Abortion rights opponents understand that medication abortion is the future of abortion care, which explains their escalating and coordinated campaign to make it impossible to access.
Senate Republicans intensified the battle earlier this month when they sent a letter to the Food and Drug Administration urging the agency to take a widely used abortion drug completely off the market.
The request effectively asks the FDA to ban medication abortion entirely.
The group of 20 senators argued that the drug, mifepristone, poses an “imminent hazard to public health” and should be classified as such by the FDA, eliminating its legal use in the United States. Seventy-two lawmakers in the House of Representatives penned a similar letter the same day.
They are at least the second and third letters of their kind in a little more than a year: In May 2019, over 100 anti-choice members of Congress applauded the FDA for sending a cease and desist to Aid Access, a telemedicine site operated by a Netherlands-based doctor who prescribes mifepristone to patients in the United States.
Since then, lawmakers and anti-abortion groups have continued to call for the agency to crack down on websites selling the drug online; now they’re pressuring the agency to ban the medication outright, and with it a method of abortion early in pregnancy that accounts for about 40 percent of abortions.
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These most recent appeals to the FDA arrive just as restrictions on mifepristone have been temporarily eased, and a new battlefront in the medication abortion wars has emerged. In July, a federal judge ruled that the FDA’s longtime requirement that the drug only be dispensed at a hospital or clinic could be suspended during the COVID-19 pandemic because the requirements unduly burdened abortion rights by forcing patients to make unnecessary trips to pick up medication that could easily be delivered to them at home.
In response, the Trump administration filed an emergency request to the Supreme Court to have the rule reinstated because the requirements “mitigate serious health risks associated with the drug,” echoing fellow conservatives’ unsubstantiated claims that the drug is so dangerous it needs to be highly regulated and perhaps removed from the marketplace altogether. The Supreme Court has not yet decided if it will take up the Trump administration’s emergency request to reinstate in-person requirements for dispensing medication abortion.
Reproductive health advocates see anti-choice lawmakers and Trump administration officials as working in tandem to sway a federal agency that might be sympathetic to their position, hoping that if they succeed, a new FDA classification of mifepristone will be difficult for their pro-choice opponents to undo.
“I think there’s a sense that it’s important to do something about medication abortion because of its increasing relevance,” said Mary Ziegler, a professor at the Florida State University College of Law who specializes in the legal history of reproductive health. “Part of the value of going through the FDA is that the decision they come to might be more insulated from challenges.”
Ziegler said anti-choice leaders aim to achieve this by attempting to cast doubt on the safety and effectiveness of mifepristone, framing their efforts to curb access as concern for women’s health. But their claims are at odds with medicine and science, according to experts who study the drug, which was approved by the FDA in 2000.
“We know from more than 20 years of research that mifepristone is extremely safe,” said Ushma Upadhyay, an associate professor at Advancing New Standards in Reproductive Health, a research group at the University of California, San Francisco. In a 2015 study of 11,000 medication abortions, less than one-third of 1 percent of patients experienced complications requiring hospital care. And over the two decades the drug has been on the market, there have been just 14 deaths.
“Pregnancy and childbirth aren’t safer than abortion,” Upadhyay continued, referencing Texas Sen. Ted Cruz’s recent claim that “pregnancy is not a life-threatening illness.” “Childbirth is 14 times more likely to end in death [than abortion is],” she said.
Advocates only expect attacks on medication abortion to ramp up, especially as this method of early abortion becomes more widely used and thus more normalized. For these reasons—as well as for reasons having to do with the drug’s safety profile—they believe it will be difficult for their anti-choice opponents to succeed in persuading the FDA to recall mifepristone. And even if they did, it would be nearly impossible to completely eliminate access to it: Many people obtain the drug by buying it on the internet.
“In the era we live in it would be really hard to eliminate access to it,” Zeigler said. “Part of the revived interest in medication abortion [among anti-choice leaders] has been a sense that it may be the future of first trimester abortion and abortion period.”
Still, the efforts to further restrict—or completely eliminate—the drug will have immediate consequences for people who need abortions. A spokesperson from NARAL Pro-Choice America said dispelling misinformation about medication abortion is “increasingly an organizational priority” for the group.
“People who need access to abortion care may not have the complete picture or all the info to make the best decision for their circumstances,” said Kristin Ford, NARAL’s national communications director. “We think it’s really important to counter their false claims and inoculate against their disinformation.”
And in the current policy environment—one where attacks on reproductive rights have become both more frequent and more extreme—advocates can’t discount the possibility that anti-abortion activists will find a way to realize their vision, especially if Donald Trump wins a second term in the White House.
“We used to think birth control was a non-issue, but then people started saying, ‘They’re coming for your pill,’ and yeah, they are actually,” Rachel Jones, Guttmacher Institute’s principal research scientist, said. “Unfortunately even though science is on our side, we have to take these threats seriously.”