A dishonest attack on women’s freedom

The US Food and Drug Administration (FDA) approved the abortion pill, mifepristone, for use 23 years ago. But now that approval is at risk of being overturned in the courts.

In November last year, the Alliance Defending Freedom (ADF), a Christian conservative legal-advocacy group, filed a claim with the US circuit court of appeals. It claimed that the FDA had fast-tracked the approval process for mifepristone and ignored the risks posed by its usage.

Just before Easter, Texas-based district judge Matthew Kacsmaryk, a President Trump appointee, ruled in favour of the ADF. The FDA’s approval of mifepristone should be suspended, Kacsmaryk said. His principal justification for the ruling was that mifepristone poses a threat to women’s health. ‘Women who have aborted a child’, he claimed, ‘especially through chemical-abortion drugs that necessitate the woman seeing her aborted child once it passes, often experience shame, regret, anxiety, depression, drug abuse and suicidal thoughts.’

This is a deeply dishonest argument. It is a political attack on women’s autonomy dressed up as a concern about women’s safety and wellbeing.

In truth, mifepristone is incredibly safe. In the US, the reported risk of death from mifepristone is cited as five deaths per million users. This makes it much safer than standard antibiotics – penicillin, for example, is estimated to cause 20 deaths per million users. Indeed, mifepristone is considered globally to be the safest, most effective and most acceptable means to induce an abortion in the earliest weeks of pregnancy. Since it was approved by the FDA over two decades ago, more than five million women have used it in the US. Globally, the numbers run into tens of millions.

Kacsmaryk’s ruling is being appealed by the FDA’s lawyers, who say the withdrawal of mifepristone would ‘harm public interest’. A Washington state federal judge has also countered the ruling, ordering the FDA to refrain from any action that would compromise the drug’s availability.

This means that, for now, the abortion pill remains available. But the case is still likely to end up before the Supreme Court. Given its conservative attitude to abortion, illustrated by its decision to overturn Roe v Wade last year, that prospect ought to trouble supporters of women’s reproductive rights.

After all, mifepristone is currently vital to women seeking abortion in the first weeks of pregnancy. (It is permitted for use for up to 10 weeks after a woman’s last period.) Using the latest pregnancy tests, women can detect pregnancy even before a missed period. Mifepristone can then be prescribed and used easily and quickly. Indeed, in many jurisdictions, it can be provided by post after just an online consultation.

Crucially, this process is extremely safe. Taken in conjunction with a second drug, mifepristone effectively causes an early miscarriage. The physical experience is similar to an early-stage miscarriage. But unlike a spontaneous miscarriage, it is deliberate, planned and prepared for.

Mifepristone has long posed a major problem for the anti-abortion movement. Over the years, this movement has won substantial public support for its campaigns against ‘late abortions’. But it has failed to gain backing for its campaigns against abortion in the earliest weeks of pregnancy, for which there is extremely high public support.

Having failed to win over the public, anti-abortion campaigners are instead attempting to use the courts to force women to stop using the abortion pill. If successful, this sets a very dangerous precedent. It means that judges will be able to block a medication, even if it has a proven track record and is regarded as a ‘best practice’ treatment by medical experts. This could encourage ideologues armed with junk science to attempt to get almost any medication or treatment blocked by a sympathetic judge.

There are party-political ramifications to this attack on the abortion pill. President Joe Biden has already said his administration will fight against the Texas ruling. This leaves the Republican leadership in a bit of a bind. Indeed, senior Republicans must be weeping at Kacsmaryk’s decision. After all, if last year’s Midterm elections proved anything, it’s that opposing abortion is a major vote loser. National exit polls at the time showed that approximately six in 10 voters support legal abortion in most cases, with just one-third wanting it to be entirely or mostly illegal. This matters electorally. Politico reports that abortion is now up there with the economy as a determining issue at the ballot box in the US. No wonder the abortion issue is now being called ‘Republican quicksand’. There is a political price to pay for attacking women’s rights.

Political expediency aside, there is a principle at stake here in the rows over the abortion pill. Anyone who cares about women’s freedom and autonomy should resist these attempts to limit reproductive choice.

Ann Furedi is author of The Moral Case for Abortion: A Defence of Reproductive Choice.