Latest ruling on pill shifts US abortion landscape again

Apr 14, 2023, 6:45 AM

FILE People march through downtown Amarillo to protest a lawsuit to ban the abortion drug mifeprist...

FILE People march through downtown Amarillo to protest a lawsuit to ban the abortion drug mifepristone Saturday, Feb. 11, 2023, in Amarillo, Texas. Some Democrat-controlled states are advancing and adopting laws and executive orders intended to shield their residents against civil lawsuits and criminal investigations related to providing abortions for women from states where there are bans.(AP Photo/Justin Rex, File)

(AP Photo/Justin Rex, File)

A federal appeals court has kept an abortion pill available, clarifying the U.S. abortion landscape but not settling it. The court’s decision late Wednesday preserved but narrowed access to an abortion pill across the U.S. It was a major development in a fast-shifting landscape in flux since June, when the Supreme Court overturned the nationwide right to an abortion.


The majority of abortions in the U.S. are obtained using a combination of two medications. Anti-abortion groups have been trying to limit access to one of them, mifepristone.

The 5th U.S. Circuit Court of Appeals in New Orleans ruled that the Food and Drug Administration’s initial approval of mifepristone in 2000 should remain in effect, overriding a district court ruling from less than a week before. Without Wednesday’s ruling, the drug would have been unavailable in at least some places starting on Saturday.

The 2-1 ruling came with a catch: The judges put on hold a series of regulatory changes beginning in 2016 that relaxed some prescribing and dispensing rules. The decision means that the drug can be used only in the first seven weeks of pregnancy, rather than 10, and it can’t be dispensed by mail to a person who doesn’t visit a doctor’s office first.


Either side could appeal Wednesday’s ruling to the U.S. Supreme Court.

In the meantime, what it means isn’t completely clear.

The latest ruling came in response to one last week from a judge in Amarillo, Texas, who ruled that mifepristone should not be available while its approval is reexamined. The same day, another federal judge in Spokane, Washington, ruled in favor of attorneys general for 17 Democrat-led states that sued to try to keep it on the market.

Those states are: Arizona, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Michigan, Minnesota, New Mexico, Nevada, Oregon, Pennsylvania, Rhode Island, Vermont and Washington, plus the District of Columbia.

The U.S. Department of Justice has asked the Washington court for clarity on its ruling. It’s also not clear what the 5th Circuit decision means for it.

In the meantime, some Democrat-controlled states are stockpiling abortion pills, while Wyoming last month became the first state to explicitly prohibit abortion drugs.



Across the U.S., advocates have sued over dozens of abortion laws.

In 2019, the Iowa Supreme Court blocked a law prohibiting abortion once cardiac activity can be detected, which occurs after about six weeks of pregnancy and often before women know they are pregnant. Officials in the Republican-dominated state have been pushing to overturn that ruling.

On Tuesday, the issue went before the state Supreme Court, where all seven justices are GOP appointees. A decision is expected this summer.

Also on Tuesday, a Montana judge denied Planned Parenthood of Montana’s request to preemptively block legislation that would ban dilation and evacuation abortions, the kind most commonly used in the second trimester of pregnancy. Opponents said they wanted to act quickly because the law would take effect immediately if Gov. Greg Gianforte signs it. Gianforte has previously approved other abortion restrictions.



Nebraska lawmakers advanced a bill on Wednesday that would ban abortion once cardiac activity can be detected.

In February, the South Carolina Senate passed such a ban. The same month, the House approved one that would apply throughout pregnancy. The two chambers have not yet negotiated which version to send to the governor.

In Florida, Gov. Ron DeSantis, who is expected to run for the GOP presidential nomination next year, has supported ending abortion access earlier than the 15-week mark already in effect there. On Thursday, he signed into law a ban on abortions after six weeks of pregnancy after the Republican-dominated Florida Legislature approved the proposal earlier in the day.

Most Democrat-controlled states adopted laws, made executive orders — or both — to protect abortion access. After Senate passage Monday, both chambers of the state legislature in Washington state have passed one, but it has not yet been signed by the governor.



Abortion is already effectively banned at all stages of pregnancy in 13 states, and when cardiac activity can be detected in one.

Courts have blocked bans throughout pregnancy in another five states, and one, Georgia, where abortion is forbidden once cardiac activity can be detected.

Republicans in many places are pushing for even tougher policies.

This month, Idaho Gov. Brad Little signed a law making it a crime for an adult to help a minor get an abortion without parental consent.

Iowa’s attorney general took another step this month, announcing her office will stop paying for emergency contraception and abortions for sexual assault victims while it studies the policy.


Abortion bans have big impacts on where woman go to end pregnancies.

A report released this week by the Society of Family Planning finds that the number of monthly abortions inside states with bans on them throughout pregnancy dropped to zero or nearly so, and the number of abortions at medical facilities overall dropped.

But big increases in the number of abortions came in states that have kept abortion legal and are near to, and easily reachable from, those with the deepest restrictions.

Among those states with big increases: Florida, Illinois and North Carolina.

Some other states that have taken the boldest steps to preserve access to abortion have seen relatively modest increases in the number provided.

The survey does not measure the number of self-managed abortions, such as with pills that were not prescribed to the user.


Mulvihill reported from Cherry Hill, New Jersey. Associated Press reporters Margery Beck in Omaha, Nebraska; Amy Beth Hanson in Helena, Montana; Anthony Izaguirre in Tallahassee, Florida; Scott McFetridge in Des Moines, Iowa, and James Pollard in Columbia, South Carolina, contributed to this report.


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Latest ruling on pill shifts US abortion landscape again