By Carrie Baker for Ms. Magazine.
Broadcast version by Roz Brown for Texas News Service reporting for the Ms. Magazine-Public News Service Collaboration

On Nov. 18, anti-abortion advocates filed a federal lawsuit challenging the FDA approval of the medication mifepristone in 2000-as well as subsequent updates to the approval in 2016, 2019 and most recently in December 2021, when the agency began allowing clinicians to mail abortion pills to their patients.

The lawsuit alleges the FDA did not have proof of the medication's safety, despite extensive evidence showing abortion pills are safe and effective-more so than many other medications, including over the counter drugs such as Tylenol.

"This is yet another attempt by anti-abortion extremists to force their beliefs on all of us," said Kirsten Moore, director of Expanding Medication Abortion Access Project (EMAA Project), which advocates for increased access to mifepristone for abortion and miscarriage care.

The conservative legal group Alliance Defending Freedom (ADF) filed the lawsuit on behalf of four antiabortion medical organizations and several doctors against the U.S. Food and Drug Administration (FDA) and the U.S. Department of Health and Human Services. ADF represented Mississippi in the case that led the Supreme Court to overturn Roe v Wade and they have helped draft anti-abortion laws adopted in many states.

The 113-page complaint argues the FDA unlawfully fast-tracked the approval of mifepristone in 2000 and did not have the required research to prove the safety of the drug under the labeled conditions of use.

To the contrary, a 2018 Government Accountability Office report concluded that the FDA "followed its standard review process when it approved the application ... for the drug Mifeprex" and "based its approval on reviews of peer-reviewed published studies, articles, and other information submitted by Mifeprex's sponsor." The FDA subsequently conducted extensive reviews of the mifepristone's safety again in 2016.

The ADF complaint regurgitates many of the objections raised by anti-abortion groups to the 2021 modification of the mifepristone approval. The FDA published a 40-page rebuttal letter to these objections, which ADF fails to address in their complaint.

Moore said the anti-abortion movement is trying to "put the genie back into the bottle" and is "trying to undo progress."

"When they look at the courts, they think, 'Why wouldn't the courts be friendly to us even if we are making new things up?' The Supreme Court just overturned a 50-year precedent that took away half the population's fundamental right to control their bodies, so why wouldn't they try?"

The ADF chose to file the case in the Amarillo Division of the Northern District of Texas, where it was assigned to a 45-year-old Trump appointee Matthew J. Kacsmaryk, who for five years before becoming a federal judge was deputy general counsel for First Liberty Institute, a Christian conservative legal organization that specializes in representing religious groups claiming they have experienced discrimination.

n 2015, Kacsmaryk wrote an op-ed for the National Catholic Register stating his opposition to same-sex marriage, no-fault divorce, birth control, abortion and sex outside of marriage-and his support for "complementarianism," a religious belief that assigns primary headship roles to men and support roles to women based on their interpretation of certain biblical passages.

"He is an anti-LGBT activist and culture warrior who does not respect the equal dignity of all people," said Sen. Dianne Feinstein (D-Calif.) during his Senate confirmation hearing, reading from a letter of the Leadership Conference on Civil and Human Rights. "His record reveals a hostility to LGBT equality and to women's health, and he would not be able to rule fairly and impartially in cases involving those issues."

Just last week Kacsmaryk ruled that the Biden administration wrongly interpreted a provision of the Affordable Care Act as barring healthcare providers from discriminating against LGBTQ+ Americans.

Texas is within the Fifth Circuit Court of Appeals, which has a majority of conservative judges-six of whom were appointed by Trump. This same court repeatedly upheld the Texas bounty hunter law last year.

Most shockingly, the ADF lawsuit asks Judge Kacsmaryk to revive the 1873 Comstock Law, which banned sending obscene literature, contraceptives, abortifacients or any sexual information through U.S. mails. After the Supreme Court ruled in Griswold v. Connecticut in 1965 that people have a fundamental right to access and use contraception, Congress removed the language concerning contraception in 1971, but left the part of the law criminalizing mailing abortifacients and information about abortion.

Before Roe v. Wade, federal courts ruled this part of the law applied only to "unlawful" abortions. After the Roe decision, the Comstock law remained on the books but was not enforced. Now that the Supreme Court has reversed Roe, ADF hopes to bring the law back into effect.

"The law that conservatives used to shut down contraceptive pills at the turn of the century-this is where they want to take us back to," said Moore.

The lawsuit seeks to reverse the increasing availability of medication abortion and telemedicine abortion. In 2020, medication abortion accounted for 54 percent of all pregnancy terminations in the U.S. After a federal court lifted the FDA requirement that clinicians distribute the medication in person in July of 2020, telemedicine abortion services surged across the United States, becoming available in 20 states, expanding further after the FDA permanently lifted the in-person distribution requirement in December of 2021.

Carrie Baker wrote this article for Ms. Magazine.

With concerning trends emerging for pregnant and postpartum women, frustration is growing that Idaho lawmakers could end the session without addressing these issues.

The maternal mortality rate doubled each year between 2019 and 2021 in Idaho. The state also ranks last for income eligibility for pregnant women on Medicaid.

House Bill 201 would have extended Medicaid coverage from 60 days to 12 months after birth but has not received a hearing.

Hilarie Hagen, health policy associate at Idaho Voices for Children, said a large coalition of health care organizations, providers and families supported the legislation.

"Providing access to affordable health coverage helps reduce maternal mortality rates, improves birth outcomes, and Idaho's maternal health trends are going to continue on their downward trajectory every year we don't take action," Hagen stressed.

Rep. John Vander Woude, R-Nampa, chairman of the House Health and Welfare Committee, said he was supportive of the bill, and he had received a number of calls in support of it. However, Vander Woude noted the committee will not hold a hearing on it this session because he believes the Legislature has to get control of the Medicaid budget first.

This week, Bonner General Hospital in Sandpoint announced it would no longer deliver babies because of a provider shortage. The hospital also cited Idaho's legal and political climate as part of the reason for closing its maternity ward.

Hagen pointed out the provider shortage has become exacerbated in recent years.

"We are increasingly seeing providers choose to leave the state because of policy decisions made by Idaho lawmakers," Hagen asserted. "It's really discouraging to see that we are reducing access for moms and their babies."

Another measure unlikely to pass this session is House Bill 81, which would have extended the federally funded Maternal Mortality Review Committee passed its sunset date in July. Hagen emphasized Idaho will be the only state in the nation without a Maternal Mortality Review Committee.


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Research from The University of Utah explores the physical- and mental-health implications of social belonging in women.
Study author Lisa Diamond said disproportionately high mental- and physical-health problems among marginalized people have been written off as "minority stress," the cumulative chronic stress experienced because of discrimination and unfair treatment and said the missing piece is what is known as "social safety," the reliable social connections, belonging and sense of protection individuals foster in their social networks.

Through her research, Diamond found women who occupied one or more marginalized categories such as those relating to race, sexuality and gender reported significantly lower social safety, leading to a greater risk for physical and mental problems.

"That sense that you have people around you that are connected to you, invested in you, that you matter to. That feeling is a critical component of human health," she said. "It is not optional. It's not like the icing on a cake. It's the cake."

Diamond added the mental and physical effects one can endure do not depend so much on what type of marginalization they experiences, but rather from the mere fact of being discriminated against and misunderstood. She said a crucial aspect to good mental and physical health is ensuring access to safe and affirmative social ties.

Diamond said the unpredictable and unprecedented COVID-19 pandemic ripped everyone's social safety right out from under them, leaving many feeling isolated. She added while remote work and online school ushered in by the pandemic have their benefits, many are still struggling to recuperate the sense of safety and normalcy they lost which has made many deficient to the "basic nourishment of affirmative social connection."

"We should think carefully about the way we structure our days and our lives, and make sure that we are prioritizing the face-to-face connections that are meaningful to us. We need that, a lot more than we thought we did," she said.

She encouraged state policymakers and community leaders to adopt what she calls a "safety first" approach which begins by identifying whether an individual has access to relationships and people who can provide them with affirmation, protection and belonging.


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New data from the Centers for Disease Control and Prevention show another increase in the nation's maternal mortality rate, and a Minnesota expert says there are several underlying factors.

The report, released last week, covers data from 2021. That year, deaths of pregnant women or new mothers in the U.S. went up by nearly 40% over the previous year.

The agency says it follows gradual increases leading up to the pandemic as well.

Dr. Stephen Contag is an associate professor in the Maternal-Fetal Medicine division at the University of Minnesota Medical School. He said improved reporting is playing a role.

But he added that there are other issues at play.

"Disparities in transportation," said Contag. "Getting to health care. Or differences in the number of obstetricians or health providers that can provide that care to patients in certain parts of the country."

The findings show that Black women are especially affected by this issue. The maternal mortality rate for this population rose by nearly 70%, compared with nearly 25% for white women.

Some health experts say COVID-19 likely played a role in the 2021 spike, and that the big jump may have peaked. But there's concern the other factors will keep pressure on these rates.

The maternal death disparities have been documented in Minnesota as well. Contag said he sees hope in reversing trends, including changing how the state's Maternal Mortality Review Committee works.

The panel is now operating under a mandate.

"Now that we have that mandate," said Contag, "it's much easier to obtain the information that we need to review these cases in a fair manner."

He suggested that will lead to more recommendations that get to the root causes of these deaths.

And earlier this year, a new Minnesota law took effect, expanding postnatal care by requiring public and private health plans to cover a series of care visits for up to 12 weeks after a baby is delivered.

Two of those visits would have to involve comprehensive care.




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