Why the Mifepristone Battle Matters

The escalating clash over the availability of a certain FDA-approved medication to terminate an early-stage pregnancy has significant implications for many LGBTQ people. Over the years, various entities have tried to block the use of hormones for gender transition and medications for HIV prevention. Now, the court battles raging over the abortion drug RU-486 (also known as mifepristone) could determine whether any federal judge has the power to pull any controversial medication off the market.

So, there was guarded appreciation when the U.S. Supreme Court announced on April 21 that it would grant a stay against a lower court decision in Texas that sought to pull RU-486 off the market. (Two justices—Clarence Thomas and Samuel Alito—dissented from the stay.)

“While today’s ruling to keep this safe, effective drug available for the time being is a sense of relief,” said U.S. Senator Tammy Baldwin, “our fight to preserve a woman’s right to control when and if to have a family continues.”

The Supreme Court’s procedural action came in a consolidation of two appeals, FDA v. Alliance for Hippocratic Medicine and Danco Pharmaceuticals v. Alliance. Both appeals asked the Supreme Court to stay an order issued by a U.S. district court judge in Texas until the merits of the case could be appealed.

Alliance v. FDA began when an anti-abortion coalition asked a federal judge (appointed by then-President Trump) in Amarillo, Texas, to strike down the FDA’s long-standing approval of RU-486. The judge did so on April 7. That same day, another federal judge (appointed by then-President Obama) in Spokane, Washington, issued a ruling to ensure that RU-486 would remain available in 18 states, which joined a lawsuit by Danco Laboratories, the company that distributes RU-486.

The Texas decision moved quickly to the Fifth Circuit U.S. Court of Appeals, which issued a stay preventing only part of the district court’s ruling from taking effect until the appeals court could rule on the merits of the decision. The FDA quickly appealed to the U.S. Supreme Court and, on April 21, the Supreme Court stayed the district court’s entire order.

 “LGBT people should care about this case,” said Jenny Pizer, chief legal officer for Lambda Legal. In fact, she said, LGBTQ people should be “profoundly alarmed” by the Texas judge’s “utterly lawless ruling” and “only slightly less alarmed” by the Fifth Circuit’s willingness to let part of the judge’s ruling take effect.

“First, many LBTQ people need ready access to emergency contraception for a range of medical reasons, including the decision not to continue a pregnancy for one’s own reasons,” explained Pizer. “The trial court’s approach just as easily (or perhaps more easily) could be aimed at HIV-related medications and puberty blockers and hormone treatments, as well as medications for many other health conditions that are especially relevant for our communities.”

Lambda Legal and other LGBTQ groups have long warned that any damage done to the right to choose an abortion could have deep implications for the right to have intimate relations, including marriage, for LGBTQ people. Abortion, said Pizer, “is an LGBTQ+ issue for personal medical reasons, [as well as for] doctrinal reasons of liberty and autonomy.”

Lambda Legal and the National Center for Lesbian Rights were among the more than 200 civil rights, health, and justice organizations that submitted a brief to urge the Supreme Court to block the Texas judge’s ban from going into effect. Twelve out of the 13 openly LGBTQ members of Congress signed onto a similar brief from 253 members of Congress.

The Congressional brief against allowing the Texas judge’s ruling to take effect said the ruling, and the Fifth Circuit’s upholding of part of it, had “perilous consequences that reach far beyond mifepristone.”

“Providers and patients rely on the availability of thousands of FDA-approved drugs to treat or manage a range of medical conditions, including asthma, HIV, infertility, heart disease, diabetes, and more,” said the brief. “Moreover, the prospect of courts second-guessing FDA’s rigorous drug safety-and-effectiveness determinations will disrupt industry expectations and could chill pharmaceutical research and development.”

The District of Columbia and 23 states also submitted a brief to the Supreme Court, asking it to stop the Texas judge’s ruling from going into effect. Those states, including California, Illinois, Massachusetts, Michigan, and Oregon, said that taking RU-486 off the market would increase the need for surgical abortions, thus increasing the stress on many clinical facilities and causing delays that affect all patients.

“Delays resulting from increased demand for [surgical] abortion procedures will obstruct access to other forms of care at those facilities, inevitably resulting in higher rates of unintended pregnancy and sexually transmitted infections, barriers to early detection and treatment for breast, ovarian, and testicular cancers, and worsened health outcomes for patients’ overall sexual and reproductive health and beyond. Those harms,” said the states’ brief, “will disproportionately impact groups already underserved by the healthcare system, including women of color, low-income women, people with disabilities, and LGBTQ individuals.”

The Texas case will now go back to the federal appeals court to rule on the merits of the litigation, and will then, almost certainly, be appealed again to the U.S. Supreme Court.

“If the [Fifth Circuit] appeals court were to accept the trial court’s brazen disregard of the decades of evidence that mifepristone is safe, that pregnancy and childbirth are riskier, and that many, many other medications are far riskier,” said Pizer, “we all will be living in a much more dangerous society.”

Meanwhile, just three days after the Texas judge issued his decision, Massachusetts’ newly inaugurated lesbian governor, Maura Healey, directed her state to stockpile RU-486 to ensure that women who need the drug can get it.

“Here in Massachusetts, we are not going to let one extremist judge in Texas turn back the clock on this proven medication and restrict access to care in our state,” said Healey on April 10. California Governor Gavin Newsom made a similar announcement the same day. Oregon’s new lesbian governor, Tina Kotek, announced April 20 that her state would stockpile RU-486, saying the Texas judge’s decision “set an alarming precedent of putting politics above established science, medical evidence, and a patient’s health, life, and well-being—with potential implications beyond this one medication.” Kotek said the Alliance’s lawsuit is “part of a larger campaign to ban abortion in every state, including those with legal protections for abortion access.”