Abortion pills become latest battleground over reproductive rights

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• Amna Nawaz:

  With abortion banned or severely restricted in 18 U.S. states, abortion pills have now become the new battleground for the anti-abortion movement.

  In a story co-produced with the "PBS NewsHour," Kaiser Health News correspondent Sarah Varney reports on a new lawsuit brought by a conservative Christian anti-abortion group that could end access to the medication nationwide.

• Sarah Varney:

  At Whole Woman's Health in Alexandria, Virginia, clinic manager Shaelin Nauta is struggling to find appointments for women coming for abortion care from nearby states.

  Shaelin Nauta, Clinic Manager, Whole Woman's Health of Alexandria: We're kind of in this half-circle around the East Coast of states, including West Virginia, Kentucky, Tennessee, Georgia, South Carolina, and many others, that have either completely banned abortion access or very much restricted it.

• Sarah Varney:

  Many patients come here for medication abortion, which involves taking two pills. The first is mifepristone, which blocks the hormone progesterone and halts the pregnancy. The second is misoprostol, which induces a miscarriage medication.

• Shaelin Nauta:

  Medication abortion is very common. I would say about everyday that we see patients, we see about 10 to 15 patients who have a medication abortion.

• Sarah Varney:

  Medication abortion can be taken up to 10 weeks into a pregnancy. About five million women in the U.S. and millions more across the world have safely used the drugs. They now account for more than half of all abortions in this country and are also used by OB-GYNs to manage early miscarriages.

  Misoprostol was approved by the Food and Drug Administration in 1988 to treat gastric ulcers, but mifepristone, which was approved in 2000 to end early pregnancy, is now being targeted by anti-abortion advocates.

  A lawsuit under way in this federal courthouse in Amarillo, Texas, could force the FDA to remove mifepristone from the market entirely. That would affect every state across the country, including those where abortion remains illegal.

• Denise Harle, Senior Counsel, Alliance Defending Freedom:

  We are living in a post-Roe America.

• Sarah Varney:

  The lawsuit was filed by an anti-abortion group represented by Denise Harle of the Christian legal advocacy group Alliance Defending Freedom. Harle claims the FDA's safety review of mifepristone was flawed.

• Denise Harle:

  The FDA has one job, which is just to protect Americans from dangerous drugs. It's caused great harm to women and girls. It's extremely dangerous. And we're asking the court to remove that chemical drug regimen until and unless the FDA actually goes through the proper testing that it's required to do.

• Sarah Varney:

  Twelve leading medical organizations, including the American Medical Association and the American College of Obstetricians and Gynecologists, say these claims are untrue.

  Decades of research show the risk of major complications from taking abortion pills is less than 0.4 percent. They are safer than commonly used drugs like Tylenol or Viagra.

  At Whole Woman's Health Alliance, CEO Amy Hagstrom Miller says medication abortion gives women more control over their health care.

  Amy Hagstrom Miller, President and CEO, Whole Woman's Health: When you have medication abortion, part of the process happens at home. And a lot of people like that. They think it's less invasive. It involves cramping and bleeding and passing of the pregnancy, very similar to a miscarriage.

  And people can be at home with their loved ones and can sort of schedule the passing of the pregnancy around their work schedule or their childcare schedule.

• Sarah Varney:

  But, here in Texas, the lawsuit wants to put a stop to that. The Alliance Defending Freedom makes a number of claims, including that the FDA used the wrong process to approve the drug.

• Denise Harle:

  The FDA also pushed the drugs through a certain special provision that's supposed to be only for treating illnesses and only for lifesaving drugs. The regulatory process was not followed.

• Sarah Varney:

  In fact, mifepristone's approval was investigated in 2008 by the Government Accountability Office, which found that the process was consistent with FDA regulations.

• I. Glenn Cohen, Harvard Law School:

  It's hard to think of a drug that has been under more scrutiny than mifepristone.

• Sarah Varney:

  I. Glenn Cohen, Harvard Law School professor, is one of 19 FDA scholars who filed an amicus brief in support of the agency.

• I. Glenn Cohen:

  We don't think there's a problem here statutorily or medically, but it'd be very dangerous to allow a single judge sitting in Amarillo to essentially order a drug that's used by many women in America off the market all of a sudden just because he believes a particular argument that's being made.

• Sarah Varney:

  But arguments unsupported by medical and legal consensus have found favor in Texas courtrooms. By filing its lawsuit in Amarillo, the Alliance Defending Freedom was almost guaranteed to draw Judge Matthew Kacsmaryk, a Trump appointee who worked in the conservative Christian legal movement.

  Elizabeth Sepper, University of Texas at Austin: It's part of a trend of conservative legal movement actors trying to get before Judge Kacsmaryk.

• Sarah Varney:

  Elizabeth Sepper is a law professor at the University of Texas at Austin.

• Elizabeth Sepper:

  He has made statements in opposition to reproductive rights, linking up reproduction to the feminist movement and making anti-feminist statements.

• Sarah Varney:

  So, why now? Why is the conservative Christian legal movement striking now with these cases?

• Elizabeth Sepper:

  Prior to Dobbs, the right to abortion would have stood in the way of this lawsuit.

  But now the conservative legal movement feels empowered to go after medication abortion, but to then extend their aims beyond abortion, to contraception, to PrEP, medication to prevent HIV.

• Sarah Varney:

  Federal judges in Texas have ruled that a religious objector can block a federal program from providing birth control to teens, and emergency room doctors must equally weigh the life of a pregnant woman and her fetus.

• Elizabeth Sepper:

  It's all part and parcel of a claim to restrict reproductive health care consistent with conservative religious beliefs.

• Sarah Varney:

  Denise Harle of the Alliance Defending Freedom said the FDA needs to study whether mifepristone can be safely administered. But she says no scientific data would be enough.

  But it's fair to say, given your — the beliefs of your organization, that you would not want to see this drug back on the market, though?

• Denise Harle:

  Oh, I would not want to see this drug back on the market.

  I think — I think chemical abortion does great harms to women and their unborn children. We certainly shouldn't be putting their health in danger, no matter what. And that's what this lawsuit is really about.

• Sarah Varney:

  Back in Alexandria, Virginia, Whole Woman's Health CEO Hagstrom Miller is bracing for a ruling that takes mifepristone off the market.

• Amy Hagstrom Miller:

  I think people know that what happens in Texas doesn't stay in Texas. Some of the most progressive states in the country will face restrictions if this — if this lawsuit is successful.

• Sarah Varney:

  If that's the case, her clinics and OB-GYNs across the country will be forced to use only misoprostol for miscarriages and early abortion care.

  While taking the two pills together is 99.6 percent effective and terminating early pregnancy, misoprostol alone, although still extremely safe, is about 80 percent effective.

• Amy Hagstrom Miller:

  There's more cramping, there's more bleeding, there's nausea, there's diarrhea, and that matters, right? That matters to pregnant people. People should have access to the highest level of medical care and should be able to have the best research and the best science.

• Sarah Varney:

  Clinic manager Shaelin Nauta says her biggest concern is that women will think they have no options.

• Shaelin Nauta:

  This will absolutely have an impact on the misinformation and on what people believe to be true. Finding out that that is banned could really turn a lot of people away from not only having a medication abortion, but abortion care in general.

• Sarah Varney:

  A decision in the case could come as soon as this Friday.

  For the "PBS NewsHour" and Kaiser Health News, I'm Sarah Varney in Amarillo, Texas.