Missouri AG pushes suit that could make abortions and miscarriages more dangerous

Missouri Attorney General Catherine Hanaway at an event in St. Louis on Nov. 24 (photo courtesy of the Missouri Attorney General’s Office)

Before the U.S. Supreme Court recognized the right to an abortion in Roe v. Wade, a lot of women and girls died trying to end their pregnancies themselves. How many is impossible to know.

Since our current court overturned Roe, women are once again dying, as ProPublica has reported. But not in numbers anywhere near those of pre-Roe deaths from self-administered abortion. Then, as one doctor explained, “‘wire coat hangers, knitting needles, and slippery tree branches’ were the most common approaches.”

The vastly lower mortality post-Roe is the result of a number of factors, including there still being states where abortion is legal to travel to, along with abortion funds and internet forums helping people get there.

But the biggest reason we aren’t seeing more deaths from self-managed abortion is modern medicine. Specifically, mifepristone.

Mifepristone has been used for medication abortion in the U.S. for the past quarter century. The FDA’s 2000 approval of mifepristone meant women could have abortions earlier in pregnancy, rather than having to stay pregnant for weeks to have more invasive, procedural abortions.

Patients report that a very early medication abortion can be no worse than a menstrual period.

Today two thirds of abortions in the U.S. are medication abortions. Mifepristone is also used to treat miscarriages, which one in 10 women with known pregnancies will experience. And it is used to treat a slew of other conditions.

Opponents of legal abortion hate medication abortion. It makes it technically possible to have an abortion as soon as you suspect you are pregnant, and abortion opponents want to keep the focus on the women that they can vilify for needing later abortions. The early miscarriage induced by a medication abortion takes place in the privacy of one’s own home, depriving anti-abortion “sidewalk counselors” of the opportunity to intimidate women as they enter clinics.

Basically, the advent of mifepristone made ending a pregnancy less painful and abortion opponents want it to be more painful.

Newly appointed Missouri Attorney General Catharine Hanaway has now joined the crusade to block access to mifepristone with a new filing in what remains of a sprawling and ridiculous lawsuit initiated in Texas that the U.S. Supreme Court mostly tossed.

The remnants have landed in Missouri.

Anti-abortion doctors sued to have mifepristone taken off the market. The ultra-conservative Fifth Circuit Court of Appeals ruled that claim was time-barred (again, it was approved 25 years ago). The U.S. Supreme Court ultimately ruled that, thanks to federal conscience protections entitling the doctors to deny treatment, their fear of having to provide emergency care to someone who had taken mifepristone wasn’t an injury giving them standing to sue.

But the case lives on.

Missouri, Idaho and Kansas had intervened as fellow plaintiffs. Those states can’t sue in Texas, so the Texas district court transferred the case to Missouri, where our federal courts are newly stacked with extremely anti-abortion Trump appointees, many of whom worked on this and other anti-abortion legal efforts as attorneys.

While the attempt to get mifepristone off the market completely is dead, plaintiffs are seeking to make it inaccessible by forcing the FDA to reinstate unnecessary restrictions. For example, requirements for multiple appointments and that the pill be taken in the presence of a physician rather than obtained at a pharmacy like most medicines.

I had hoped Hanaway might see her job as being a good lawyer working in the interests of all Missourians, rather than a culture warring partisan like her recent predecessors. It was not to be.

The filing is another piece of work indicative of how unseriously Hanaway takes her ethical obligations as the state’s top lawyer. It is filled with distortions about the law and women’s health care. In it, she and her counterparts claim to be seeking to protect women’s safety. In reality, all the evidence shows and all the nation’s major medical groups agree that her desired outcome would put us in danger.

It’s impossible to believe this accomplished lawyer doesn’t understand that — she just doesn’t care.

The filing adds an additional claim against the FDA for approving a second generic version of mifepristone in September. Hanaway acknowledges that the generic is chemically identical to the branded mifepristone, but argues it shouldn’t have been approved because the brand-name drug is unsafe.

That isn’t true. As the American College of Obstetricians and Gynecologists, the American Medical Association and nine other medical associations explained in an amicus brief, mifepristone is among the most studied drugs in the world. And those studies show it is safe.

The claim that making mifepristone harder to get will make abortion safer is audaciously disingenuous. Plaintiffs purport to lament the end of the in-person prescribing requirement because it severs the relationship between patient and doctor. These are the same people working to keep it illegal to have a medication abortion under the supervision of a local doctor.

They are also fighting to keep mifepristone from women who are miscarrying. Even under the somewhat loosened regulations, mifepristone is largely unavailable in Missouri for miscarriage treatment because the process to become an approved prescriber remains arduous.

Mifepristone is currently completely unavailable for abortion care despite the passage of the Reproductive Freedom Initiative due to state restrictions currently being challenged in court.

Plaintiffs want mifepristone harder to access outside of Missouri. That means patients will have to have later abortions waiting for appointments and travel multiple times or spend days in hotel rooms for unnecessary additional visits. That will be too much for some people to manage or afford, causing more to order mifepristone online to self-manage — which is a massive improvement over slippery tree branches, but shouldn’t be one’s only option.

Hanaway’s filing specifically laments that the generic’s approval could make mifepristone less expensive. Plaintiffs want to punish women for ending pregnancies by making the process as expensive, stressful, late, and medically invasive as possible.

This duplicity is not new, but it stings more coming from Missouri’s first female attorney general.

Missouri Independent is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Missouri Independent maintains editorial independence. Contact Editor Jason Hancock for questions: info@missouriindependent.com.