With the future of a popular abortion pill at risk, some Illinois clinics are looking at an alternative option to continue offering medication abortion, the most common method to terminate pregnancies nationwide.
The drug in question, mifepristone, is still legal and available in Illinois and many other states.
But the fate of the widely used abortifacient hangs in the balance due to battling court rulings handed down last week, leaving many abortion providers here and across the country scrambling to come up with a backup plan in case mifepristone is pulled from the market.
Medication abortions, which account for more than half of all pregnancy terminations in the United States, consist of a two-drug regimen: First the patient takes a dose of mifepristone, which blocks the hormone progesterone, to stop the pregnancy from growing. About 24 to 48 days later, a second medication called misoprostol is taken to cause the uterus to cramp and bleed, expelling the pregnancy.
If the use of mifepristone were to be halted, Planned Parenthood of Illinois officials say their clinics will continue offering medication abortions using multiple doses of misoprostol — a medication used to treat a number of health conditions that would still be available — in lieu of the mifepristone-misoprostol combination.
While a misoprostol-only regimen would still offer patients a nonsurgical abortion option, experts say that using misoprostol on its own is slightly less effective than the mifepristone-misoprostol combination.
It could also be more cumbersome, particularly for pregnant people traveling here from other states: Patients would need to take a dose of the medication every three hours or so, for three to four rounds of doses, depending on the gestation of the pregnancy, Planned Parenthood of Illinois officials said.
“We also acknowledge that it will cause hardships for our patients,” said Planned Parenthood of Illinois President and CEO Jennifer Welch. “It might mean that they have to stay longer or spend more time in Illinois. So it would be more difficult and more costly, so we’re trying to prepare for all of that.”
A Texas judge on Friday ordered a hold on federal approval of mifepristone, which the Food and Drug Administration has permitted for use in the United States since 2000.
Although millions of patients have used the medication for nonsurgical abortions over the past two decades, Trump-appointed U.S. District Judge Matthew Kacsmaryk determined that the “FDA acquiesced on its legitimate safety concerns — in violation of its statutory duty — based on plainly unsound reasoning and studies that did not support its conclusions,” according to the ruling.
Seventeen states — including Illinois — and the District of Columbia had previously filed a lawsuit to protect access to mifepristone. On Friday, an Obama-appointed judge in Washington state handed down an order that barred U.S. officials from making any changes that would restrict the mifepristone, at least in those states that had sued.
The Biden administration has appealed the Texas ruling and the Justice Department has asked that it be kept on hold as the legal challenge moves through the courts. The case could go as far as the U.S. Supreme Court — whose justices in June voted 5 to 4 to overturn Roe v. Wade, the landmark 1973 ruling guaranteeing the right to an abortion nationwide.
Medication abortions comprise around half of all pregnancy terminations at Planned Parenthood of Illinois, which has 17 clinics statewide, most located in the Chicago area. Restricted to early pregnancy, abortion pills can be taken up to 70 days gestation.
The American Academy of Obstetricians and Gynecologists says that medication abortion, including the use of mifepristone, is safe and effective.
“Mifepristone is safe,” said Molly Meegan, chief legal officer and general counsel with the professional membership organization. “It is one of the safest drugs on the market. It has been used for decades.”
In its clinical guidelines, the organization recommends a combination of mifepristone and misoprostol as “the preferred therapy for medication abortion because they are significantly more effective than misoprostol-only regimens.”
“If a combined mifepristone–misoprostol regimen is not available, a misoprostol-only regimen is the recommended alternative,” the guidelines say.
Misoprostol alone has often been effectively used to induce abortions in other countries, particularly where mifepristone isn’t legal or available, according to the Society of Family Planning.
“It’s not as effective, but it’s still very effective,” Meegan added. “And it’s very safe.”
Welch called the Texas ruling a “politically motivated attack, just another attempt to further restrict essential health care like abortion.”
“I am afraid that it will succeed — even though the case should not proceed, I’m afraid that it will,” she said. “We are preparing for the possibility of the ban on mifepristone being upheld.”
After the fall of Roe in June, Illinois has seen a surge in abortion patients traveling from other states where the procedure has either been banned or highly restricted.
Planned Parenthood of Illinois has predicted that the state could see 20,000 to 30,000 more abortion patients each year once federal abortion protections were dissolved.
“Illinois is a haven for abortion care in the Midwest,” Welch said. “We have seen patients traveling to us from more than 30 different states. So more than half the states in the country have forced patients to travel here for their essential health care.”
As abortion providers nationwide have grappled with increasing restrictions on the procedure post-Roe, medication abortions have often been a cornerstone of their plans to improve access.
Recent changes to FDA rules have allowed abortion pills to be distributed by mail in some states, including Illinois, eliminating the need for some patients to ever leave home to have an abortion.
Long-standing regulations had previously required mifepristone be dispensed in-person at a hospital or health center. But in 2021, the FDA permanently rolled back that restriction; after the change, patients could have a telehealth visit with a health care provider and then receive the medications by mail.
If the Texas decision is upheld, it’s unclear if abortion pill-by-mail services would be affected.
The Texas judge seemed to agree with plaintiffs in the case — which was filed by the conservative organization Alliance Defending Freedom on behalf of health care providers — who argued the mailing of abortion pills violates the 1873 Comstock Act.
That law forbids sending via mail every “article, instrument, substance, drug, medicine, or thing which is advertised or described in a manner calculated to lead another to use or apply it for producing abortion.” But the more than century-old law was rarely applied when abortion rights were affirmed under Roe.
The Texas decision found that, “Plaintiffs have a substantial likelihood of prevailing on their claim that Defendants’ decision to allow the dispensing of chemical abortion drugs through mail violates unambiguous federal criminal law.”
As the matter moves through the courts, some Democrat-led states have begun stockpiling abortion medications.
Gov. Gavin Newsom announced Monday that California “has secured an emergency stockpile of up to 2 million pills of misoprostol, a safe and effective medication abortion drug, in the wake of an extremist judge seeking to block mifepristone, a critical abortion pill.”
Massachusetts Gov. Maura Healey posted on Twitter that the University of Massachusetts and health care providers there had begun stockpiling doses of mifepristone, at her request.
“Mifepristone is safe and effective. It’s been the gold standard for over two decades,” she tweeted. “We’re keeping it available in Massachusetts — no matter what some extremist, Trump-appointed judge in Texas says.”
Eric Scheidler, executive director of the Chicago-based Pro-Life Action League, praised the Texas ruling, calling the FDA’s approval of mifepristone rushed and dangerous.
If the decision stands, he acknowledged that providers might opt to continue offering medication abortions using only misoprostol, but he still called the potential suspension of mifepristone “a major setback for the abortion industry.” he said.
“Misoprostol is already used in some countries and occasionally in the U.S. as a stand-alone abortion drug, but it is less effective than when used in combination with mifepristone, and no less painful,” he said. “But women will be allowed to suffer for the sake of abortion industry profits.”
He called medication abortion a “horrific experience for women.”
“Not only is a medication abortion excruciatingly painful, but the woman is often left having to dispose of her aborted child — a tiny fetus or embryo — in her toilet or sanitary pad,” he said.
However, many Illinois leaders have condemned the Texas ruling and vowed to fight it.
Attorney General Kwame Raoul on Tuesday, along with a coalition of two dozen other attorneys general, filed an amicus brief challenging the decision.
“I am proud to join this coalition and continue our fight to protect access to medication abortion and the right of women to make their own reproductive health decisions,” Raoul said in a written statement. “The unprecedented and legally unsound decision made by a single judge in Texas needs to be appealed to preserve continued access to safe, legal abortion in Illinois and across the nation.”
U.S. Sen. Tammy Duckworth praised the Biden administration for appealing the Texas ruling.
“Mifepristone was approved by the FDA 20 years ago after a rigorous scientific and legal process,” she said in a written statement, “but access to this critical medication that millions of Americans rely on was stripped away with a stroke of a pen by a single person who was hand-picked by Republican extremists dead-set on a nationwide abortion ban.”
The Associated Press contributed.