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This Trump-appointed federal judge may ban a widely used abortion pill: California is ready

Zuzu Gehrman, 18, a three-time rape survivor, protests the overturning of Roe V. Wade outside SF City Hall on June 24, 2022. | Camille Cohen/The Standard

Last June, the United States Supreme Court overturned the constitutional right to an abortion. Now, health care providers across California anticipate a ruling that could restrict access even further, effectively banning a widely used abortion pill.

Any day now, Judge Matthew J. Kacsmaryk, a Trump appointee on the United States District Court for the Northern District of Texas, will rule on a lawsuit challenging the Federal Drug Administration’s 23-year-old approval of mifepristone, one of two medications used in more than half of abortions nationwide. While misoprostol, the other drug, can safely terminate a pregnancy, it is less effective than with mifepristone, health experts say.

Kacsmaryk has a history of anti-abortion activism. Should he rule in favor of the lawsuit, brought by a coalition of anti-abortion medical associations, the nationwide distribution of mifepristone would be in jeopardy. That outcome would not only create confusion for patients, abortion proponents say, it would insert a “horrifying” political influence into the arena of public health.   

“This is their attempt at a nationwide abortion ban,” said Shannon Olivieri Hovis, director of NARAL Pro-Choice California, referring to abortion opponents. “The implications of setting a precedent like this are very dangerous. It’s imperative to our public health system overall that the FDA as a research and scientific entity is able to operate and do its job free from these political influences.” 

Mifepristone, which is used for cervical preparation during abortion procedures, is typically taken first to stop a pregnancy from further developing. Misoprostol follows to empty the uterus, causing cramping and bleeding. When medication abortions don’t work, patients may need an in-clinic procedure, Planned Parenthood Northern California explained. 

Plaintiffs in the suit argued that the FDA acted improperly in approving mifepristone, claiming that evidence of risk was ignored. But the drug has been heavily studied and proven to be safer than Tylenol

Dr. Karen Meckstroth, a clinical professor in obstetrics and gynecology and director of UC San Francisco’s Center for Pregnancy Options, said the change would be significant for patient experiences. 

Providers like her would need to use three to four times more the amount of misoprostol without the ability to use mifepristone. That could mean more pain and side effects for patients and added time required for providers to monitor care.

“When you shake that up, there’s always unknown risk in addition to the known risk,” Meckstroth said. “The fact that a completely nonmedical judge with a political agenda could block safe medical care for millions of people is kind of unheard of and hard to fathom.”

Law experts clarified Kacsmaryk would be limited in such a ruling. He cannot force the FDA to enforce a ruling, which the Biden administration is ready to appeal. The matter could come before the Supreme Court. 

Southern California has seen more out-of-state patients seeking abortions in the wake of last June’s ruling, Olivieri Hovis said. NARAL California will soon announce with the Legislative Women’s Caucus and Future of Abortion Council a “pretty substantial” package of bill proposals to protect patient privacy and prevent data-tracking that may be used against them, as well as protecting providers.

In the meantime, San Francisco officials are watching. 

The city’s Department of Public Health (SFDPH) said it would consider offering medication abortion with misoprostol only in the event that it can no longer offer mifepristone. 

“While the Dobbs decision had minimal impact on services in California, we continue to monitor the possible impact of the proposed restrictions from the federal level,” the department said in an email. “SFDPH works alongside a robust network of health care providers and reproductive health specialists to support reproductive choices and proudly stands to protect a woman’s right to choose.”

Planned Parenthood Northern California is also prepared to similarly pivot while supporting efforts to restore the use of mifepristone. Meanwhile, San Francisco’s city attorney appears ready for a drastically changed climate for reproductive rights.

“It is alarming that the future of women’s health and safety is in the hands of a Trump-appointed federal judge,” City Attorney David Chiu said in a statement. “I fervently hope the judge rules with integrity and weighs the overwhelming evidence that mifepristone is safe, after over 20 years as the standard of care. If not, his ruling will have a devastating impact on tens of millions of women who rely on this medication.”