The Fight Over the Abortion Pill Mifepristone and the Financial Impact of Abortion Access
People wait in line on March 15, 2023, to enter the J Marvin Jones Federal Building and Courthouse in Amarillo, Texas, where a judge ruled on April 7, 2023, to suspend the Food and Drug Administration’s two-decade-old approval of the abortion pill mifepristone. (Moises Avila/AFP via Getty Images)
April 21, 2023, update: The U.S. Supreme Court said on Friday that the abortion medication mifepristone will continue to be widely available for the moment. The legal battle over whether to permanently implement restrictions on the pill, and whether the FDA’s longstanding approval of the drug should stand, will continue in appeals court.
April 13, 2023, update: A federal appeals court on Wednesday ruled that the abortion medication mifepristone can continue to be available, partly overruling U.S. District Judge Matthew Kacsmaryk’s decision from last week. But the three-judge panel for the Fifth Circuit also halted measures the Food and Drug Administration had taken in recent years to expand access to mifepristone, from approving it for use 10 weeks into a pregnancy instead of seven to allowing it to be mailed to patients. The court said its ruling will stand until the full case is heard. Both the Biden administration and the plaintiffs can appeal Wednesday’s ruling to the Supreme Court.
The battle over abortion in America continues to escalate, with competing rulings from two different courts last week over the latest flashpoint: abortion pills.
On Friday, a federal judge in Texas suspended the Food and Drug Administration’s two-decade-old approval of the abortion pill mifepristone, and another judge in Washington state issued a ruling less than an hour later that would maintain the availability of the pill in more than a dozen states.
These rulings come in the wake of the U.S. Supreme Court eliminating the constitutional right to an abortion, a slew of restrictions and bans going into effect in more than a dozen states and a recently published study that showed that people who were denied abortions suffered more financial hardship.
FRONTLINE — which has reported on the issue of abortion since the inception of the series — looks at the latest developments and the potential implications for people trying to access abortions.
The Rulings & Mifepristone
Mifepristone is the first of two pills used to end a pregnancy and was originally approved for this purpose by the FDA in 2000. On Friday, U.S. District Judge Matthew Kacsmaryk — a Trump appointee in Amarillo, Texas, who was critical of Roe v. Wade — issued a preliminary ruling that blocks the FDA’s approval of mifepristone. He stayed his own order for seven days to give the FDA time to appeal, and the Justice Department has already filed a notice that it’s appealing the ruling. In the meantime, the drug will continue to be available.
More than a dozen states already have restrictions on abortion pills, but if this ruling is upheld, it could eliminate access to one of the medications commonly used in abortions even in states where abortion is still legal.
In the Washington state ruling Friday, U.S. District Judge Thomas O. Rice issued a preliminary injunction in a separate case that ordered the FDA to maintain access to mifepristone in the 17 states, as well as the District of Columbia, that had brought the case.
Experts say that the clashing rulings will likely move up to the U.S. Supreme Court.
The Texas lawsuit was filed in November by several anti-abortion groups who say that the FDA didn’t follow the scientific evidence when it approved the drug and that mifepristone should never have been approved. Both the FDA and the Justice Department have disputed the lawsuit’s allegations. An analysis published by The New York Times found that more than 100 scientific studies have concluded that mifepristone and misoprostol, the second pill used in medical abortions, are safe and effective at ending pregnancies.
Medical abortions, also called medication abortions, now account for more than half of all U.S. abortions, according to a 2022 study by the Guttmacher Institute. These types of abortions were explored in the 2019 FRONTLINE documentary, The Abortion Divide.
Rebecca Mercier, an abortion provider featured in the documentary, is shown advising a patient on how the combination of mifepristone and misoprostol works. She describes it as a great procedure for anyone who “wants to just have everything happen in the privacy of their own home.”
Abortion rights groups have decried Kacsmaryk’s ruling, with the ACLU’s national political director calling it a “devastating decision,” and on Monday, executives of more than 250 pharmaceutical and biotech companies released a letter, saying that the ruling “ignores decades of scientific evidence and legal precedent” and “set a precedent for diminishing F.D.A.’s authority over drug approvals.”
Erik Baptist, the attorney representing the anti-abortion groups that filed the Texas lawsuit, said in a statement, “This is a significant victory for the doctors and medical associations we represent and, more importantly, the health and safety of women and girls.”
If Kacsmaryk’s ruling against mifepristone is upheld, some medical providers are considering alternatives to the two-dose regimen of mifepristone and misoprostol, such as offering misoprostol alone to perform a medical abortion. The single-dose regimen is used safely in many other countries where mifepristone is not as available, but is considered slightly less effective and more likely to cause side effects like nausea. In their lawsuit, the anti-abortion groups also requested that misoprostol be banned for abortion use, but Kacsmaryk’s preliminary ruling on Friday focused on mifepristone alone.
The Connection Between Abortion Access and Financial Hardship
A study published in February in the peer-reviewed American Economic Journal: Economic Policy found that people who were denied abortions suffered more financial hardship in the years following compared to those who were able to receive abortions.
“We’re talking about the question: ‘Will being denied access to abortion affect people’s lives?’” said Caitlin Knowles Myers, an economics professor at Middlebury College who, along with more than 150 other economists, filed an amicus brief with the Supreme Court in the Dobbs v. Jackson Women’s Health Organization case that cited the study before its publication. “And the answer is yes, of course. We see it everywhere we look in the data.”
Some of the patients featured in The Abortion Divide explained that one of the reasons they chose to have an abortion was because of their financial situation.
Megan and her husband Charles were seen in the documentary consulting with a doctor before Megan took mifepristone.
“We’ve been married for five years. We have two children that were very planned,” Megan said in the documentary, describing how it wasn’t an easy decision to go to the abortion clinic. “We just bought a house, we are recovering financially from that, and this was just not the time, not a good time.”
The study, titled “The Economic Consequences of Being Denied an Abortion,” draws on credit report data to analyze financial impacts over time for two groups of people: the “Turnaway” group, or those turned away from abortion clinics because they were past a state- or clinic-set gestational limit; and the “Near Limit” group, who were able to receive abortions.
According to the study, participants in both groups had similar financial outcomes in the three years before they became pregnant. But researchers found that the Turnaway group experienced greater financial stress over time. They determined that people in the Turnaway group experienced a 78% increase in the amount of debt 30 days or more past due and an 81% increase in negative public records on their credit reports — incidents such as evictions, bankruptcies and tax liens — compared to the three years before they were denied an abortion.
“This work clearly shows that restricting a woman’s access to abortion services can have very large and long-lasting negative effects on her economic well-being,” said Laura Wherry, one of the authors of the study and an assistant professor of economics and public service at New York University.
“It wasn’t like they had kind of a rough year or two, and then things got back to normal,” Sarah Miller, co-author of the study and an associate professor of business economics and public policy at the University of Michigan, said of the Turnaway group. “They sort of were put onto this trajectory of worse financial outcomes and, at least in the period we were able to observe, it didn’t seem like they were able to recover from that.”
In comparison, the people in the Near Limit group had financial outcomes that either stayed flat or improved in the years after their abortions, Wherry said.
Diana Greene Foster, co-author of the study and a professor at the University of California San Francisco’s ANSIRH and department of obstetrics, gynecology and reproductive sciences, said studies including this one have shown that the lack of access to the procedure impacts those who are already vulnerable, such as those who might not be able to travel out of state for an abortion or order pills online.
Foster said, “The people who carry a pregnancy to term, who are likely to be the most disadvantaged people in a state that bans abortion, those people will experience serious physical health hardship, economic hardship.”
Watch the full documentary The Abortion Divide: