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Embattled abortion medication remains legal, for now

Wyoming patients and providers can still legally access mifepristone and have other options if it becomes illegal.

Jackson OB-GYN Dr. Giovannina Anthony, second from left, a plaintiff in a lawsuit challenging Wyoming’s new ban on most abortions, hugs her attorney after Ninth District Court Judge Melissa Owens issued a temporary order blocking the law Wednesday, March 22, 2023, in Jackson. (Kathryn Ziesig/Jackson Hole News&Guide/Pool)

CHEYENNE, Wyo. — It’s still legal for Wyomingites to access the abortion drug mifepristone — for now. 

That comes after Supreme Court Justice Samuel Alito decided Friday to halt until 11:59 p.m. ET April 19 lower court decisions that restricted access.

Mifepristone is commonly paired with another drug, misoprostol, to induce an abortion in the first 10 weeks of pregnancy. 

While Wyoming only has one clinic currently providing abortions, future rulings about mifepristone could affect how and what kinds of abortions patients here can receive.

For example, many residents seeking abortions in the rural Mountain West turn to the telehealth organization Just The Pill, which mails abortion medications to individuals. That organization has maintained that it will continue working with patients, even if mifepristone isn’t available in the future.

“We are prepared to offer the safe and effective misoprostol-only regimen to patients if needed,” Dr. Julie Amaon, medical director of Just The Pill, stated. “We stand firmly by our mission to improve abortion access in the face of increasing restrictions, especially in underserved communities.”

Misoprostol-only abortions are effective, according to a review of the available research, and about as safe as those with both medications. However, research and anecdotes point to the possibility of more side effects using misoprostol alone.

“It’s more painful. It’s more bleeding. It’s more cramping. It takes longer,” Dr. Giovonnina Anthony, an OB-GYN at Women’s Health and Family Care, said. “I have to tell patients that, and it’s just heartbreaking.”

Anthony’s clinic in Jackson is the only healthcare facility in Wyoming providing abortions, and it only utilizes medication abortions. Late on Wednesday, Anthony said she put in an order for Mifeprex — the brand name for mifepristone.

“If we have any issues with Mifeprex between now and July 1, I will go to a misoprostol-only option, because we do have regimens for that,” she said. 

Already, several state leaders have publicly declared that they would stockpile abortion medications ahead of court rulings. Massachusetts and Washington, in particular, have said they would stock up on mifepristone. 

That could affect access to the medication even if it remains legal.

The misoprostol-only regimen could be a future option for Planned Parenthood of the Rocky Mountains too, according to CEO and President Adrienne Mansanares. Either way, though, she says they’ll continue to provide support wherever and however it is legal to do so. 

“​As of right now, we are welcoming patients with open arms for medication abortion care in the states where it is available,” Mansanares said. “Most patients coming from Wyoming choose our Fort Collins Health Center in northern Colorado. And so we’re prepared and very proud to support patients still.”

Anticipating more patients traveling from Wyoming to out-of-state Planned Parenthood clinics, Mansanares said their Fort Collins Health Center has extended hours and made sure there’s staff on hand. 

Thanks to a donor-created endowment, Wyoming residents are also eligible for funding in case they need gas or hotel rooms to access Planned Parenthood locations, Mansanares said.

“So we have dollars available to support gas money,” she said. “Over half of our abortion care patients are already parents, and so many of those patients have kiddos at home. We can help support childcare.”

Chelsea’s Fund also helps provide aid to those in Wyoming seeking abortions. 

A second Wyoming abortion clinic is scheduled to open this spring in Casper, according to a press release from Wellspring Health Access. There is no opening date listed, but it said more details will be posted shortly. 

“We plan to finally open the doors to our Casper, Wyoming clinic after an arsonist attacked it last May,” Wellspring Health Access founder and president Julie Burkhart said in a statement. “In accordance with state and federal law, we plan to offer medication abortion services, and we will become the first clinic in the state of Wyoming to offer procedural abortion care.” 

Wellspring Health Access and Dr. Anthony in Jackson are plaintiffs in a suit over Wyoming’s abortion ban. The judge in that case has issued a temporary restraining order on the state’s new law, which means abortion remains legal in the state.

However, a second law passed this legislative session would make medication abortions illegal in Wyoming. That law would go into effect in July unless it becomes part of the ongoing legal battle in Jackson. It is the first state law in the country that specifically targets medication abortions.

At the federal level, it’s possible that the legal wrangling over mifepristone could result in the Food and Drug Administration simply not enforcing rules, University of Pittsburgh School of Law associate professor Greer Donley told PBS Newshour. That is, the FDA could allow manufacturers and distributors to continue their work with mifepristone without intervening — even if it’s no longer deemed an FDA-approved medication. 

Back in Jackson, Anthony sighed talking about recent court hearings and state laws.

“It’s so sad,” she said. “And it’s so confusing to everybody. And the patients are freaked out and our staff are scared and it’s awful.”

How we got here

The U.S. Food and Drug Administration originally approved its use to terminate a pregnancy in 2000 for up to seven weeks after conception, expanding that timeline to 10 weeks in 2016. Medication-induced abortions made up more than half of all abortions in 2020, according to the Guttmacher Institute. 

Anti-abortion groups and doctors filed suit in a federal court in Texas late last year, arguing that the FDA shouldn’t have approved or expanded access to mifepristone because of its risks. 

“The FDA should have to answer for the damage it has done to the rule of law and the harm it has caused to countless women and girls,” case attorney Erik Baptist with Alliance Defending Freedom wrote in a statement.

The conservative Christian Alliance Defending Freedom is also representing lawmakers, the secretary of state and an anti-abortion group in Wyoming trying to join a lawsuit over the state’s abortion ban. 

The FDA based its mifepristone approvals on “a thorough and comprehensive review of the scientific evidence,” and hasn’t identified any new safety concerns since expanding its access in 2016, according to its website. Research into mifepristone plus misoprostol abortions has found less than 1% of patients have serious complications. 

Other groups point to 2012 research in the journal Obstetrics and Gynecology, which found U.S. residents are more likely to die in childbirth than from medication abortions. Maternal mortality rates have only increased since then, according to federal data.

The American Medical Association defends the FDA’s approval of mifepristone and stated losing access to the drug could affect patients “experiencing miscarriages, choosing medication abortions, experiencing bleeding or hemorrhaging during certain serious pregnancy complications, being treated for Cushing’s Syndrome and other existing and growing treatments not related to pregnancy.”

Complicated court rulings

U.S. District Court Judge Matthew Kacsmaryk in Texas found on April 7 that there was enough evidence to issue a preliminary injunction on the medication, which would have effectively rolled back FDA approval of mifepristone as the case progressed. 

The judge gave appellate courts seven days to issue their own decision before his injunction went into effect. Late on Wednesday, the 5th Circuit Court of Appeals ruled that mifepristone would remain authorized for use, but that it could no longer be mailed to patients or authorized after seven weeks of pregnancy.

In response, the U.S. Department of Justice kicked the decision up to the Supreme Court. 

“We will be seeking emergency relief from the Supreme Court to defend the FDA’s scientific judgment and protect Americans’ access to safe and effective reproductive care,” U.S. Attorney General Merrick B. Garland stated Thursday.  

Justice Alito halted the appellate court’s restrictions Friday afternoon.

Around the same time as the Texas ruling, the District of Columbia and 17 Democrat-led states — including Colorado — fought in Washington State to maintain mifepristone’s availability. A federal judge there agreed with the plaintiffs, ruling on April 7 that the FDA cannot restrict access to the drug. That judge also ruled that those particular states wouldn’t be affected by the decision in Texas.

This article was originally published by WyoFile and is republished here with permission. WyoFile is an independent nonprofit news organization focused on Wyoming people, places and policy.