Health

Subterms

    More stories

    • 125 Shares199 Views

      in US Politics

      US supreme court blocks ruling limiting access to abortion pill

      by

      The supreme court decided on Friday to temporarily block a lower court ruling that had placed significant restrictions on the abortion drug mifepristone.The justices granted emergency requests by the justice department and the pill’s manufacturer, Danco Laboratories, to halt a preliminary injunction issued by a federal judge in Texas. The judge’s order would significantly limit the availability of the medication as litigation proceeds in a challenge by anti-abortion groups.The decision offered a victory to the Biden administration as it defends access to the drug in the latest fierce legal battle over reproductive rights in the US. The president praised the decision and said he continues to stand by the FDA’s approval of the pill.“As a result of the supreme court’s stay, mifepristone remains available and approved for safe and effective use while we continue this fight in the courts,” Biden said in a statement. “The stakes could not be higher for women across America. I will continue to fight politically driven attacks on women’s health.”The court’s ruling means that access to mifepristone will remain unchanged at least into next year as appeals play out and patients can still get medication abortions with the drug in states where it was previously available.Reproductive rights groups celebrated the ruling, while cautioning it does not necessarily herald the final outcome of the case. “This is very welcome news, but it’s frightening to think that Americans came within hours of losing access to a medication that is used in most abortions in this country and has been used for decades by millions of people to safely end a pregnancy or treat a miscarriage,” said Jennifer Dalven, director of the Reproductive Freedom Project at the American Civil Liberties Union. “Make no mistake, we aren’t out of the woods by any means. This case, which should have been laughed out of court from the very start, will continue on.”The decision came in the most pivotal abortion rights case to make its way through the courts since Roe v Wade was overturned last year. More than half of abortions in the US are completed using pills.The case was brought by a conservative Christian legal group arguing the Food and Drug Administration improperly approved mifepristone more than 23 years ago.The Biden administration vigorously defended the FDA against the charge, emphasizing its rigorous safety reviews of the drug and the potential for regulatory chaos if plaintiffs and judges not versed in scientific and medical arguments begin to undermine the agency’s decision-making.Conservative justices Clarence Thomas and Samuel Alito dissented, with Alito writing that the Biden administration and Danco “are not entitled to a stay because they have not shown that they are likely to suffer irreparable harm in the interim”.The order granting the stay was unsigned, so it is not known how each of the other seven justices voted.The case has moved quickly through the courts in recent weeks, as contradicting rulings have thrown the future of the drug into question.In early April, a federal judge in Texas, Matthew Kacsmaryk, first ruled in the lawsuit brought by a coalition of anti-abortion groups to suspend the FDA’s 23-year-old authorization of mifepristone entirely, writing that the agency wrongly approved the drug. After a challenge by the Biden administration in the fifth circuit court of appeals, a divided three-judge panel said the drug’s approval could stand, but imposed restrictions on it, limiting its use to seven weeks of pregnancy instead of the current 10-week limit, and banning delivery of the pill by mail.The Biden administration then asked the supreme court to intervene before the restrictions went into effect. Alito twice stayed the lower court ruling, keeping access to mifepristone unaltered while the court deliberated.Complicating matters, another federal judge issued a ruling directly contradicting Kacsmaryk’s, ordering the FDA to refrain from making any changes to the availability of mifepristone in 18 jurisdictions.That judge – Judge Thomas O Rice, in Washington – reaffirmed that order after the fifth circuit’s ruling.Both the Biden administration and pharmaceutical companies have warned of regulatory chaos around drug approvals, should the supreme court allow the restrictions on mifepristone to go into effect.“If this ruling were to stand, then there will be virtually no prescription, approved by the FDA, that would be safe from these kinds of political, ideological attacks,” president Biden said in a written statement after the Kacsmaryk’s decision in early April.The US vice-president, Kamala Harris, echoed the point in a statement responding to the appellate decision: “If this decision stands, no medication – from chemotherapy drugs, to asthma medicine, to blood pressure pills, to insulin – would be safe from attacks.” More

    • 200 Shares139 Views

      in US Politics

      ‘A gamechanger’: this simple device could help fight the war on abortion rights in the US

      by

      Joan Fleischman has always had people flying in from across the world to her private abortion practice in Manhattan. In the two decades her clinic has been open, she has seen clients from far-flung places, such as Ireland, the Bahamas and Mexico, who couldn’t get abortions in their home countries. In the last year, that changed. Since the US federal right to abortion was overturned in June 2022, she is now more likely to see patients flying in from her own country.Often they are from Texas, sometimes Ohio, or Florida. Some with links to the city, others with none.After years of providing abortion care, Fleischman, 60, still finds these trips shocking. “Usually if somebody needs unusual medical care, they are willing to fly around the world for it – like for advanced neurosurgery or something. It’s always struck me as incredible that people are flying to me for the most simple procedure.”There’s a reason people fly to see Fleischman. She provides abortions through manual uterine aspiration – using a small, hand-held device to remove pregnancy tissue. The device is gentle enough that the tissue often comes out almost completely intact. It is also a quick and discreet procedure where a patient might be in and out of the door in less than an hour.Fleischman is co-founder of the MYA Network, a network of primary care clinics and clinicians in 16 states. They believe the tool could be radical in the hands of more primary care clinicians – clinicians they are amping up to train.The time to do that, they say, is now. The future of mifepristone, a major abortion pill used in more than half the abortions in the US, is in question due to a lawsuit brought by anti-abortion groups seeking to overturn the FDA’s approval of the drug. It could be determined by the same supreme court that ruled last year to overturn Roe v Wade. Manual aspiration is not new: it is used by many big abortion clinics across the US. But those are are notoriously over-stretched. In 2020, before Roe v Wade was overturned, 38% of reproductive-aged women lived in counties with no abortion provider at all.Especially given the threat to mifepristone, the MYA Network believes that primary care clinicians, who are vastly more common than abortion providers, are well-placed to help.But while more than 73% of primary care doctors believe abortion care to be within their scope of practice, a tiny fraction – less than 10% – of primary care doctors actually provide it.The network is planning to unveil an online curriculum and in-person trainings for the procedure, which many of the clinicians and institutions in the network have already been doing in their own states.“The number of clinicians who could be trained would be limitless,” says Michele Gomez, one of the doctors in the MYA network of clinicians.“There are so many clinicians out there who want to do something to help but just don’t know how, and this information and support could be a gamechanger.”As a young woman, Joan Fleischman often felt compromised. She frequently traveled overseas as a teenager to do basic aid work with a volunteer group, and would feel fear and humiliation from the unwanted sexual attention she would receive. That was the beginning of her understanding, as she describes it, of the constant vulnerability women walk around with.By the age of 18, Fleischman had her first abortion – an experience she describes as routine, mundane even. The pregnancy came as she started her first year at the University of Chicago, and was the least of her concerns. “It was a no brainer. I was like, ‘Pregnant? Nope, I’m going to be a doctor.’ So I went to Planned Parenthood and took care of it,” says Fleischman.It wasn’t until she started providing abortions that she even thought about the experience again.Fleischman was in her 30s, living in New York and already trained as a family practice doctor, when she saw an advertisement offering to teach doctors how to do surgical abortions.“I realized that after all these years in training, I’d never got to even see an abortion. I had saved lives, helped people at the height of the Aids crisis. I had delivered babies. These are things a family doctor does,” she says. “I was like, ‘why? That’s ridiculous.’ That’s where the passion started.”Fleischman took up more training, learning to perform abortions at a Planned Parenthood, in 1995.Planned Parenthood – as Fleischman pointed out herself – is the place where people “go to get it done”. It is a vital lifeline for many people, providing hundreds of thousands of abortions every year, many to low-income and uninsured clients.But the efficiency of their service contrasted with Fleischman’s training as a family doctor – which emphasizes the importance of the doctor-patient relationship. She was used to that relationship entailing a level of intimacy – her work involved home visits with patients, and entering lifelong relationships with them and their families.Fleischman recalls her Planned Parenthood training:“Women went station to station. They got their blood drawn, and then they sat in a little waiting room with other people. They got their ultrasound; they sat in another little waiting room, always with paper gowns on. They had been fasting for the whole night before. They saw a counsellor. Then they were in a bigger waiting room. And then they got called by name, to come in for their procedure. The surgeon went from room to room to room, doing 50-60 abortions a day.”She wanted to personalize the experience. For patients to be able to come in with their partners, to be talked through their options and their concerns, fully. “I just felt so disconnected. It seemed to me that the doctor was really a technician emptying uteruses,” she continues.“I was like, ‘I want to create a different model. I want people to have a different experience going through this’.”As the US is learning, ethical quandaries always arise when abortion is banned: what to do for the woman who turns up septic after a failed, self managed abortion? How to deal with life-threatening pregnancies that require intervention but also require an abortion? What about cases of rape, incest or pregnant children?Essentially: how much pain is the state willing to impose on people when it restricts reproductive freedom?In Bangladesh, a sort of answer to some of these questions came following the 1971 civil war, during which soldiers abducted Hindu and Bihari Muslim women and set up rape camps. Pregnancy as a result of rape skyrocketed; in the following years, suicide and maternal mortality also shot up. Abortions, of course, did not stop happening. In 1978, while abortion remained illegal, an estimated 800,000 abortions took place in the country, resulting in around 8,000 deaths.“Menstrual regulation”, as it came to be known – using the same manual aspiration technique that Fleischman now uses – became a sort of legal loophole, allowing safe abortions for early pregnancies.By 1974, menstrual regulation was legal and by 1979, Bangladesh started providing the procedure through its national family planning program.Now, one might walk through a busy street in Bangladesh and find a sign advertising menstrual regulation in a country where, at least officially, abortion is only allowed in life-threatening situations. A woman simply comes in and explains she has missed her period. She doesn’t take a pregnancy test before the procedure, and nobody asks her to. As long as she sees the clinician before 12 weeks, they will “restore her period” for her.“It’s just a clever policy, a wink and a nod – everybody knows what’s going on. It’s kind of a recognition that women need this care,” says Bill Powell, a senior medical scientist at IPAS, an international organization that trains medical professionals across the world to use manual aspiration.It also gives doctors discretion without explicitly violating the law. “They say: ‘I know if I don’t provide this care, this woman is going to go off and do something that is unsafe, and she’ll be back to my facility ill, needing emergency care, so therefore, I am saving her life by providing this procedure’,” Powell explains.Fleischman, who worked in Bangladesh in her youth, and her colleagues in the MYA network are adamant they are only proposing manual aspiration be used legally in the US – for abortion care where it is legal, and miscarriage management where it is not. But its use in ordinary medical settings could still provide a radical opportunity in the US, she says, by expanding the number of clinicians who can easily perform the procedure up until 12 weeks.Others have touted this idea, in a slightly different way: anyone can learn to use a manual aspiration device, and manage their own abortions, some activists argue. All they need to learn to do is to insert a cannula, which is like a large straw, through the natural opening of the cervix, and then attach the aspiration device. The device is like a syringe, which creates a vacuum. Once the pressure is released, the contents of the uterus are gently removed. The self-management option has other advantages – like cutting out the middle man in a climate where doctors are increasingly scared to provide abortion care, and equipping people with self knowledge when the future of access to abortion is unclear.Fleischman understands the necessity of self-managed abortion, especially in places where the procedure is illegal. But she believes that after receiving care, people should always be able to follow up with a clinician who knows their case if anything goes wrong, or even if it doesn’t. It dismays her that people are living in a climate in the US where they might not have that option; where people might be too scared to look for help; and where they may suffer with complications alone in the rare instances when something does go wrong.In states where abortion is legal, manual aspiration provides the opportunity to treat abortion like mainstream medicine, rather than something that’s siloed into abortion clinics, which are visible, small in number and under constant threat.The case brought by anti-abortion groups against the FDA’s approval of mifepristone – which is one of two abortion drugs used in more than half of all abortions in the US – will almost certainly be decided by the supreme court. The uncertainly over its future, Fleischman argues, could make the expanded use of manual aspiration critical to preserving abortion and miscarriage care.Some providers may switch to abortions using only the second drug, misoprostol. But misoprostol-only abortions are slightly less effective, and more often require care for incomplete abortions. That could result in straining already stretched abortion clinics, which will likely have more people knocking at their doors for both surgical abortions and follow-up care.With manual aspiration on the other hand, doctors can be mostly certain that the procedure is complete before the patient leaves the state.And in states with bans, clinicians could be trained to use the device to treat miscarriages. “It’s useful even where you are not allowed to provide induced abortion care … [to treat] miscarriage, or spontaneous abortion,” explains Ian Bennett, a family planning doctor who is part of the MYA network and a professor at the University of Washington.Bennett trains several dozen students a year in manual aspiration, teaching them the procedure as part of their regular medical training, and says students are actively seeking out this instruction in the new, post-Roe environment.Students “are selecting programmes where abortion care is integrated into their training, even over some that might be more prestigious,” he says.Clinicians in areas that border states with bans, which have seen big increases in demand for abortion services as a result, are also a target for training, as are “red parts of blue states”, explains Gomez. Clinicians in states where abortion is legal, who want to do something to fight the war on abortion could easily do so by integrating abortion into their practices, Fleischman and her colleagues say.“It’s done in a couple of minutes,” explains Fleischman.“When it’s done, you know that it’s done. There’s very few bleeding issues. You walk into an office, and an hour later, it’s resolved. I have people flying in and out of Dubai for this procedure. They schedule the appointment, they come in, and they depart that afternoon,” she continues.“There’s absolutely no reason this shouldn’t just be part of regular medicine.” More

    • 125 Shares169 Views

      in US Politics

      Democratic senators condemn federal judge’s ruling to block abortion drug

      by

      Top Democratic senators across the US are pushing back after a federal judge in Texas decided to block the FDA-approved abortion drug mifepristone.On Sunday, the New York senator Kirsten Gillibrand criticized as an “outrage” Judge Matthew Kacsmaryk’s decision, which is currently halted until at least Wednesday 19 April by the supreme court.Speaking to CNN, Gillibrand said: “To take away the right to have medicine is an extension of taking away this right to privacy, to say we can’t have medicine sent by doctors by mail to people across the country is further invading into this right to privacy, where the court and government has a right to what’s in your mail, and who you’re talking to and what communications you’re having. It’s an outrage.”She went on to condemn the supreme court, which in June 2022 decided to overturn Roe v Wade, a ruling that declared the constitutional right to an abortion for nearly half a century.Gillibrand said the supreme court’s decision was an “all-out assault on women’s reproductive freedom,” adding: “What we are seeing in these Republican legislatures as well as these very conservative courts is a continuation of that assault.”Similarly, the Minnesota senator Amy Klobuchar called Kacsmaryk’s decision “unbelievable”.“What is going to be next? Is that judge going to not like birth control pills? Are we going to have a judge that doesn’t like [cholesterol medication] Lipitor? There’s a reason that Congress gave the FDA the power to make these decisions about safety,” Klobuchar told ABC.“I can tell you who is harmed by this. It’s women that are going to have to take a bus across the country from Texas to Minnesota or to Illinois. That’s the problem right now,” she added, pledging to “aggressively litigate” the ruling if the supreme court decides to uphold it.The Wisconsin senator Tammy Baldwin, meanwhile, said that Kacsmaryk “is not guided by science”.“What we have in Texas is a judge who is not guided by science, but is part of an extreme Republican concerted effort to ban abortion nationwide,” Baldwin told NBC.“We do not need judges, politicians or government telling women about what sort of healthcare they can have. It is an issue that is not only playing out in the court in Texas, but in the state of Florida, with the governor signing a near six-week ban, Idaho forbidding travel out of state for minors, Wisconsin where we’ve gone back to literally 1849. That is the date our criminal abortion ban was passed and that’s 174 years ago,” Baldwin said.Last month, Baldwin and the Connecticut senator Richard Blumenthal, a Democrat, led the introduction of the Women’s Health Protection Act of 2023, which would safeguard abortion rights nationwide and “restore the right to comprehensive reproductive healthcare for millions of Americans”.skip past newsletter promotionafter newsletter promotionFollowing Kacsmaryk’s ruling, the justice department and the drug’s manufacturer, Danco Laboratories, asked the supreme court to intervene in an attempt to halt the restrictions, which would have limited mifepristone’s use after seven weeks of pregnancy as well as ban mail delivery of the drug. Mifepristone is currently approved until 10 weeks.On Friday, the conservative supreme court justice Samuel Alito temporarily blocked the Texas lower court ruling and instead imposed on to it a five-day stay, allowing the justices more time to decide on their next steps.Alito’s move allows for the country’s most common method of pregnancy termination to remain unchanged until at least the end of Wednesday.Despite nationwide outrage from progressive lawmakers and reproductive rights activists, conservative lawmakers have defended the growing wave of various abortion bans.In an interview on Sunday with NBC, the Republican senator Bill Cassidy of Louisiana said reactions to the Texas ruling are “totally alarmist”.“It’s totally alarmist. And by the way, when did the FDA think they could go above the law?” Cassidy said, adding: “Dobbs, I think, was the correct decision,” in reference to the supreme court’s overturning of federal abortion rights last year.Cassidy’s comments come two days after Florida’s Republican governor, Ron DeSantis, signed into law a six-week abortion ban across the state, which currently has a 15-week ban. More

    • 163 Shares199 Views

      in US Politics

      ‘It’s a scary time’: Florida Democrat vows to keep fighting six-week abortion ban

      by

      Last week, Lauren Book, the top Democrat in the Florida senate – was placed in handcuffs, arrested and charged with trespassing, after refusing to leave an abortion rights demonstration near the state capitol building in Tallahassee.Hours before, Republican lawmakers in the state senate advanced the legislation, which would dramatically restrict the state’s current ban on abortion from 15 weeks of pregnancy to six weeks – before many women even realize they’re pregnant. Critics say the narrow window would amount to a “near-total” ban on abortions in the state.The bill would have far-reaching implications across the south. After the supreme court’s decision to eliminate a woman’s constitutional right to an abortion, Florida became a haven for women seeking reproductive care from states where access was prohibited or severely restricted, including Louisiana and Alabama.“It’s a scary time,” Book told the Guardian ahead of the vote. “Women are being put in very, very dangerous situations to get the healthcare they need and deserve.”Republican dominance in the state legislature means the bill’s fate is “all but sealed”, she acknowledged. The Republican-controlled house is expected to give the bill final approval as soon as this week. It will then be sent to Governor Ron DeSantis, a Republican who is widely expected to run for president and who has signaled his support.But Book, who has led the opposition to this bill in the state senate, vowed to keep fighting – as a political leader and, she said, as a mother furious that her twins – a boy and a girl – no longer have the same rights to bodily autonomy.“In the course of just two generations, we’ve seen our rights won and lost,” she said in a floor speech last week. “It is up to us to get them back. No one is going to save us but ourselves.”Book became senate minority leader in 2021, having served in the chamber since 2017. The following year, DeSantis signed into law a ban on abortions after 15 weeks of pregnancy, without exceptions for rape or incest.A sharp backlash to last summer’s supreme court decision overturning Roe v Wade fueled a string of ballot-box successes for abortion rights and powered Democrats to victory in states across the country in the 2022 midterm elections. But not in Florida.In November, DeSantis won re-election by nearly 20 points in a state that was once a presidential battleground, while Republicans claimed a supermajority in both chambers of the state legislature.Emboldened, Republican lawmakers have advanced a dizzying array of legislative proposals that have thrilled conservatives, alarmed liberals and offered a policy platform from which the governor could launch a presidential bid.As minority leader, Book believes it is her role to rally the opposition – and help Democrats claw back power in 2024. “We are going to do the work to get the numbers out in ’24,” she said, “because the alternative is not acceptable. It’s dangerous and it is killing women.”In addition to the abortion bill, the state’s Republican lawmakers are pressing forward with legislation that would impose new controls on trans youth, limit drag performances, ease media defamation suits, expand the state’s controversial “Don’t Say Gay” law, ban diversity and equity programs at public universities and colleges, place new restrictions on public-sector unions, and allow a divided jury to impose a death sentence. Already this session, DeSantis signed a law expanding Florida’s school voucher system, and another allowing Floridians to carry a concealed weapon without a permit.But while DeSantis’s conservative crusade may excite his base, Book said she expects it will backfire on him.“We’re not doing the things that matter to Floridians. We’re not doing the things that make life here better,” she said, arguing that the legislature should be focused on tackling the rising cost of property insurance. “Instead, we’re attacking small groups of people, we’re taking away women’s rights, all under the banner of freedom and allowing this guy to run for president.”The governor’s office did not respond to a request for comment.With the abortion bill barrelling toward the governor’s desk, Book said she and her Democratic colleagues are using every legislative tool at their disposal to draw attention to the “dangerous consequences” of the legislation.They offered numerous amendments, including one that would allow women seeking abortions to cite religious exemption. Another put forward by Book would have renamed the so-called “Heartbeat Protection Act” to the “Electrical activity that can be manipulated to sound like a heartbeat through ultrasound protection at the expense of pregnant people’s health and well being act.” All were rejected.When the bill came before the senate health policy committee for debate, Democrats extended the session so medical providers and opponents would have more than the allotted “30 seconds” to testify, Book said. In speeches, she shared the stories of women, including a constituent, who faced life-threatening complications after the loss of desired pregnancies because their states new abortion restrictions prevented doctors from administering miscarriage care.skip past newsletter promotionafter newsletter promotionAnd last week, senate Democrats engaged in an emotional floor debate ahead of the senate vote on the six-week ban. From the public gallery overlooking the chamber, protesters repeatedly disrupted the proceedings, shouting down lawmakers who spoke supportively of the legislation. Several were removed before the senate president ordered the gallery cleared.The displays of opposition have had little effect.State senator Erin Grall, a Republican sponsor of the bill, said during the debate that “bodily autonomy should not give a person the permission to kill an innocent human being”. Republicans have sought to emphasize that the measure allows for exceptions in cases of rape, incest or human trafficking until 15 weeks of pregnancy – additions DeSantis has called “sensible”.Critics counter that the exceptions are narrow, noting that the proposal will require victims to “provide a copy of a restraining order, police report, medical record, or other court order” before they can receive an abortion.Book, a sexual assault survivor, says the paperwork requirement will keep women from seeking care. “Show your documents to prove that you were raped?” Book said. “You don’t even need to do that now to carry a gun.”The bill’s proponents also tout provisions that would expand funding for anti-abortion pregnancy centers and provide families car seats, cribs and diapers. Book called the initiatives “insulting”.“You’re going to give them car seats or a crib? What about healthcare? What about child care? Those are things that people need,” Book said. “They’re not pro life. They’re pro-birth.”Book sees a backlash brewing in Florida, though it won’t come in time to stop Republicans from passing the ban.According to a recent survey by the Public Religion Research Institute, nearly two-thirds of Floridians believe abortion should be legal in most or all cases. Another poll published last month found that roughly three in four Florida voters, including 61% of Republican respondents, say they oppose a six-week abortion ban with no exceptions for rape or incest. (Notably, the measure that passed the Florida senate does allow for exceptions, which was not asked as part of the polling question.)Activists on both sides of the abortion debate are, meanwhile, waiting on a decision by the Florida supreme court, which is weighing a challenge to the state’s current 15-week ban. The six-week proposal would only go into effect if the 15-week ban is upheld.Book said she would like to see the matter settled by Florida voters in the form of a ballot initiative, like it was in Michigan and other states. In the meantime, she is urging women in Florida and around the country “not to take matters into your own hands”.Protesters have once again gathered in Tallahassee, as the Republican-controlled house charges ahead with a debate on the measure scheduled for Thursday. Among them will be Nikki Fried, chair of the Florida Democratic party, who was arrested alongside Book last week. For Book, the women’s resistance is proof that however bleak it may appear now, the fight for abortion rights in Florida is only just beginning.“​I’m heartened by the women who are now occupying Tallahassee and not going quietly into the night,” she said. “I think that is emblematic that this is not over.” More

    • 150 Shares159 Views

      in US Politics

      ‘We will not cave’: governors stockpile abortion drugs as access is threatened

      by

      Several Democratic governors have moved swiftly to protect access to medication abortion in their states after a ruling by a Texas judge late last week threatened access to the widely used abortion drug mifepristone.In an announcement on Monday, Governor Maura Healey of Massachusetts said her state had ordered about 15,000 doses of mifepristone, the first of two drugs in a medication abortion regimen that has been approved for use up to the 10th week of pregnancy.Healey also issued an executive order that she said would help protect access to medication abortions and shield providers who perform them.In California, Governor Gavin Newsom, also a Democrat, said his state had secured an emergency stockpile of up to 2m pills of misoprostol, the second drug in the regimen that can be used safely on its own, though is slightly less effective as a single medication. That drug, which is used to treat other medical conditions, is also being targeted by anti-abortion groups seeking to remove it from the market.“In response to this extremist ban on a medication abortion drug, our state has secured a stockpile of an alternative medication abortion drug to ensure that Californians continue to have access to safe reproductive health treatments,” Newsom said in a statement. “We will not cave to extremists who are trying to outlaw these critical abortion services. Medication abortion remains legal in California.”Their actions come after US district judge Matthew Kacsmaryk, an appointee of Donald Trump known for his anti-abortion views, issued a ruling late on Friday that invalidated the 23-year-old approval of mifepristone by the Food and Drug Administration (FDA). On the same night, a federal judge in Washington state issued a contradictory ruling that ordered the FDA to maintain the drug’s approval in at least 17 states where Democrats had sued.On Monday, the US justice department appealed the Texas ruling, asking a federal appeals court to place a hold on the “extraordinary and unprecedented order”. Underscoring the legal uncertainty surrounding the dueling orders, the administration separately asked the federal court in Washington state for clarity.With access to the drug imperiled, and Democrats stymied in Washington by the Republican majority in the House of Representatives, a handful of liberal state governors said they were taking matters into their own hands.“A judge has made a politically motivated decision to override doctors, patients and medical experts and block access to critical medications,” Healey said on Monday, unveiling the plan at a press conference outside the Massachusetts statehouse in Boston. “Today, we collectively are saying loud and clear: not on our watch.”In anticipation of the Texas ruling, the Democratic governor of Washington, Jay Inslee, announced last week that his state would stockpile a three-year supply of mifepristone in the event the drug became more difficult to access. Days later, Kacsmaryk issued his ruling.Several other Democratic governors and state attorneys general have condemned the ruling while seeking to make clear that, at least for now, the drug remains available. Some went further, promising to keep medication abortion legal and accessible in their states, although without providing further details.More than half of abortions in the US rely on medication abortion, and most of those involve the two-drug protocol. If the appeals court doesn’t intervene, the Texas ruling would take effect on Friday with far-reaching implications for access.The FDA approved mifepristone to terminate pregnancy in 2000, when used with misoprostol. Despite claims made in the Texas lawsuit, there is decades’ worth of scientific research concluding that mifepristone is safe.States have become the epicenter of the fight over abortion rights since the supreme court’s landmark decision last June to overturn Roe v Wade. Since then, more than a dozen Republican-led states have enacted abortion bans or severely restricted access to the procedure.​Anti-abortion groups have long targeted medication abortion, the most common method for terminating a pregnancy in the US. But it became the focus of efforts after the supreme court’s landmark decision last June to overturn Roe v Wade, allowing states to regulate abortion.Although more than a dozen Republican-led states moved quickly to ban or severely restrict abortions​, with scores of new limits pending before state legislatures this session, Democratic-led states have pushed in the opposite direction. Yet if the Texas ruling stands, experts say it would upend access nationwide, limiting the drug even in states where abortion is legal.Abortion opponents in blue states denounced the efforts by Democratic governors to preserve access to medication abortion.“It is appalling that Gavin Newsom is so obsessed with ending the lives of children in the womb that he is attempting to stockpile dangerous and potentially illegal drugs,” California Family Council president Jonathan Keller wrote on Twitter. “California again proves the only ‘choice’ they care about is abortion.”Newsom said the judge’s ruling “ignores facts, science and the law” in a way that puts “the health of millions of women and girls at risk”.“Abortion is still legal and accessible here in California and we won’t stand by as fundamental freedoms are stripped away,” he said.Other supporters of abortion rights similarly denounced the conservative judge’s decision on abortion as “unprincipled” and out of step with the American public. In states where the issue has been put on the ballot, from right-leaning Kansas to battleground Michigan and liberal Vermont, voters have opted to preserve or expand access.“I’ve fought like hell to protect abortion access and I’m not backing down,” Michigan’s governor, Gretchen Whitmer, said on Friday. “I will keep taking steps to expand access to reproductive healthcare and fight against anyone threatening our rights.”Whitmer recently signed legislation repealing the state’s nearly century-old abortion ban, after Michigan voters overwhelmingly approved a ballot initiative in November to enshrine abortion protections into the state constitution.Democrats and reproductive rights advocates believe the issue will continue to motivate voters in the coming election cycles after lifting them to victories across the country in the 2022 midterms. Last week’s election of a liberal judge to serve on the Wisconsin supreme court brought fresh evidence of the enduring potency of abortion politics.“This decision will only enrage Americans further and move them to more action,” Mini Timmaraju, president of the Naral Pro-Choice America advocacy group, said on a call with reporters on Monday. “Our eyes are on 2023 and 2024 – 2022 was just the beginning.” More