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Twenty-four states have banned abortion or are likely to do so. Clinics in neighboring states are overwhelmed with demand for appointments. Most of the patients I care for at Trust Women clinic in Kansas describe making numerous phone calls and waiting weeks for an appointment. A few months ago, our clinic received over 16,000 phone calls for an appointment in just one day.
The bans have created a climate of chaos and fear, with millions of people unsure what is legal in their home states.
As each new day reveals more troubling consequences of tearing away a right people have relied on for 50 years, a new threat looms. Anti-abortion groups have sued the FDA attempting to ban a safe, effective drug used in medication abortion—a move that could inflame our abortion access crisis.
The groups suing in Alliance for Hippocratic Medicine v. FDA want the agency to withdraw their approval of mifepristone, one of the drugs used in the most common medication abortion protocol in the U.S.
Mifepristone has been on the market for more than 20 years, with a stellar record of safety and effectiveness and countless studies to back it up. This challenge to mifepristone has no sound scientific or legal rationale. This is a transparent effort to make abortion difficult or impossible for people to access, hand-delivered to Judge Matthew Kacsmaryk, a conservative federal judge in northern Texas with a record of disdain toward reproductive rights. Within a matter of days, this judge could block access to a drug used in more than half of abortions in the U.S., even in states committed to supporting abortion access.
One patient recently came to my clinic seeking a medication abortion. She finished her work shift in eastern Texas at 6pm and drove 11 hours through the night to reach the clinic in Wichita, Kansas, by the morning. After receiving the medications—mifepristone and misoprostol—she drove back that day—all to minimize the costs of being out of work, staying away from home, and paying for childcare.
If mifepristone were banned, she still could have had a medication abortion using only misoprostol. Though it’s safe and commonly used in other countries, this regimen punishes people seeking abortion with even more burdens—burdens that may be impossible for people to overcome. Using misoprostol only (without mifepristone) results in cramping and bleeding shortly after. People traveling out of state would either have to endure the process while driving or flying back home—or more likely, would have to stay longer in a state where they sought care, racking up bills for food, lodging, childcare, and losing wages for time they’re not working.
There are reliable sources for getting mifepristone online, and people can safely take the medication and manage their own abortions. While only three states explicitly ban self-managed abortion, law enforcement has abused other laws in attempts to prosecute people, and health care providers have reported patients who seek follow-up care.
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The other option would be to have an in-clinic abortion. But clinics are already overwhelmed with demand and have long waitlists for people seeking procedures. Adding all the patients who otherwise would have chosen medication abortion will cripple these clinics. Abortion is a time-sensitive service. Taking mifepristone off the market would put it out of reach for even more people who need it.
People with low incomes, and people of color who face structural barriers, are most likely to suffer as a result. They will have a harder time navigating the growing number of obstacles to care. They’re more likely to be targeted by the criminal legal system if they manage their own abortions. We know that not being able to get an abortion when you need one carries deep financial and psychological consequences.
Every abortion ban is an assault on people’s autonomy. Every person deserves to have the type of abortion they want, without barriers or stigma. No matter what results from the FDA lawsuit, it’s clear that the anti-abortion movement will not stop attacking abortion access where we still have it.
In the short term, we must make sure that people have the information and resources they need and support the groups that provide them a safety net. Sites like I Need an A have up-to-date information on where someone can get an abortion. Abortion funds are doing heroic work to help people travel and cover their expenses. There are resources like the Repro Legal Helpline for patients with concerns about their legal risk.
We must also fight for a future where abortion justice is a reality, beyond the insufficient protections Roe v. Wade gave us.
As I sat down with my patient from eastern Texas to counsel about and dispense these medications, I saw a person beyond the numbers—beyond the 11 hours she drove, beyond being one of 16,000 people who called for an appointment. I saw a person dedicated to her kids’ wellbeing, to keeping her job in order to provide financial stability for her family, and to protecting her own health. I saw a person exercising her right to bodily autonomy to achieve her life goals.
Protecting access to these safe and effective medications—and removing all other barriers to abortion care—is essential for countless people and their families and communities that rely on them.
Dr. Jennifer Kerns is an Associate Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco and a physician at Trust Women in Wichita, Kansas.
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