortion care, regardless of circumstance or geography,” she said.
Contact Christine Fernando at cfernando@usatoday.com or follow her on Twitter at @christinetfern.
