It was a Mississippi law that – brought before the Supreme Court of the United States – finally overturned America's fundamental right to abortion. And it could be a lawsuit from Texas that means the end of the most widely used abortion pill in America. The central figure in this case is Matthew Kacsmaryk, a 45-year-old district judge for the Northern District of Texas, nominated by then-President Donald Trump. A devout Christian who has been fighting abortion since early adulthood. Before his appointment, however, Kacsmaryk assured the Senate that as a judge he was "no longer in the role of advocate" of the so-called pro-life policy.
Sofia Dreisbach
North American political correspondent based in Washington.
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The federal judge is expected to rule soon on a lawsuit filed last year by the Alliance for the Defense of Liberty aimed at banning the abortion pill mifepristone. Among the authors of the lawsuit is the Christian "Alliance for Hippocratic Medicine", which writes on its website that its members vowed to "respect human life from the moment of fertilization to natural death". The organization claims that the U.S. Food and Drug Administration (FDA) ignored "authoritative evidence" of physical harm from drug abortions when approving mifepristone in 2000.
On Wednesday, all parties involved will be allowed to speak in a hearing in court: the lawyers of the US Department of Justice as representatives of the FDA, the manufacturing company and also the group that filed the lawsuit. What is unusual, however, is that this date has so far only become public through media reports, not through an official announcement. As the "Washington Post" reported over the weekend, citing anonymous participants, Judge Kacsmaryk had announced the hearing on Friday in a telephone call with lawyers – but also said that he would not publicly announce this until late Tuesday evening in order to "minimize disruptions and possible protests".
He then asked the participants to remain silent about the phone call. One reason for the decision was the fact that some employees of the court had received threats in the course of the lawsuit. Actually, access to court proceedings for the public is a precious asset of the American justice system. Such a deliberate delay in announcing the date is highly unusual.
"The drug is safe"
It is considered likely that Kacsmaryk will rule in favor of the abortion opponents. Observers suspect that the decision will be challenged regardless of the outcome – so it could eventually end up before the Supreme Court with its conservative majority of judges, according to the District Court of Appeal. If the approval of mifepristone were suspended, it would have far-reaching consequences for the remaining abortion clinics in predominantly Democratic states that continue to offer abortions. In only 26 out of 50 states abortions are allowed by law, in 13 they are completely prohibited, in five others partially prohibited. In the remaining six states, bans have been blocked by courts.
The American Medical Association, America's largest advocacy group for doctors, issued a sharp warning in February against banning the drug. Medical abortions account for more than half of all abortions in the United States. The decision to withdraw mifepristone imposes "heavy, almost unimaginable costs" on pregnant women. Abortions with this drug are "safe and effective. This is not an opinion – it is a fact based on hundreds of studies and huge amounts of data collected over the course of two decades," the medical association said.
For a drug-induced abortion, a combination of the drugs mifepristone and misoprostol is the most common and effective method, as well as in Germany. Mifepristone inhibits the hormone progesterone, which is crucial for maintaining pregnancy. The drug was approved by the FDA in 2000 for abortion up to the seventh week and in 2016 up to the tenth week – first only for use under supervision, then during the pandemic in 2021 also for home after consultation via telemedicine. About 24 hours after mifepristone, pregnant women take misoprostol; it causes contractions to initiate termination. Abortion with misoprostol alone is possible, but has a lower success rate and more side effects.
Since the repeal of the federal right to abortions in the United States last June, the legal battle has largely shifted to an attempt to make it harder for American women to access abortion pills. In some cases, this has cushioned the far-reaching abortion bans in the states and is therefore a thorn in the side of conservative legislators and organizations. However, figures from the pro-abortion Guttmacher Institute show that drug rather than surgical abortions have already increased during the pandemic. Instead of 44 percent in 2019, they accounted for 2020 percent of all abortions in 54.