Texas judge could halt access to abortion pill mifepristone

An upcoming court decision could threaten access to abortion pills across the United States, including in sanctuary states like California and New York that recently moved to protect abortion access.

A judge in the state of Texas is expected to rule as early as February 24 on whether to overturn US Food and Drug Administration (FDA) approval of mifepristone, an essential medication used in more than half of the abortions that happen through clinics and physicians’ offices in the US.

Abortion access advocates are raising the alarm, warning that the Texas judge, who was appointed by former US President Donald Trump, could single-handedly force the FDA to withdraw its approval of mifepristone, causing the drug to be removed from the US market.

Cat Duffy, a policy analyst with the National Health Law Program, said the judge has a range of options, including overturning FDA approval, eliminating access to the drug via telehealth but allowing access in-person, and dismissing the case.

“If the judge does rule to force the FDA to revoke its approval of mifepristone, then that will effectively ban the use of mifepristone nationwide, and that includes in states that have enacted rigorous protections for abortion access,” Duffy told Al Jazeera.

Abortion access has been curtailed across the US since the Supreme Court overturned Roe v Wade, which for nearly 50 years had protected abortion as a federal right. Its Dobbs v Jackson ruling last June said the US Constitution does not guarantee a right to abortion.

Mifepristone approved decades ago

In the US, there are two common abortion methods. Dilation and curettage, also known as D&C or surgical abortion, involves dilating the cervix and removing tissue from the uterus. Medication abortion, or “the abortion pill”, most often involves the combination of two medications: mifepristone and misoprostol. Mifepristone blocks hormones to end a pregnancy and misoprostol causes cramps to empty the uterus.

Medication abortion is a safe method that can be taken at home, and has helped promote access to abortion in rural communities.

The FDA first approved mifepristone in 2000. Medication abortions have increased steadily in recent years, and in 2020, this type of abortion accounted for 53 percent of abortions in the US that happen via facilities like clinics and physicians’ offices.

The lawsuit by the Alliance for Hippocratic Medicine, a coalition of groups that assert “abortion is not healthcare”, against the FDA alleges the agency improperly used accelerated drug approval for mifepristone, failed to study its safety, and ignored the potential hormonal effects on teenagers.Alliance Defending Freedom counsel Julie Blake told Al Jazeera: ​​“The FDA has been entrusted by Congress to serve as the nation’s gatekeeper of legal drugs but it failed its responsibility to protect the health, safety, and welfare of women and girls when it approved chemical abortion drugs and removed safeguards on their use.”

For example, the suit alleges the FDA extended the use of mifepristone from seven weeks to 10 weeks, which the group claims is unsafe.

“There’s been a tremendous amount of research that has been published and continues to consistently document the safety of this treatment,” said Daniel Grossman, professor in the department of obstetrics, gynaecology and reproductive sciences at the University of California, San Francisco. “In terms of hormonal effects on young people, there has not been any evidence to indicate that that’s a concern.”