America’s most common form of abortion—medication abortion—is under dire threat, even in states where the procedure remains legal. A lawsuit before a federal judge in Texas might cut off access to Mifeprex, a key drug used to terminate pregnancies. The suit’s plaintiff, an anti-abortion group, contends that Mifeprex was not properly vetted by the US Food & Drug Administration and should therefore be taken off the market due to safety concerns. (The FDA approved Mifeprex in 2000 and it has a better safety record than surgical abortions, childbirth, and Tylenol.) Lawyers for the FDA counter that those “safety concerns” (such as cramping and bleeding) are normal parts of the body expelling pregnancy tissue.
If this lawsuit succeeds and the FDA pulls Mifeprex from the market, it could have seismic effects across the nation, including in our region. Medication abortion now accounts for over half of all US abortions, and withdrawing Mifeprex’s authorization would severely restrict abortion access. Clinicians say there are workarounds—performing more surgical abortions, or doing medication abortions with just misoprostol (a drug that is considered safe but less effective)—but none would be expected to offset the loss of Mifeprex.
To find out more, we called Diane Derzis, the owner of five abortion clinics, including two in Virginia. (For our February issue, we wrote about what it’s like to work at her clinic Bristol Women’s Health in southwest Virginia.) Here’s what Derzis has to say about the lawsuit.
If this lawsuit succeeds and Mifeprex is withdrawn from the market, what would that mean for places like DC where abortion is legal?
Well, it means there’s no pill. It doesn’t make any difference that abortion is legal in those states. Your state is not going to protect you, because if the pill is not available, you’re not going to get it.
And how likely is it that the judge will rule that way?
This judge was appointed by Trump and he [has a history of writings that are] anti-choice. So if or when he rules against the FDA, getting Mifeprex will be illegal. And I think the chances of him ruling positively for us are [low].
But this will be appealed, right?
Yeah, but then it’s going to go to the Fifth Circuit, which is one of the most conservative circuits in the country. And the likelihood of the suit winning there is about as good as it was with this judge. And then it’s going to the Supreme Court, and we already know how the Supreme Court feels.
Listen, this pill has been on the market over 20 years. It’s safe. The only reason that this is in front of a judge is because of, politically, what the pill does. This is setting an unbelievable precedent. If he rules against the pill, we’re now having the judiciary involved in the FDA. I can’t really tell you how far-reaching this decision is, but I do know it’s bad.
Right, so you’re worried that political concerns could start interfering with the FDA’s medical decisions in other contexts?
Absolutely. I mean, what if [a religious group] didn’t want you to have a blood transfusion? How would you feel if they took the blood supply out? That may sound so ridiculous to some people, but it is the same thing.
At your clinics, what percentage of abortions currently involve Mifeprex?
And how severely would it restrict abortion at your clinics if Mifeprex were taken off the market?
Very severely. That’s why they’re doing this—they know what a difference it will make. [Mifeprex] is how most women in this country are having abortions now.
So if Mifeprex is withdrawn, what will that look like logistically at your clinics? Would you do more surgical abortions?
I would have to. If this judge removes Mifeprex from the stream of commerce, then you’re left with a pill [misoprostol] that can be taken on its own, but it doesn’t work nearly as well as [Mifeprex] does. I’m sure there are other options, but none of them are as good or as safe as [Mifeprex]. I mean, millions and millions of women have taken this pill successfully.
Are there other workarounds to consider?
I’m sure a lot of very smart people are behind the scenes trying to figure out what would be the regimen we could use if we don’t have the Mifeprex. But my question has to be, Why are we in this position? We’re taking an FDA-approved, time-tested medical drug off the market, just because the anti-choice people deem that it needs to be done.
Ordering abortion pills through the mail—even in states where abortion is restricted—is increasingly common. But another aspect of this lawsuit is that the judge might rule that mailing abortion pills is a violation of the Comstock Act. If people can’t order pills by mail anymore, do you expect to see a huge surge in demand at brick-and-mortar clinics?
I do, I think so.
Could that be a problem for access? Would there be enough appointments to accommodate that?
Well, I think if we have to operate 24 hours a day, we will. People don’t understand that we’re just as adamant about keeping choice available as they are about denying it. And there’s some good news here, and that is there are a lot of women coming out of medical school who have trained to do abortions. So there are a lot of doctors that are coming. Too little too late? I don’t know. At least that’s one positive thing.
But for me, as a citizen in this country, this is so beyond frightening. [Anti-abortion activists] have waited 50 years to do this. And they had the snare set so beautifully—they’ve got this federal judge, and it’s gonna go right back up to the Supreme Court. I really am scared. I’ll tell you that. Every book you’ve ever read and you thought “thank god it’s just a book because this is so bad”—that’s what this is.