[ Across the South, eight states — Alabama, Arkansas, Kentucky,
Louisiana, Mississippi, Tennessee, Texas, and West Virginia — have
near-total bans on abortion. ]
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FDA’S ABORTION PILL HAS LIMITED IMPACT ACROSS THE SOUTH  
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Elisha Brown
January 13, 2023
Facing South
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_ Across the South, eight states — Alabama, Arkansas, Kentucky,
Louisiana, Mississippi, Tennessee, Texas, and West Virginia — have
near-total bans on abortion. _

The Food and Drug Administration's new policy on mifepristone, one
of the pills used in medication abortion, allows pharmacies to apply
for certification to carry the drug., Robin Marty via Flickr.

 

In the six months since the United States Supreme Court struck down
the constitutional right to abortion, the Biden administration has
taken cautious steps to affirm abortion access on a federal level.

In late December, for example, the Justice Department issued an
opinion
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ruling that the U.S. Postal Service can lawfully mail abortion pills
anywhere in the country, regardless of state restrictions; even if a
state bars pregnant people from taking the medication, the person can
travel to another state where it's not banned. The latest move came
last week, when the Food and Drug Administration changed its policy on
the dispensing of mifepristone, one of the two pills used in
medication abortions. 

On Jan. 3, the FDA updated
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its protocol to allow pharmacies to dispense mifepristone, the first
pill taken in medication abortion that blocks progesterone, a hormone
needed for a pregnancy. The second drug, misoprostol, taken 24 to 48
hours after mifepristone, causes contractions to expel the fetus; it's
less regulated because it's also used to treat ulcers and
miscarriages. Previously, only certified prescribers — typically
doctors — could give mifepristone to patients.

The American College of Obstetricians and Gynecologists praised
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the FDA's decision, noting the lack of clinical evidence that
in-person dispensing improves patient outcomes. Reproductive rights
advocates also welcomed the move.

"The big story is for the first time pharmacies are going to be able
to carry medication abortion," Rachel Rebouché, a reproductive
health scholar and dean of the Beasley School of Law at Temple
University in Philadelphia, told Facing South.

However, the American Pharmacists Association noted
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that the FDA's action doesn't override state policies restricting
abortion or mifepristone access specifically. That's why the top
retail pharmacies
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CVS and Walgreens, have indicated that they will seek approval to
carry mifepristone while still adhering to restrictive state laws.

Across the South, eight states — Alabama, Arkansas, Kentucky,
Louisiana, Mississippi, Tennessee, Texas, and West Virginia — have
near-total bans on abortion. And four of the five Southern states
where abortion is legal for now — Florida, Georgia, North Carolina,
South Carolina, and Virginia — have laws in place that blunt the
effect of the FDA's decision.

New state restrictions likely

Among the Southern states, only Florida, Georgia, and Virginia exempt
patients from taking mifepristone in front of a doctor, according to
the Kaiser Family Foundation
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However, Florida, which enacted a 15-week abortion ban last year,
requires in-person counseling sessions at a health care facility
before a medication abortion. And Georgia's six-week ban requires
people to make a decision about abortion before most know they're
pregnant. The FDA allows medication abortion for up to 10 weeks of
pregnancy, though the World Health Organization approves it for up to
12 weeks.

Medication abortion is "going to be the ground zero of the abortion
debate in this country," Rebouché said. Unlike big chains,
independent pharmacies could be less likely to apply for mifepristone
certification out of fear of harassment and protests, she said. 

Anti-abortion advocates plan to picket outside of CVS and Walgreens
locations in eight U.S. cities next month, including Washington, D.C.,
Politico reported
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Georgia Rep. Earl "Buddy" Carter and 24 other House Republicans —
13 representing Southern states, including Carter — sent a letter
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to FDA Commissioner Robert Califf this week urging the agency to undo
its mifepristone update, writing that the change "will turn many post
offices and pharmacies into abortion clinics." 

Politico also revealed that lawmakers in the Republican-controlled
House of Representatives plan to introduce legislation to expand
pharmacists' right to refuse prescribing mifepristone. Abortion
restrictions are also on the agenda in Republican-controlled
statehouses this year. In Georgia, anti-abortion advocates have said
they will press lawmakers for more restrictions against mailing
abortion pills, according to local
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reports
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In Texas, Senate Bill 300 [[link removed]]
sponsored by Republican state Sen. Bob Hall aims to give pharmacists
more power to refuse filling abortion-pill prescriptions. 

And in Alabama, Republican Attorney General Steve Marshall made
national headlines this week when he said he would prosecute people
who take abortion pills, AL.com reported
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Marshall said pregnant people who seek the pills could be targeted
under the state's chemical-endangerment law for harming "unborn
children." A spokesperson for Marshall later walked back the
statement
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in a comment to the Washington Post, clarifying that the attorney
general will target "illegal providers, not women."

The battle over medication abortion will continue to play out in the
courts, too. In November, Alliance Defending Freedom, a right-wing
counterpart to the ACLU
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that gained prominence during the Trump administration
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filed a federal lawsuit
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against the FDA on behalf of anti-abortion health care organizations
and doctors. The complaint
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alleges that the agency's 2000 approval of mifepristone was illegal
and asked the court to undo it. 

The suit was filed in the U.S. District Court for the Northern
District of Texas, Amarillo division, where Trump-appointed Judge
Matthew Kacsmaryk presides. Last month Kacsmaryk ruled
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that Title X,
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a federal program that gives free contraception to students, violates
the constitutional rights of Texas parents. He ordered teenagers to
seek parental permission before getting birth control at federally
funded health care clinics. 

While the FDA's updated mifepristone rule will not be a game changer
for most people seeking to end a pregnancy in Southern states, it
could help some rural residents, according to Rebouché. For example,
if a pregnant person in a rural community is seeking a medication
abortion in a state without draconian laws targeting abortion
providers, the doctor could call in that prescription to the closest
pharmacy certified to carry mifepristone. 

"The takeaway is that this is a big step forward and an inroad for
pharmacies which had not been involved in the dispensation of
medication abortion, but a lot is yet to be seen about what role
pharmacies will play," she said.

Elisha Brown is a staff writer at Facing South and a former Julian
Bond Fellow. She previously worked as a news assistant at The New York
Times, and her reporting has appeared in The Daily Beast, The
Atlantic, and Vox.

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