What LA residents need to know about the federal abortion rulings

If you or someone you know is in need of abortion resources, check out: LA County Abortion Safe Haven Project, AidAccess.org, PlanCPills.org

Many women, and people in need of abortions, in Los Angeles County are wondering about their ability to access an abortion medication after a federal judge in Texas ordered a hold on federal approval of mifepristone. The ruling, which is currently working its way through the federal judicial system, could ban the widely used abortion medication. This comes as part of a dangerous trend towards the restriction of reproductive rights. 

Given the confusing details of the ruling with new developments rapidly coming in (as of time of publication the Supreme Court had delayed a decision till at least Friday), we talked to some legal experts, reproductive health care advocates, and medical professionals to get some answers. Here’s what you need to know.

Mifepristone is one of two drugs, used in combination, to perform medical abortions, the other being misoprostol. Since mifepristone’s approval by the Food and Drug Administration (FDA) in 2000, women have been able to have safe abortions in the privacy of their homes. After the Supreme Court overturned Roe v. Wade last year, many states restricted or outlawed abortion. However, due to changes made by the FDA allowing the drug to be shipped by mail, some women living in these states continued to have access to the abortion pill.

Abortions are extremely common, you may have had one or certainly know someone who’s had one. The latest decision by a Trump-appointed conservative judge could take away many women’s ability to make decisions over their bodies and their access to life-saving healthcare, even including here in California.

Impact on LA County residents

The Supreme Court ruled in Dobbs v. Jackson Women’s Health Organization that abortion is not a constitutional right and that it should be up to the states to make their own rules. Last November, 73% of Californians voted in favor of Proposition 1, which codified an individual’s right to reproductive freedom into the state constitution. Regardless of how the Supreme Court decides on the mifepristone situation, people in California will continue to have the legal right to an abortion, and access to in-clinic abortion procedures — however, they might no longer have access to one of two widely used abortion pills depending on how things shake out in federal court over the coming weeks.

In wake of the ruling, Governor Gavin Newsom announced that California has secured a stockpile of up to 2 million misoprostol pills. If mifepristone,which is used in combination with misoprostol, is banned, the second pill, misoprostol, can still be taken to complete an abortion. Stockpiling misoprostol may ensure individuals continue having access to medical abortions in California. And it is common in many countries outside of the United States to use misoprostol on its own.

Misoprostol is not currently at risk of being banned and will continue to be available on the market for the foreseeable future. Simona Grossi, a law professor at Loyola Law School, says that Newsom’s decision to stockpile the pill might be an economic decision. If the state were to stockpile mifepristone and it winds up being banned, the state will no longer be able to legally sell it, potentially leading to a huge economic loss.

On April 4, representatives from the County Office of County Counsel, LA County Department of Health Services (DHS), LA County Department of Public Health (DPH), and the Los Angeles County Sheriff’s Department (LASD) gave a verbal presentation to the Los Angeles Board of Supervisors meeting on actions they are considering to ensure women in the county — and those who travel here — continue having access to safe abortions.

LA County Health Services is currently working on doubling its stock of mifepristone, the abortion pill, said Dr. Christina Ghaly, director of health services. If the drug were to be banned and manufacturing were stopped, Ghaly said the county would consider alternatives.

“[If] mifepristone was not available from United States suppliers we could look at obtaining supply from out of the country,” said Ghaly.

California’s Sherman Food, Drug, and Cosmetics Act allows state and local prosecutors to dictate how to pursue violations involving the sale of unapproved drugs. Although some conservative counties might seek to enforce a potential ban of mifepristone, LA County will not, according to Steven De Salvo, senior deputy county counsel. On April 3, District Attorney George Gascón issued a statement that his office will not prosecute anyone who seeks, assists, or provides abortions.

At the April 4 meeting, Supervisor Lindsey Horvath (District 3) asked Captain Brandon Dean what role the Sheriff’s Department would play in enforcing a potential ban. She noted the historic role the Los Angeles Police Department played in endangering women seeking abortions.

“This isn’t something we are actively going to be pursuing at this time,” said Dean.

Resources available to you

Jackie Hernandez is a reproductive health care educator and advocate based in Los Angeles. She administers a page on Instagram called @SaludAlPueblo where she shares information and resources about public health issues. She highlights inequalities in the healthcare system and disparities that communities of color experience.

When Hernandez heard about the latest ruling she said was not shocked but felt “anger and disappointment.” She ordered abortion pills for herself and advocated that her friends and family do the same in case they need them in the future.

The Los Angeles County Abortion Safe Haven Project is a guide that provides information and resources on abortion care, family planning, and related services. It contains information on abortion providers, how to pay for an abortion, and mental health support. The resource guides are available in 12 different languages.

The project warns about “crisis pregnancy centers” (CPCs), which are usually privately run by religious organizations and deter women from seeking abortions. They are common throughout the country and often located close to abortion clinics.

“They convince people to stay pregnant by pretending to give people the right to choose,” said Hernandez.

Many CPCs are not staffed by medical professionals and therefore not bound to federal privacy laws such as the Health Insurance Portability Accountability Act (HIPAA). This means they are not legally required to protect their patients’ information or confidentiality, according to a report by the American College of Obstetricians and Gynecologists.

People in need of abortion services can also check out websites such as aidaccess.org or plancpills.org for information on how to get the abortion pill through the mail. However, federal ruling might impact this.

Mifepristone is safer than Tylenol

There are generally two ways of electively ending a pregnancy, which doctors refer to as: medical abortion and in-clinic abortion. A medical abortion consists of taking medication, whereas in-clinic means a physical procedure.

A medical abortion, or the abortion pill, is a two step process. This method is safe and effective for women who are up to 11 weeks pregnant. First, you take the mifepristone pill, which blocks your body from creating a hormone called progesterone and separates the pregnancy from the uterus. This essentially pauses the pregnancy from continuing. Up to 48 hours later, you take the second pill, misoprostol, which empties the uterus. This second step can last a few hours and can cause symptoms such as bleeding, cramping, nausea, and diarrhea.

Many women prefer a medical abortion because they can take the medication in a place of their choice, such as at home. Having an abortion is an intimate decision and having the ability to do it in a safe space is important. In 2020, 53% of abortions in the U.S. were medical, according to the Guttmacher Institute, a research and policy organization that advocates for reproductive rights.

“Mifepristone is an incredibly safe drug,” said Dr. Katrina Heyrana, Ryan residency program director and staff physician at Cedars-Sinai.

The FDA has evaluated the safety of mifepristone four times under the risk evaluation and mitigation strategy (REMS) program, which is a drug-specific evaluation. Mifepristone is safer than other commonly prescribed pharmaceuticals and over-the-counter medications such as Viagra (generic: sildenafil) and Tylenol (generic: acetaminophen), according to Heyrana.

“Mifepristone puts fewer people in the hospital than those medications yearly,” said Heyrana.

Mifepristone can also be used to treat miscarriages, which are out of a pregnant person’s control and exceedingly common. We likely all know at least one person in our lives who has gone through a miscarriage. Mifepristone can help ease the miscarriage by passing the tissue faster and decrease the chance of needing additional procedures. Without mifepristone, more people having miscarriages might end up in the emergency room due to sepsis and incomplete miscarriages.

“This is the reason that we say abortion is healthcare,” said Hernandez.

Misoprostol can still be used on its own to perform an abortion. However, it might not be as effective and can cause more pain and discomfort that would be the case if administered with mifepristone, according to Hernandez.

Data from recent studies found that 78% of women had complete abortions when using only misoprostol compared to 96% when used in combination with mifepristone. Studies also found that it takes longer to terminate the pregnancy and requires higher doses.

Heyrana explains that in a misoprostol-only regimen a patient would have to take misoprostol three times, around every three hours, to complete an abortion compared to just once when combined with mifepristone. In a medication abortion, with both mifepristone and misoprostol, bleeding, cramping, nausea, and diarrhea can last a minimum of four hours. When using misoprostol alone, symptoms should be expected to last 12 to 24 hours.

“Imagine having those symptoms for three times the amount of time,” said Heyrana. “Although effective, it’s certainly less preferable.”

Using the single pill method can also lead to more incomplete abortions, said Hernandez. An incomplete abortion is when tissue and blood from the pregnancy remain in the body. It can lead to prolonged bleeding, pain that is unbearable, and a life-threatening infection. An in-clinic procedure would be required to complete the abortion.

As a result of fears of pain and complications more people will likely opt for the in-clinic option because of the increase in discomfort and pain, according to Hernandez. But as abortion rights are increasingly restricted, and clinics in conservative states are closed, more women are being forced to cross state lines for abortions — which could potentially strain the resources of clinics in California. This will become especially true if medical abortions are limited and more women are forced to use the in-clinic option.

There are two main kinds of in-clinic abortion procedures depending on how far along people are in their pregnancy. An aspiration abortion is available for women who are 14–16 weeks along in their pregnancy. This procedure is the most common and involves a gentle suction to empty the uterus. For those further along, dilation and evacuation procedure is another option. In-clinic abortions are effective and much faster than a medical abortion, only taking five to ten minutes.

Although in-clinic abortions are quick and effective, many people prefer the privacy of a medical abortion because there is a lot of stigma surrounding abortions. Many women might feel anxiety and fear going into abortion clinics, with some choosing to travel to a clinic outside of their own community to avoid running into someone they know, said Hernandez. Many people can also be afraid of going to an abortion clinic due to fear of being harassed by anti-abortion activists that shame their decision.

“People still run the risk of being persecuted by their own community,” said Hernandez.

Medical providers and advocates such as Hernandez are trying to destigmatize abortion by being careful with their terms they use. In recent years, medical providers and advocates have moved away from using the term surgical abortions. Not only was the term inaccurate because the procedure did not involve a surgery but there are also negative misconceptions associated with surgical abortions that anti-abortion advocates weaponized, said Hernandez.

What’s next?

On April 7, U.S. District Court Judge Matthew Kacsmaryk in Amarillo, Texas, ruled that both the initial approval of mifepristone in 2000 and recent FDA decisions allowing the pills to be prescribed via telemedicine, sent by mail, and dispensed at retail pharmacies are unlawful.

Later that day, a federal judge in Washington state issued a conflicting decision that called to not roll back the FDA approval of mifepristone for the 17 states named in that lawsuit and the District of Columbia, which does not include California.

On April 12, a federal appeals court ruled that the abortion pill could remain on the market but prohibited its use beyond seven weeks of pregnancy and its distribution by mail. 

“Conflicts of opinions like this one are very good candidates for the Supreme Court review,” said Grossi.

The Biden administration (the U.S. Department of Justice), then filed an emergency appeal to the Supreme Court asking to put Kacsmaryk’s order on hold while the litigation is ongoing.

The question now is whether the Supreme Court will allow for the status quo to remain, that is FDA approval of mifepristone, or whether it will side with the ruling from Texas while they go through the legal process and make a final decision on the matter.

“Litigations like this can take a long time,” said Courtney Cahill, law professor at the University of California at Irvine. “At the very least, it’s going to take until the next Supreme Court term, which doesn’t start until October.”

On April 14, the Supreme Court granted the emergency appeal to keep the status quo and allowed the parties challenging the legality of the drug until April 19 to file a response. Today, the Supreme Court decided to maintain the status quo to allow time for further deliberation, and set a new deadline for a decision of Friday.