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      ‘Feels horrible to say no’: abortion funds run out of money as US demand surges

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      Laurie Bertram Roberts never expected Americans to keep forking over money to pay for other people’s abortions. But the abortion fund director didn’t think it would get this dire.When the US supreme court overturned Roe v Wade last year, people donated tens of thousands of dollars to Roberts’ organization, the Mississippi Reproductive Freedom Fund, which is dedicated to helping people afford abortions and the many costs that come with it. But, in August, Mississippi Reproductive Freedom Fund had to stop funding abortions. It’s now closed until January 2024.“We just don’t have the money,” said Roberts, who co-founded the fund a decade ago. “It’s a strategic decision, to focus on fundraising for the next couple months, so that when we reopen, we’ll have money.”For now, the fund – which has historically also helped people with other costs of living and parenting – is only offering access to its pantry of food and household supplies. This will be the longest the Mississippi Reproductive Freedom Fund has ever been shut down.“I didn’t think the emergency funding was gonna stay the same,” Roberts said in reference to the post-Roe donation spike. “But I didn’t expect for our funding to dip by 35 to 40% from last year.”When the US supreme court overturned Roe, Americans rushed to rage-donate millions to abortion funds and clinics scattered across the United States.Now, with the first year of post-Roe life in the rearview mirror, much of that money has been spent and the flow of donations has dried up for many organizations. And yet, as states continue to enact new bans and restrictions, the demand for help – and the cost of providing that help – has only grown.The Mississippi Reproductive Freedom Fund isn’t the only abortion fund that’s had to turn its lights off recently. In mid-June, just three days before the anniversary of Roe’s overturning, Indigenous Women Rising announced that its abortion fund had hit its monthly budget and would cease operations until July. The Mountain Access Brigade, which serves people in Appalachia, closed its support hotline for 10 days in July to save money. By mid-July, the Utah Abortion Fund announced that it had already exceeded its monthly budget and would close until late August.“You have increasing costs and decreasing donations,” said Hayley McMahon, who sits on the board of the Appalachian abortion fund Holler Health Justice and studies barriers to abortion at Emory University’s Rollins School of Public Health. “Those two things combined are a perfect storm for just absolutely wiping out abortion funds.”Much of the south and midwest have now banned or significantly limited abortion, forcing people in those states who want abortions to travel farther. Over the summer, Indiana, North Carolina and South Carolina all implemented significant new restrictions, which put even more pressure on abortion funds. In July, the Abortion Fund of Ohio helped 355 people. In August, the same month that neighboring Indiana outlawed almost all abortions, that number surged to 562.Lexi Dotson-Dufault, the Abortion Fund of Ohio’s patient navigation program manager, said that the money trickling into the fund is simply not enough to meet the demand. With three months left to go in 2023, the Abortion Fund of Ohio has already offered assistance to roughly 2,400 people. That’s 700 more than it helped in 2022, and almost three times as many people as it helped in 2021.“We don’t want to have to set limits as to what we can give people,” Dotson-Dufault said. “I think if the money doesn’t come in the way we need to, we will start to have to.”Three-quarters of US abortion patients have incomes below the federal poverty line. The cost of an abortion, meanwhile, has perhaps never been higher: more and more people have to travel for the procedure, buying flights and gas, booking hotel rooms, taking time off work. More than 60% of people who have had abortions have already given birth before, so they may also need to secure childcare.Although the vast majority of US abortions take place in the first trimester of pregnancy, abortion fund callers are more often in their second trimester, according to a study of callers to the National Network of Abortion Funds between 2010 and 2015. Post-Roe, people who work at abortion funds told the Guardian that they are now seeing even more people who are later on in their pregnancies – which becomes a problem both for abortion seekers and the funds, because abortion becomes more expensive later in pregnancy. It also becomes harder to find – not every clinic will perform abortions into the second trimester – so people often have to travel even further.From July 2021 through June 2022, the Missouri Abortion Fund spent about $235,000 helping people get abortions. Between July 2022 and June 2023, they spent over $1m – but they only helped 300 more people than the previous year, said Jess Lambrecht, the fund’s executive director. The typical client used to cost less than $1,000; now, they frequently cost multiple thousands of dollars.“Basically, our budget tripled, but so has our cost,” Lambrecht said.The Nevada-based Silver State Hope Fund has already been forced to become “very, very frugal” when giving out money, said Erin Bilbray-Kohn, the fund’s vice-president and acting executive. Within three days of Roe’s demise, Bilbray-Kohn raised $50,000 for the fund. But now, the fund’s finances have become so strained that it’s using the money it had once set aside to pay for next spring.Before Roe’s demise, the fund spent about $10,000 each year. Now, it’s spending $16,000 each month. So many people are desperate for help: the woman who got pregnant by her abusive partner, the woman with Type I diabetes whose pregnancy threatened her life, the girl whose college scholarship would have been jeopardized if she had a baby.“I wake up in the morning worried we’re not going to have enough funds,” said Bilbray-Kohn, who started to cry as she shared her clients’ stories. “I’m working really aggressively to try to raise that money so that we can fill up those coffers and be OK in the spring.”The Silver State Hope Fund is also currently suing, aided by the ACLU, to abolish a Nevada law that blocks people from using Medicaid to pay for abortions. Roughly 80% of the people calling the Silver State Hope Fund are Medicaid-eligible, Bilbray-Kohn estimated. If the fund wins its lawsuit, many of its current callers could rely on Medicaid instead and the fund could free up money to pay for other callers.Abortion funds aren’t the only abortion rights organizations that are now scrambling for money. The clinics left behind in states that have now banned the procedure are also struggling to stay open, as they pivot to offering more broad reproductive healthcare services.When the supreme court overturned Roe, the West Alabama Women’s Center had to stop performing abortions and send its patients out of state. Within 48 hours, it raised $180,000 for patients’ travel, recalled Robin Marty, the clinic’s executive director. “Now I go and I try to ask for any sort of funding online, and we can get maybe $50 to $100 every time I do it,” Marty said.As of late August, though, Marty estimated that she had enough money in the bank to pay her staff’s salaries through October.For now, the Mississippi Reproductive Freedom Fund’s phone line is still open; the organization is redirecting people towards other, open abortion funds. But the phone line will be shut down entirely for the month of December.“I know we are making the right decision, but it feels horrible to tell people no,” Roberts said. But, Roberts added, “If we’re not making strategic plans to make sure that we’re sustaining ourselves and sustaining fundraising, we’re not gonna make it. We won’t be here next year and we won’t be here the year after that and I want to make sure we’re still here. There’s not less of a fight to fight. It’s just getting more intense.” More

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      GOP-run states are eyeing abortion beyond their borders. Blue states are fighting back

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      The Planned Parenthood clinic in Spokane, Washington, is just a 30-minute drive from the Idaho border, and since May, when Idaho’s “abortion trafficking” law went into effect, it’s been sitting on a timebomb.Like many blue-state abortion clinics, the Spokane health center has been inundated with patients from out of state since the supreme court overturned Roe v Wade a year ago in Dobbs v Jackson Women’s Health Organization decision, allowing abortion to be banned outright or severely restricted in many states. In Spokane, they have received patients from as far away as Texas and Florida. But the new law in Idaho, which criminalizes anyone who helps a minor travel out of state for an abortion without the permission of their parents, threatens this already unsustainable reality. It is the first effort to criminalize travel for the purposes of abortion, and to make the state’s ban on abortion within its borders into something more like a ban on its citizens accessing abortion anywhere.The Idaho law marks a major escalation in the post-Dobbs battle over abortion: an attempt by an anti-choice state to extend its abortion ban beyond its borders. And it puts a target on those who travel along the interstate highway to the Spokane Planned Parenthood. If the trafficking law is ultimately enforced – if an aunt or a sister drives a teenage girl across the Idaho border to have an abortion, and gets caught – the prosecution and civil suits that follow will more likely than not center around a procedure that takes place at the Spokane center. “Nobody wants to be the guinea pig case,” says Sarah Dixit, the public affairs manager for Planned Parenthood of Greater Washington and North Idaho. “Nobody wants to be the example of what it looks like when a state tries to enforce one of these laws.”If Idaho gets its way, the Spokane clinic won’t have a choice.But Washington is one of a growing list of Democratic-controlled states that are pushing back through abortion “shield” laws that aim to extend protections to doctors providing abortions to out-of-state patients and to the patients themselves. Ten states have passed different versions of such laws and more are likely to come.In April, the state passed a set of bills that add new legal protections for medical providers, restrict the reach of out-of-state subpoenas, prohibit the use of state resources for out-of-state anti-abortion legal actions, protect patient data from use in out-of-state legal actions, and expands access to abortion care. The bills provide some much-needed peace of mind to a reproductive health field that’s reeling from anxiety and uncertainty about what’s legal, what’s actionable, and what an emboldened and inventive anti-choice movement might do next. They also advance an untested legal theory about what obligations states have – and don’t have – to honor and assist with the enforcement of other states’ laws.The five bills, collectively referred to as Washington’s “shield law”, were signed by Governor Jay Inslee in Seattle on 27 April. But they were nearly a year in the making. The state senator Yasmin Trudeau, a Democrat representing Tacoma was one of the law’s architects. A millennial, Trudeau is acerbic and funny, and surprisingly candid for a politician. She remembers being at a state senate event with her mother when the Dobbs draft opinion was leaked on 3 May 2022. Like many women, they were both intimately invested in the abortion right: Trudeau was born when her mother, denied an abortion, was just 14. “She was forced to marry and forced to mother,” Trudeau told me. At the time of the leak, Trudeau herself was pregnant, and all too familiar with the burden and gravity of pregnancy. “Carrying a baby,” she said, “is not like carrying a purse.” She began looking into what could be done to secure the rights of women and medical providers in Washington.Trudeau was connected to other Washington legislators looking to expand and secure abortion access in their state. Among them was Drew Hansen, a lawyer and Washington house member from Bainbridge Island who did much of the legwork in shaping the bills. Like Trudeau, he set to work as soon as he learned that Dobbs was coming. “As soon as the draft decision leaked, we started mapping out what other states would have to do to prosecute or enforce civil liability,” Hansen told me. He talked to law enforcement about what interstate prosecutions look like and require; he talked to north-west reproductive rights activists, law professors and a panel of OBGYNs. “I spent all last summer and fall incorporating their feedback, going through drafts [of the bills],” he said. The idea was to get a complete picture of all the ways that another state’s laws could impede access in Washington, and get as close as they could to eliminating them.Washington, like other states that have passed abortion shield laws – including California, Illinois, Massachusetts, Minnesota and New York – is looking to provide some clarity in a confusing new era. Even in pro-choice states, the end of Roe v Wade has changed the abortion landscape, and providers are now staring down a vast, complex and ever-changing regime of new criminal penalties and civil liabilities imposed by anti-choice states.The possibilities unravel in an endless stream of questions, which Hansen and Trudeau alike say they have received from anxious, uncertain medical practitioners. Could an abortion provider based in Spokane be subpoenaed to comply with the Idaho travel ban, made to describe the care they provided or incriminate someone who brought a patient to their doors? Could that same provider be sued under Idaho’s law that allows people who can claim a blood relation to an aborted fetus to file civil suits against those who facilitated an abortion? Or could she be targeted by an “aiding and abetting” clause that seeks to sweep up anyone even tangentially related to an abortion into a net of legal liability?Many of these questions are still unanswered, looming ominously in the muck of legal chaos that Dobbs has unleashed. The Washington shield law aims to provide at least some answers: an assurance that the state will argue that no one following Washington’s laws, and acting within Washington’s borders, will be legally punished by another state while Washington stands idly by.There are limits, however, to what a shield law can accomplish. There is only so much protection the laws can extend to the patients and their companions who travel for abortion care – and then have to travel back. Prosecutions and lawsuits are possible for returning patients and companions, because just as Washington’s shield law prevents Idaho’s anti-choice attacks from reaching over the border, Idaho also has no need to respect Washington’s own legal regime. There’s nothing in the shield law that can protect women from being prosecuted or sued once they travel back into Idaho after a legal abortion in Washington.There’s also nothing that prevents Idaho from arresting a Washington abortion doctor if she crosses into their territory for, say, a ski trip. A doctor who practices in both Washington and Idaho may find her license suspended in the latter state over abortion procedures she provided legally in the former. Washington’s law, in particular, is not as aggressive and proactive as those of some other pro-choice states. Some, like Massachusetts, have worked to provide more protection for telemedicine providers in their state, advancing the novel new claim that medical care is subject to the laws of the state where the provider is – not where the patient is located. This means that abortion providers in Boston, under state law, can prescribe abortion medication to a patient living in, say, Florida. Not so in Washington: under the shield law there, a Walla Walla provider who prescribes pills to her Sioux Falls patient online would not be protected.Some of this, of course, is on purpose. Both Trudeau and Hansen are eager to point out the limits of the law, casting Washington’s abortion shield regime as alternately comprehensive and constitutionally modest. Idaho, they both told me, is free to do whatever it wants – in Idaho. It’s just not free to do it in Washington. “The idea is not to interrupt what other states are doing,” Trudeau said. “We’re not the state that’s trying to come down on other states. We’re the ones trying to outline what the obligations are.”If Trudeau sounds defensive, it might be because those obligations are not entirely clear. Abortion shield laws like Washington’s have to be crafted in ways that avoid running afoul of the full faith and credit clause of the US constitution, which states: “Full faith and credit shall be given in each state to the public acts, records, and judicial proceedings of every other state.” Courts have traditionally interpreted this to allow for some degree of flexibility and discretion by states as to how they cooperate with other states, but a zealous and aggressive anti-abortion legal movement is likely to press the issue.This is what is most confounding about shield laws like Washington’s, and what is likely to be subject to considerable fighting in federal courts: the question they raise about what the states owe to one another, and how to mitigate those obligations when they conflict with the passionately held desires – and personal freedoms – of their citizens. In an interconnected country – where commerce, social life and healthcare are all dense with inextricable interstate connections – it remains uncertain if states like Washington will really be able to legally harden their own borders, and meaningfully protect themselves from the reach of other states’ anti-abortion laws.It raises questions, too, about just how long this country can remain so deeply and profoundly divided against itself. If legal judgements and criminal investigations no longer command inter-state cooperation, then what does it mean for the states to be in union with each other? If something is considered a fundamental right of citizenship in one state, and a crime 30 minutes away in another, then what entitlement does one state have to protect conduct that its neighbors want to prosecute? And what entitlement do other states have to stop their people leaving to a place where they might commit what the law understands as murder?Shield laws are likely to be the subject of lawsuits between pro- and anti-choice states sooner rather than later. In a federal judiciary that has been profoundly reshaped by a conservative legal movement propelled by anti-abortion animus, it would appear likely that many federal courts will invoke the obligations of interstate cooperation, or expansive estimations of anti-choice states’ interests in preventing their citizens from obtaining abortions. But as far as Hansen and Trudeau are concerned, the abortion shield law is nothing less than an assertion of Washington state’s sovereignty, and its right to democratic self-government.“The people of our state have spoken on this issue,” says Trudeau, and both election results and popular polling suggest that the strength of pro-choice sentiment in Washington is not ambiguous. “It’s a judgment of democratically elected officials in Washington state to decide what conduct is criminal and what is not,” Hansen says.As for the coming constitutional challenges, he thinks he’s done his homework. “I ran it by civil procedure scholars, by constitutional law scholars. No one could identify any federal constitutional barrier or federal statutory barrier,” Hansen told me. “No one could tell me why we couldn’t do it.” More

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      Fresh US abortion bans show Republicans trying to soften message

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      After repeated failed attempts to pass stricter bans, Republicans in some US states are changing their messaging, touting “common sense” abortion laws presented as more lenient than outright bans, but that are more restrictive than they seem when looked at in detail.Nebraska’s state legislature passed a 12-week ban on Friday, days after another 12-week ban cleared its final hurdle in North Carolina.Meanwhile, South Carolina’s senate will again weigh a six-week abortion ban that the legislature has repeatedly tried and failed to pass in previous weeks.In Nebraska, Republican lawmakers praised the ban as a compromise, but their Democratic colleagues did not see it that way. “This place is morally bankrupt,” said the Omaha state senator Machaela Cavanaugh. “I’m looking forward to 2025 when I no longer have to serve with many of you.” Cavanaugh filibustered for hundreds of hours in recent months in an attempt to stop the bill passed on Friday, an anti-trans measure to which the abortion ban was attached.Two weeks ago, a six-week ban was tanked in Nebraska, partly by one of its original co-sponsors – the Republican state senator Merve Riepe – who had come to think of it as too extreme, as many women do not yet realize they are pregnant at six weeks. Ahead of the earlier vote, which Riepe abstained from, he passed around a news article warning that abortion was hurting the Republican party, according to the Washington Post. Polling has consistently found that strong majorities of Americans oppose abortion bans.The Nebraska ban includes no exceptions for fetal anomalies or pregnancies incompatible with life and threatens doctors with jail time.Republicans in Nebraska’s technically non-partisan legislature (where each lawmaker nonetheless identifies either as Republican or Democrat) have painted the bill as a huge step down from the six-week ban.Nebraskans crowded the statehouse as the bill progressed on Wednesday, drowning out the lively debate on the house floor with angry chants and foot stomping. By the end of the night, lawmakers were forced to seek refuge, fleeing the capitol rotunda through a back tunnel flanked by police escorts in a bid to avoid angry protesters.With the legislative session about to end, lawmakers craftily advanced the ban by attaching it to a measure limiting gender-affirming care to transgender people.“You are willing to drive this state into the ground. You look ridiculous,” Cavanaugh, said on Wednesday, adding: “Women will die, children are dying, and you are responsible.”In North Carolina, the 12-week ban was passed on Wednesday, when Republican politicians overrode the Democratic governor’s veto. The fresh ban brings the current limit down from 20 weeks.Republicans described the bill as “pro-life plan, not an abortion ban”, as they passed it amid protestors chanting “shame” from inside the state legislature. But the bill will make it incredibly difficult to obtain an abortion in North Carolina, a state that has become somewhat of a safe haven for abortion in the increasingly restrictive Bible belt.Most notably, the bill limits the use of medication abortion – the most common US method of abortion – to 10 weeks of pregnancy, and requires three in-person visits to get pills or any other form of the procedure. Those restrictions will make it harder to get an abortion for those with uncompromising work schedules, those who can’t afford to pay for childcare and those traveling from out of state.Further worsening the effect of abortion bans on low-income people and women of color, it will also make people seeking abortions wait 72 hours between visits. It will require women to watch ultrasounds before they have an abortion, and to be warned about unfounded medical side-effects of abortion before having one.Strict licensing requirements written into the bill could also shutter a number of the state’s remaining 14 clinics, and oblige abortion providers to report details on people who have sought an abortion to the state department of health and human services.And in South Carolina on Wednesday, a six-week abortion ban finally progressed to the senate, after weeks of Republicans repeatedly trying and failing to move it forward. But even if it passes, it must be upheld by the state supreme court, which blocked a similar six-week ban earlier this year. (The composition of that supreme court has since changed – the judge who wrote the decision striking down the ban has been replaced by judge who GOP lawmakers hope will overturn it.) Meanwhile, Republican and Democratic women have repeatedly united in a filibuster to stop the bill from passing. They have said they plan to do so again.Some 900 amendments were affixed to the legislation – many by Democrats hoping to delay the passage of the bill. Some of those amendments included making the state liable for funeral costs of people who die after being denied an abortion, and making men liable for child support and the costs of half of all pregnancy expenses, starting from fertilization. More

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      Conservative judges hear challenge to abortion pill access in controversial lawsuit

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      Three US appeals court judges who have previously favored abortion restrictions prepared to hear oral arguments on Wednesday on the future of the major abortion drug mifepristone.The case – which has landed before judges Jennifer Walker Elrod, James Ho and Cory Wilson – essentially calls on them to rule on whether the federal government should suspend or scale back the federal Food and Drug Administration’s (FDA) approval of mifepristone in 2000, along with later actions that made the pill more widely accessible.Mifepristone has consistently been found to be safe and effective, and advocates argue that it is safer than the erectile dysfunction medication Viagra and low-level pain reliever Tylenol.But an emboldened anti-abortion movement set its sights on mifepristone after the US supreme court’s conservative majority last year eliminated federal abortion rights that had been established by the Roe v Wade decision in 1973.After a coalition of groups brought a lawsuit in November against the FDA’s approval of the drug, Texas-based federal judge Matthew Kacsmaryk in April issued a ruling suspending the FDA’s approval of mifepristone. Joe Biden’s administration appealed, sending it to the appellate court in New Orleans where Elrod, Ho and Wilson sit – and to the supreme court, which indefinitely blocked the suspension as the case proceeds.The plaintiffs in the dispute are an alliance of physician groups who generally argue they have standing to bring the case because they have members in Texas and elsewhere in the US who have treated women and girls experiencing complications after taking mifepristone for abortions. The Alliance for Hippocratic Medicine, the American Association of Pro Life OB-GYNs, the American College of Pediatricians and the Christian Medical & Dental Associations contend that the complications – bleeding and pain – are dangerous, and have trotted out unproven arguments that women who have abortions are prone to suicide and depression.Studies have shown that 95% of women who had abortions reported five years later that it had been the right decision for them.Their effort to in essence ban mifepristone also hinges on a 150-year-old law known as the Comstock Act, which criminalizes the mailing or shipping of any “lewd, lascivious, indecent, filthy or vile article”, along with anything that is “advertised or described in a manner … for producing abortion”.Interpreted widely enough, opponents of the plaintiffs say, the previously dormant Comstock Act could prohibit the legal mailing of any abortion instrument, even to states which have chosen to keep abortion legal since last year’s supreme court ruling, bringing the US one step closer to a national abortion ban that – according to polling – most Americans would not support.Meanwhile, the FDA’s efforts to rebuff the physician group has involved defending mifepristone’s approval process against claims that it was inadequate, along with characterizing the plaintiffs as lacking standing despite their contentions to the contrary.Jennifer Dalven, the director of the American Civil Liberties Union’s Reproductive Freedom Project, on Monday described the fifth circuit panel hearing the case as “one of the worst panels of judges that could have been assembled for those who believe mifepristone should remain on the market”.“This case should’ve been laughed out of court from the start – it has no basis in science, it has no basis in law, it’s been roundly criticized by experts from across the ideological spectrum,” Dalven said during a virtual briefing with reporters. “But we’re living in strange times, and some judges have shown that they’re willing to blatantly ignore the rule of law to achieve their own ideological goals.”Donald Trump nominated Ho and Wilson to their posts during his presidency. (He also nominated Kacsmaryk, whose ruling is the subject of Wednesday’s hearing.)Trump’s fellow Republican president George W Bush nominated Elrod.All three in 2021 upheld a Texas law which outlawed an abortion method commonly used to terminate pregnancies in their second trimester.A 2018 opinion from Ho called abortion “a moral tragedy”. And in 2019, though he concurred with an opinion which found that an abortion ban in Mississippi had to be struck down under legal precedent then in effect, he asserted: “Nothing in the text or original understanding of the constitution establishes a right to an abortion.”For her part, Elrod not only wrote the 2021 opinion addressing Texas’s ban of the second-trimester pregnancy abortion method, but also an opinion that same year which declined to order Louisiana state officials to issue a delayed license for a Planned Parenthood abortion clinic in New Orleans. The opinion declared no one had the federal right to operate an abortion clinic.Either side could appeal any ruling from Elrod, Ho and Wilson to the supreme court, which could take a year or more to issue the final word on the matter.The Associated Press contributed reporting More

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      Democratic states stockpile abortion pills as legal fight for access looms

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      Despite a reprieve by the US supreme court, a growing number of Democratic states are stockpiling abortion pills as the legal fight for access to the abortion drug mifepristone is set to continue.On Friday, the supreme court decided to temporarily block a lower court ruling that would have significantly restricted the availability of mifepristone, an FDA-approved abortion medication.Nevertheless, as the case continues to wind through America’s court system and remains challenged by anti-abortion groups, more Democratic states are now stockpiling abortion pills amid an unpredictable legal battle.Earlier this month, Matthew Kacsmaryk, a Trump-appointed federal judge in Texas issued a preliminary injunction that suspended the FDA’s approval of mifepristone, calling it a drug that is used to “kill the unborn human”.Swiftly after Kacsmaryk’s ruling, Democratic states have been stockpiling abortion pills including mifepristone as well as misoprostol, the second drug in the abortion regimen which can also be used on its own, although less effectively.At the Massachusetts governor Maura Healey’s request, the University of Massachusetts Amherst has purchased approximately 15,000 doses of mifepristone. The stockpile is expected to offer “sufficient coverage” in the state for over a year.“Mifepristone has been used safely for more than 20 years and is the gold standard. Here in Massachusetts, we are not going to let one extremist judge in Texas turn back the clock on this proven medication and restrict access to care in our state,” Healey said last week.Meanwhile, the Democratic governors of New York and California both announced plans to stockpile misoprostol in attempts to safeguard their states’ abortion access.New York’s governor Kathy Hochul announced last week that New York will be purchasing misoprostol in order to stockpile 150,000 doses, a five-year supply.Hochul also pledged that if mifepristone is removed from the market, New York will commit up to an additional $20m to providers to support other abortion methods.In a similar move, governor Gavin Newsom of California announced last week that the state has secured an emergency stockpile of up to 2m misoprostol pills“We will not cave to extremists who are trying to outlaw these critical abortion services. Medication abortion remains legal in California,” Newsom said, adding that California has shared the negotiated terms of its misoprostol purchase agreement to assist other states in securing the pill at low cost.Since then, additional Democratic states have followed suit.The governor of Maryland, Wes Moore, recently announced a partnership with the University of Maryland’s medical system to purchase a “substantial amount of mifepristone”.“This purchase is another example of our administration’s commitment to ensure Maryland remains a safe haven for abortion access and quality reproductive health care,” said Moore, who also released $3.5m in previously withheld funding for the state’s abortion care clinical training program.On Thursday, Oregon made a similar announcement, with its governor Tina Kotek revealing the state has secured a three-year supply of mifepristone, regardless of the supreme court’s ruling on the pill.“Here in Oregon, I will make sure that patients are able to access the medication they need and providers are able to provide that medication without unnecessary, politically motivated interference and intimidation,” Kotek said.With Democratic states rushing to stock up on abortion pills, the tumultuous legal fight for abortion access is far from over. In the last nine months, 13 states have banned abortion. With anti-abortion groups fighting for increased pill restrictions nationwide, even states that have legalized the procedure may become affected.Following the supreme court’s decision to temporarily block mifepristone restrictions, the next stage of the litigious battle over the drug will take place in the fifth circuit, with oral arguments scheduled for 17 May. The case will then likely return back to the supreme court.In a statement to the New York Times, Erik Baptist, a senior counsel for the Alliance Defending Freedom, a conservative legal organization representing a coalition of anti-abortion groups and doctors, pledged to continue fighting against abortion care.“The FDA must answer for the damage it has caused to the health of countless women and girls and the rule of law by failing to study how dangerous the chemical abortion drug regimen is and unlawfully removing every meaningful safeguard, even allowing for mail-order abortions,” he said about the 23-year-old FDA-approved drug.Meanwhile, the Joe Biden administration and civil rights organizations promised to continue fighting for reproductive rights.“I’ll continue to fight attacks on women’s health. The American people must also continue to use their vote as their voice and elect a Congress that will restore the protections of Roe v Wade,” Biden tweeted shortly after the supreme court issued its decision.The American Civil Liberties Union echoed similar sentiments, with Jennifer Dalven, ACLU’s Reproductive Freedom Project director saying: “Make no mistake, we aren’t out of the woods by any means … And as this baseless lawsuit shows, extremists will use every trick in the book to try to ban abortion nationwide.”Dalven added: “But if our opponents think we will allow them to continue to pursue their extreme goals without fierce backlash, they are sorely mistaken.” More

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      US supreme court to decide on abortion pill access after extending deadline

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      The supreme court is poised to decide whether to preserve access to a widely used abortion medication, after extending its deadline to act until at least Friday.Less than a year after the court’s conservative majority overturned Roe v Wade and eliminated a constitutional right to an abortion, the justices are now weighing new legal questions in an escalating case in Texas with potentially sweeping implications for women’s reproductive health and the federal drug approval process.For now, the court is not weighing the merits of a legal challenge brought by abortion opponents seeking to suspend the Food and Drug Administration’s 23-year-old approval of mifepristone. At issue before the court is whether to allow restrictions on the drug imposed by a lower court that would sharply limit access to the drug, including in states where abortion remains legal.The justices had initially set a deadline of 11.59pm on Wednesday, but that afternoon, Justice Samuel Alito issued a brief order extending the court’s deadline by 48 hours. The one-sentence order provided no explanation for the delay but indicated the court expects to act before midnight on Friday.The legal clash began in Texas, with US district judge Matthew Kacsmaryk’s ruling to revoke the FDA’s approval of mifepristone, a drug first approved more than two decades ago and used by more than 5 million women to end their pregnancies.The Biden administration immediately appealed the decision, which it assailed as an unprecedented attack on the the FDA’s decision-making. The US court of appeals for the 5th circuit then temporarily blocked the Texas decision, preserving access to mifepristone while the legal case plays out, but reversed regulatory actions taken by the FDA since 2016 that expanded access to the pill. Those changes include allowing patients to receive the drug by mail, and extending its use from seven to 10 weeks of pregnancy.The Biden administration and drugmakers next asked the supreme court to pause the lower court’s ruling, arguing that reimposing the barriers would create chaos in the marketplace and cause confusion for providers and patients.Alliance Defending Freedom, a coalition of anti-abortion doctors and organizations, has argued that the FDA failed to follow proper protocols when it approved mifepristone and has since ignored safety risks of the medication. Medical experts have said the claims are dubious and not based on scientific evidence.Complicating the legal landscape around this case, a federal judge in Washington state, Thomas Rice, issued a contradictory ruling in a separate lawsuit brought by Democratic attorneys general in 17 states and the District of Columbia. The order, which Rice reaffirmed after the appeals ruling in the Texas case, blocked the FDA from limiting the availability of mifepristone in those states.Since the fall of Roe, more than a dozen US states have banned or severely restricted abortion. But many other states have moved in the opposite direction, approving legislation and ballot measures that protect abortion rights. Amid the patchwork legal landscape, attention has turned to medication abortion, which can be obtained by mail and administered at home.Mifepristone is the first pill in a two-drug regimen that is the most common method of ending a pregnancy, accounting for more than half of all abortions in the US. Decades of research and data from hundreds of medical studies have shown that it is both a safe and effective way to end a pregnancy.The drug first won FDA approval in 2000, and over the years the agency has loosened restrictions on its use. Those changes include allowing the drug’s use from seven to 10 weeks of pregnancy, lowering the dosage of mifepristone needed to safely end a pregnancy, allowing the pills to be delivered by mail, eliminating the in-person doctors visit requirement and approving a generic version.Depending on how the justices rule, those changes could be reversed, at least while the case proceeds through the courts. On Wednesday, GenBioPro, the manufacturer of the generic form of mifepristone, sued the FDA to keep the drug on the market, setting up a new front in the legal battle over access to abortion medication. More

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      Fate of US abortion drug hangs in balance ahead of Friday deadline

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      FDA authorization for a key abortion drug could be nullified after Friday, unless an appeals court acts on a Biden administration request to block last week’s ruling suspending approval of the drug.The drug, mifepristone, is used in more than half of all the abortions in the US. The ruling, issued by a federal judge in Texas, applies across the country.Writing that the ruling would “inflict grave harm on women, the medical system, and the public” if it went into effect, the Department of Justice on Monday requested the fifth US circuit court of appeals temporarily block Judge Matthew Kacsmaryk’s ruling while the appeals process plays out.The issue may ultimately fall into the hands of the US supreme court and its conservative supermajority, which eradicated abortion rights last year by overturning Roe v Wade.Kacsmaryk stayed his decision for seven days to allow the Biden administration time to appeal. Shortly after the ruling from Texas, Obama-appointed Washington district judge Thomas Rice issued a contradictory ruling that directs the FDA to keep the drug available in 17 states.The dueling opinions set the stage for the supreme court to possibly intervene.“On one hand, you have a ruling that says to defer to the expertise of the FDA and keep the status quo while another says to second-guess the FDA with junk science,” says David S Cohen, law professor at Drexel University, who focuses on reproductive rights.“When you have different rulings from different federal courts it is more likely for the US supreme court to get involved.”The New Orleans-based appellate court is one of the most conservative in the US. Republican appointees comprise three-quarters of its bench, with six judges nominated by former President Donald Trump. The court has routinely ruled against the Biden administration and on behalf of Texas’s abortion laws.If the appeals court declines to put a hold on Kacsmaryk’s ruling, then the Biden administration would likely appeal to the high court.“It’s possible that the mifepristone issue makes its way to the [Supreme] Court this week, either because the Fifth Circuit refuses to even temporarily pause Kacsmaryk’s ruling, or because it takes too long to do anything,” writes Steve Vladeck, a constitutional law professor at The University of Texas.In his ruling, Kacsmaryk echoed the arguments of the anti-abortion groups that brought the case, writing that the FDA disregarded science that the drug causes harm, despite repeated studies finding it extremely safe. Legal experts say that the decision – the first time the judiciary has intervened to overturn FDA approval of a drug – could create a precedent that throws the entire drug approvals system into disarray.More than 250 pharmaceutical and biomedical companies who strongly denounced Kacsmaryk’s ruling in an open letter and warned that it could upend the FDA approval process as well as the entire US healthcare system.“Judicial activism will not stop here,” they cautioned. “If courts can overturn drug approvals without regard for science and evidence, or for the complexity required to fully vet the safety and efficacy of new drugs, any medicine is at risk for the same outcome as mifepristone.”Mifepristone is used for abortion, miscarriage management and other medical care. If access to the drug is upended, abortion providers have said they will continue to prescribe the second of the two-drug protocol for abortions. However, that drug, misoprostol, has been found to be somewhat less effective and associated with more painful side effects than the combination of pills.With the mifepristone in doubt, the Biden administration asked Rice, the district judge in Washington, for clarification on how to proceed if the Texas ruling goes into effect, given that his decision orders the government to take no action that would hinder its availability.Legal experts have argued that the FDA does not need to enforce Kacsmaryk’s ruling, even if it goes into effect.The ruling does not formally compel the FDA to seize the pills and take them off the market, Cohen says, and leaves the door open for the Biden administration to apply what’s called “enforcement discretion”, which would entail issuing guidance protecting the distribution of mifepristone. In the past, the FDA has granted drug manufacturers this type of safe harbor even in the absence of agency authorization, including for infant formula.“The ruling does not force the FDA to do anything,” says Cohen. “It’s up to the FDA to determine what to do next. They can use enforcement discretion to protect access to mifepristone. We shouldn’t read into Kacsmaryk’s ruling as having more power than it does – it is limited – and there’s a huge amount of authority the FDA can retain.” More