UPDATE (April 23, 2023)
The Supreme Court’s decision on April 21st preserves, for now, evidence-based access to mifepristone in states that have not banned or severely restricted abortion care. While this is undeniably good news for safe and effective abortion and miscarriage care in many states, the multi-regional access crisis continues and will likely accelerate when Florida’s 6-week ban goes into effect. Today, the ability to exercise reproductive autonomy is still starkly divided in the U.S., depending on where you live, your level of wealth and privilege, and your position in the structures of white supremacy.
As the mifepristone case works its way back to SCOTUS, our nationwide solidarity and organizing will be more important than ever. The Kacsmaryk and 5th Circuit rulings make it clear that dividing our movements and preventing us from helping each other remains a central strategy. We are heartened by new levels of legal coordination, the push for new telehealth shield laws, and by new abortion training initiatives. But we know the next months and years will take all of our efforts to ensure (for the first time in the U.S.) our fundamental human rights to reproductive autonomy and justice.
Last night, Judge Matthew Kacsmaryk of Texas ordered the FDA to revoke its longstanding approval of mifepristone, a medication essential to abortion care and miscarriage management. Kacsmaryk’s ideological decision ignores both science and the law. Since its U.S. approval in 2000 (it has been approved in Europe since the 1980s), mifepristone has been exhaustively studied for both safety and efficacy. It is safer than acetaminophen with an efficacy well above 95% in the standard regimen for most medication abortions.) In addition, legal experts doubt Kacsmaryk has the authority to revoke mifepristone’s longstanding approval, much less enforce it, which federal law leaves up to the discretion of the FDA. Mifepristone’s status is far from clear, especially In light of a second and competing federal court decision in a case in Washington State that protects mifepristone’s approval and provision. We urge clinicians and the Biden administration to think twice before giving into the demands of one extremist judge.
A decision to revoke mifepristone’s FDA approval would likely have a devastating impact on people who choose abortion, particularly those who already struggle to access abortion care as a result of geography, income, age, immigration status, or other existing racial/ethnic/gender-based oppression and surveillance. It would also pose particular challenges for states where medication abortion with mifepristone currently plays a key role in preserving abortion access.
For those who are able to access abortion, alternatives will remain for both medication and procedural abortion. International organizations such as AidAccess will continue to offer the mifepristone and misoprostol regimen, although wait times and legal risks will continue to place heavy burdens on patients. There are also effective misoprostol-only regimens, which were discovered and championed by activists in Brazil in the 1980s. Decades of research have shown that misoprostol-only regimens are safe and effective. A study published last month found that people self-managing their abortions with a miso-only regimen reported an efficacy rate of 88%. As with the mife-miso regimen, miso-only regimens can also be effective well into the 2nd-trimester, as the World Health Organization, the National Abortion Federation, Medicins Sans Frontiers and other organizations have established. In addition to the regimens linked below, a number of organizations will be offering misoprostol-only telemedicine abortion services in the states where they are legally allowed to operate.
We know, however, these strategies will be insufficient in the face of a coordinated campaign of forced birth and pregnancy criminalization that has intensified since the Dobbs decision. It is important now more than ever for clinicians to unite, community-build and refuse collaborations with law enforcement agencies. We also believe this is a time that calls for active engagement including protest, advocacy, and civil disobedience. This includes disruption of oppressive systems and policies that threaten the reproductive autonomy of all communities we care for. It is especially incumbent upon those with the greatest power and privilege to elevate their voices and leverage their advantages to center those who stand, once again, to lose the most.
–The RHEDI Staff [April 8, 2023]
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