US braces for Texas verdict on abortion pill access

A district court decision due in Texas in the coming days could have sweeping ramifications on access to abortion pills in the US, and reverse recent moves by the Biden administration to make it easier to get hold of them.

Judge Matthew Kacsmaryk – who was appointed by Donald Trump – is due to rule shortly on a lawsuit brought by anti-abortion group Alliance for Hippocratic Medicine that is seeking to force the FDA to rescind its decades-old approval of mifepristone (Mifeprex and generics), which is used alongside misoprostol in a two-drug abortion regimen.

If successful, the group – which was also a player in the lawsuit that led to the overturning of Roe vs Wade, stripping women in the US of their constitutional protection for the right to abortion – could make it much harder for women to get access to abortions even in states where they remain legal.

Some 18 US states have already implemented restrictions on the drugs to end pregnancies as part of legislation to severely restrict or entirely ban abortion, forcing women to travel elsewhere for access. Abortion drugs are now the most common way that people terminate pregnancies, and it is increasingly relied on by those with limited access to abortion care, due to state laws or geography.

There has been kickback against the restrictions. Last month, the FDA ruled that retail pharmacies in the US will be able to dispense mifepristone-based therapies to end pregnancies, whereas formerly women seeking terminations had to get the drugs dispensed by a healthcare provider at a registered clinic.

Last year, the regulator also allowed patients to receive them via mail-order, and the US Department of Justice recently issued guidance confirming that the US Postal Service can deliver abortion drugs to people in states that have banned or severely restricted access to abortion care.

And on 2nd February, members of Congress also reintroduced a bill to protect people's right to travel across state lines for abortion services.

Pro-choice groups are concerned that, even if Kacsmaryk stops short of a total ban on mifepristone, he cold roll back these and other measures introduced to try to help women seeking a termination. A Politico report notes that Kacsmaryk previously worked for a conservative group called First Liberty Institute, which brought cases aimed at restricting abortion access.

The FDA first approved the use of mifepristone with misoprostol as a two-drug regimen to terminate pregnancy in 2000, but according to the complaint the agency "exceeded its regulatory authority" in doing so and "failed America's women and girls when it chose politics over science and approved chemical abortion drugs for use in the US".

The Biden administration has pledged to launch an appeal against any ruling that limits access to mifepristone, and the President said in his State of the Union speech earlier this week that he and "the Vice President [...] are doing everything we can to protect access to reproductive health care," adding that "Congress must restore the right the Supreme Court took away last year and codify Roe v. Wade to protect every woman's constitutional right to choose."

Meanwhile, abortion rights groups are disseminating information about a misoprostol-only regimen that can be effective in ending pregnancies.