How safe is the abortion pill compared with other common drugs | CNN



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A federal judge in Texas ruled on Friday to suspend the Food and Drug Administration’s approval of mifepristone, the first drug in the medication abortion process, nationwide by the end of this week.

The judge sided with the coalition of anti-abortion national medical associations that filed the lawsuit. He argued that the FDA failed to adequately consider risks associated with the drug, including “the intense psychological trauma and post-traumatic stress women often experience from chemical abortion.”

However, data analyzed by CNN shows mifepristone is even safer than some common, low-risk prescription drugs, including penicillin and Viagra. There were five deaths associated with mifepristone use for every 1 million people in the US who have used the drug since its approval in 2000, according to the US Food and Drug Administration as of last summer. That’s a death rate of 0.0005%.

Comparatively, the risk of death by penicillin — a common antibiotic used to treat bacterial infections like pneumonia — is four times greater than it is for mifepristone, according to a study on life-threatening allergic reactions. Risk of death by taking Viagra — used to treat erectile dysfunction — is nearly 10 times greater, according to a study cited in the amicus brief filed by the FDA.

“[Mifepristone] has been used for over 20 years by over five million people with the capacity to become pregnant,” said Ushma Upadhyay, an associate professor in the department of obstetrics, gynecology and reproductive science at the University of California, San Francisco. “Its safety is very well established.”

The Justice Department, the FDA, and Danco — a manufacturer of mifepristone that intervened in the case — have already appealed the ruling.

Within hours of the decision in Texas, a federal judge in Washington state issued a conflicting ruling that the federal government must keep mifepristone available in the 17 Democrat-led states and the District of Columbia that had sued in a separate lawsuit.

If the Texas ruling is allowed to take effect this week, 40 million more women of reproductive age would lose access to medication abortion care around the country, according to data from abortion rights advocacy group NARAL Pro-Choice America. That’s in addition to the 24.5 million women of reproductive age living in states with abortion bans.

“The court’s disregard for well-established scientific facts in favor of speculative allegations and ideological assertions will cause harm to our patients and undermines the health of the nation,” said Dr. Jack Resneck, Jr., president of the American Medical Association, in a statement. “By rejecting medical facts, the court has intruded into the exam room and has intervened in decisions that belong to patients and physicians.”

Medication abortion has become the most common method for abortion, accounting for more than half of all US abortions in 2020, according to the Guttmacher Institute.

The growing popularity of medication abortion is largely because of its accessibility, said Abigail Aiken, associate professor at the University of Texas at Austin who leads a research group on medication abortion.

“It reduces the cost, it reduces barriers where people may not want to go to a clinic,” she said.

It is also a safer option than both procedural abortion or childbirth. The rate of major complications — like hemorrhages or infections — for medication abortions is about one-third of a percent, according to a 2015 study conducted by Upadhyay. That means out of more than 11,000 cases, 35 experienced any major complications.

The likelihood of serious complications via procedural abortion — performed second-trimester or later — is slightly higher than medication abortion at 0.41%, according to the same study. And childbirth by far comes with the highest risk, at 1.3%.

If access to mifepristone is cut off, abortion clinics and telehealth organizations could pivot to misoprostol-only abortions, Aiken told CNN. Although misoprostol-only abortions are used around the world, they are less effective, associated with a higher risk of serious complications and often more painful than the mifepristone and misoprostol combination, she said.

In the latest study of self-managed misoprostol-only medication abortions in the US, Johnson found misoprostol-only abortions to be a safe alternative, though less safe than using both pills. The study, published in February, analyzed data from online telehealth medication abortion provider Aid Access from 2020. Nearly 90% of 568 users reported completed abortions and 2% experienced serious complications using only misoprostol.

Mifepristone and misoprostol together is still considered the gold standard, Aiken told CNN. People who used the two-pill combination were less likely to experience serious complications than those who went with the misoprostol-only regimen.

“It’s clear people can use these medications, mifepristone and misoprostol, at home even without the help of a medical professional very safely,” said Aiken.

Because misoprostol is used to treat multiple ailments including stomach ulcers, it’s readily stocked in pharmacies and unlikely to be taken off the market anytime soon, Johnson told CNN.

However, a lesser-effective method means more people will likely have unsuccessful abortions.

“It’s possible that it might not work for some people, and it will prolong their abortions,” said Upadhyay. “Then by the time they get back to the clinic, they’re seeking abortion later in pregnancy.”

Before the ruling, 19 states already restricted telehealth abortion care, limiting access to medication abortion. Nearly half of US adults were unsure whether medication abortion was currently legal in their state as of late-January, according to a survey conducted by the Kaiser Family Foundation. Experts say that confusion will only be exacerbated.

“People are not going to be sure mifepristone or misoprostol in fact, is available. I think it’s going to be confusing,” said Aiken. “As people look around for options or feel unsure about their options, they may end up delaying [care].”

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The Abortion Wars Are Back On, Thanks To Hacks Parked On The Court By Trump And McConnell

The important thing to know about a Texas court’s nationwide ban of the drug mifepristone is that it’s based on a lie. Well, to be more precise, it’s based on a whole series of lies, but one lie in particular stands out from the others … a Big Lie, if you will. That lie is about the approval process for the drug, which has been on the market since 1988 and is offered for sale in more than 80 countries.

The plaintiffs, a consortium of anti-choice groups that incorporated in Amarillo, Texas after anti-choice activist Matthew Kacsmaryk was confirmed to the only federal court in the district, stake their claims on the fact that the FDA approved mifepristone in 2000 under an emergency protocol known as Subpart H. This protocol allows lifesaving drugs to reach the market sooner and has mostly been used to fast-track AIDS drugs. In reality, mifepristone went through four years of rigorous examination before its approval. But in response to political pressure, the FDA used Subpart H to impose additional dispensing protocols known as Risk Evaluation and Mitigation Strategies or REMS.


Back in March, when the parties made their case to Judge Kacsmaryk for injunctive relief, Slate legal writer Mark Joseph Stern observed that, not only were the plaintiffs lying about the approval process, but that Kacsmaryk seemed to accept their false version of events:

This entire argument is built upon a lie. The FDA did not fast-track mifepristone in 2000. Rather, the agency took more than four years to greenlight the drug, doing so only after extensive (and arguably superfluous) examination of its (very minor) risks. When the FDA did finally approve the use of mifepristone, after an unusually thorough review, however, it imposed heightened restrictions on its distribution. It was theseextra barriers to mifepristone access that were set up through a process known as accelerated approval. The plaintiffs here exploit confusion about these procedural details to peddle the false narrative that the agency recklessly hastened review of mifepristone. It is an extremely ominous sign that Kacsmaryk appeared to agree with their false history.

And that turned out to be exactly what happened when Kacsmaryk dropped his ruling on Good Friday, a love letter to the anti-choice loons that put him on the federal bench to do just what he did. Reasoning that Subpart H is reserved for “serious or life-threatening ‘conditions,’” he ruled that it was inappropriate to use for a drug that ends pregnancy, since “Pregnancy is a normal physiological state most women experience one or more times during their childbearing years — a natural process essential to perpetuating human life.”

It’s an offensively stupid argument, in an opinion chock full of offensively stupid arguments and outright lies about the dangerousness of the drug, which has almost no risk of side effects. For instance, Kacsmaryk presents a bevy of reasons that the six-year statute of limitations on FDA challenges does not apply. Perhaps the government ignored the plaintiff’s administrative challenges (it did not); perhaps the REMS modification in 2016 or the approval of a generic version of the drug in 2021 restarted the clock; perhaps any administrative challenge would have been futile; or maybe you can ignore the plain meaning of the law under the doctrine of equitable tolling, AKA “vibes, man.” In any case, Kacsmaryk deems it wholly appropriate for him to “stay” the FDA’s 23-year-old approval of the drug, making it a dicey proposition for manufacturers to keep selling it.

And that’s not the craziest part! The court relies on the Comstock Act of 1873, a law that prohibits using the mail to transport “Every obscene, lewd, lascivious, indecent, filthy or vile article, matter, thing, device, or substance.” Clearly this violates the First Amendment, which is why it’s never enforced, despite remaining on the books. The law has a provision that bans using the mail to send “every article or thing designed, adapted, or intended for producing abortion, or for any indecent or immoral use,” which birth control advocate Margaret Sanger successfully challenged in a 1936 case involving the importation of an early form of diaphragms.

Nevertheless, Kacsmaryk expresses astonishment that none of the parties in this case cite the Comstock Act as a reason to challenge the FDA’s approval of dispensing mifepristone by mail, and he cites a 1915 case as standing for the proposition that, in 2023, the US has “a national policy of discountenancing abortion as inimical to the national life.” This requires ignoring the Food and Drug Administration Amendments Act of 2007 (“FDAAA”), which Congress enacted expressly to permit the mail-order distribution of mifepristone. But ignoring inconvenient factual and legal realities is Matty K’s specialty!

He even sneaks in a passage about fetal personhood, musing that perhaps fetuses have standing to sue:

Parenthetically, said “individual justice” and “irreparable injury” analysis also arguably applies to the unborn humans extinguished by mifepristone — especially in the post-Dobbs era. [And then he cites to an amicus brief filed in Dobbs by anti-abortion activists saying] (“Nothing in the Constitution or in our Nation’s legal traditions authorizes the Court to adopt [the] theory of life” that States are required “to regard a fetus as lacking even the most basic human right — to live — at least until an arbitrary point in a pregnancy has passed.”)

There is so much that’s gross about this opinion — from excoriating the defendant for using the “unscientific” term “fetus” instead of “unborn child,” to speculating that women would be better off having to have surgical abortions than taking a pill and experiencing an afternoon of cramping. We couldn’t get it all in here if we tried, although Robyn did a great job over the weekend.

But let’s talk instead about the competing order from Judge Thomas Rice in the Eastern District of Washington which came out at roughly the same time last week. Because the FDA is still tinkering with that mifepristone REMS, and so 17 states plus DC sued to stop the government from enacting even more restrictions on distribution. So on Friday night, Judge Rice granted an injunction block the FDA from “altering the status quo and rights as it relates to the availability of Mifepristone under the current operative January 2023 Risk Evaluation and Mitigation Strategy under 21 U.S.C. § 355-1 in Plaintiff States.”

And that puts the FDA in a weird place, because WTF is even happening right now? Judge Kacsmaryk’s order, which goes into effect this Friday if it’s not blocked by a higher court, purports not to be a nationwide injunction, but rather a stay of the FDA’s 23-year-old approval under Section 705 of the Administrative Procedure Act (5 U.S.C. § 705). This law which allows courts to “postpone the effective date of an agency action or to preserve status or rights pending conclusion of the review proceedings.” But perhaps sensing the glaring defects of his ruling, Kacsmaryk wrote: “If the Fifth Circuit reverses this Court’s Section 705 analysis, the Court clarifies that it alternatively would have ordered Defendants to suspend the chemical abortion approval and all subsequent challenged actions related to that approval until the Court can render a decision on the merits.”

The government has appealed to the Fifth Circuit, which is a nightmare lineup, stacked with Trump appointees. It has not appealed the Washington decision, and, as we discussed in depth on the Opening Arguments podcast (shameless plug alert!), there is a universe in which both orders can coexist. The FDA could colorably argue that the Washington order blocks it from taking any enforcement action against mifepristone suppliers, but that’s not a longterm solution. And unfortunately, the Fifth Circuit and the Supreme Court have shown themselves remarkably willing to countenance the most vile, illegal arguments in an effort to ban abortion.

And Lemon, it’s only Monday.

[Slate / Alliance for Hippocratic Medicine v. FDA, docket via Court Listener / State of Washington v. FDA, docket via Court Listener]

Catch Liz Dye on Opening Arguments podcast.

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US access to abortion pills in limbo after conflicting judicial rulings

Access to the most commonly used method of abortion in the U.S. plunged into uncertainty Friday following conflicting court rulings over the legality of the abortion medication mifepristone that has been widely available for more than 20 years.

For now, the drug the Food and Drug Administration approved in 2000 appeared to remain at least immediately available in wake of two separate rulings that were issued in quick succession by federal judges in Texas and Washington.

U.S. District Judge Matthew Kacsmaryk, a Trump appointee, ordered a hold on federal approval of mifepristone in a decision that overruled decades of scientific approval. But that decision came at nearly the same time that U.S. District Judge Thomas O. Rice, an Obama appointee, essentially ordered the opposite and directed U.S. authorities not to make any changes that would restrict access to the drug in at least 17 states where Democrats sued in an effort to protect availability.

The extraordinary timing of the competing orders revealed the high stakes surrounding the drug nearly a year after the U.S. Supreme Court overturned Roe v. Wade and curtailed access to abortion across the country. President Joe Biden said his administration would fight the Texas ruling.

The whiplash of the conflicting decisions is likely to put the issue on an accelerated path to the Supreme Court.

“FDA is under one order that says you can do nothing and another that says in seven days I’m going to require you to vacate the approval of mifepristone,” said Glenn Cohen of Harvard Law School.

Abortion providers slammed the Texas ruling, including Whole Woman’s Health, which operates six clinics in five states and said it would continue to dispense mifepristone in person and by mail over the next week as they review the rulings.

The abortion drug has been widely used in the U.S. since securing FDA approval and there is essentially no precedent for a lone judge overruling the medical decisions of the Food and Drug Administration. Mifepristone is one of two drugs used for medication abortion in the United States, along with misoprostol, which is also used to treat other medical conditions.

‘Political attack’

Kacsmaryk signed an injunction directing the FDA to stay mifepristone’s approval while a lawsuit challenging the safety and approval of the drug continues. His 67-page order gave the government seven days to appeal.

“The Court in this case has substituted its judgment for FDA, the expert agency that approves drugs,” Biden said. “If this ruling were to stand, then there will be virtually no prescription, approved by the FDA, that would be safe from these kinds of political, ideological attacks.”

Clinics and doctors that prescribe the two-drug combination have said that if mifepristone were pulled from the market, they would switch to using only the second drug, misoprostol. That single-drug approach has a slightly lower rate of effectiveness in ending pregnancies, but it is widely used in countries where mifepristone is illegal or unavailable.


 

The lawsuit in the Texas case was filed by the Alliance Defending Freedom, which was also involved in the Mississippi case that led to Roe v. Wade being overturned. At the core of the lawsuit is the allegation that the FDA’s initial approval of mifepristone was flawed because it did not adequately review its safety risks.

Courts have long deferred to the FDA on issues of drug safety and effectiveness. But the agency’s authority faces new challenges in a post-Roe legal environment in which abortions are banned or unavailable in 14 states, while 16 states have laws specifically targeting abortion medications.

Since the Texas lawsuit was filed in November, legal experts have warned of questionable arguments and factual inaccuracies in the Christian group’s filing. Kacsmaryk essentially agreed with the plaintiffs on all of their major points, including that the FDA didn’t adequately review mifepristone’s safety.

“The Court does not second-guess FDA’s decision-making lightly.” Kacsmaryk wrote. “But here, FDA acquiesced on its legitimate safety concerns — in violation of its statutory duty — based on plainly unsound reasoning and studies that did not support its conclusions.”

Mifepristone has been used by millions of women over the past 23 years, and complications from mifepristone occur at a lower rate than that seen with wisdom teeth removal, colonoscopies and other routine medical procedures, medical groups have recently noted.

19th century law

Elsewhere, Kacsmaryk sided with plaintiffs in stating that the FDA overstepped its authority in approving mifepristone, in part, by using a specialized review process reserved for drugs to treat “serious or life-threatening illnesses.” The judge brushed aside FDA arguments that its own regulations make clear that pregnancy is a medical condition that can sometimes be serious and life-threatening, instead calling it a “natural process essential to perpetuating human life.”

His order also agreed with plaintiffs in invoking a controversial 19th century law that anti-abortion groups are now trying to revive to block sending abortion medications through the mail. Originally passed in 1873 and named for an “anti-vice crusader,” the Comstock Act was used to prohibit the mailing of contraceptives, “lewd” writings and “instruments” that could be used in an abortion. The law was seldom invoked in the 50 years after Roe established a federal right to abortion.

Kacsmaryk, though, agreed with plaintiffs that the law — as literally interpreted — prohibits mailing mifepristone.

His order, if upheld, would also dismantle a number of recent FDA actions intended to ease access to the drug.

In late 2021 the FDA — under the Biden administration — dropped a requirement that women pick up the drug in person, opening the door to delivery by mail-order pharmacies. In January the agency dropped another requirement that prevented most brick-and-mortar pharmacies from dispensing the pill.

Anti-abortion groups, which are newly encouraged about their ability to further restrict abortion and prevail in court since last’s year’s reversal of Roe v. Wade, embraced the Texas ruling.

“The court’s decision today is a major step forward for women and girls whose health and safety have been jeopardized for decades by the FDA’s rushed, flawed and politicized approval of these dangerous drugs,” said March for Life President Jeanne Mancini.

Legal experts warned that the ruling could upend decades of precedent, setting the stage for political groups to overturn other FDA approvals of controversial drugs and vaccines.

“This has never happened before in history — it’s a huge deal,” said Greer Donley, a professor specializing in reproductive health care at the University of Pittsburgh Law School. “You have a federal judge who has zero scientific background second guessing every scientific decision that the FDA made.”

Still, because of the contradictory nature of the rulings, Donley and other experts said there would be little immediate impact.

“In the short term, nothing’s going to change,” Donley said. “This is the time to be preparing for the fact that in a week, potentially, mifepristone becomes an unapproved drug in this country.”

(AP)

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Abortion pills at heart of reproductive rights challenges in Poland, US

An activist in Poland was convicted on Tuesday for helping a pregnant woman access abortion pills, as a legal case in the US attempts to ban access to medical abortion altogether. In countries where reproductive rights are already under threat, abortion pills can provide discreet access to safe terminations, but legal battles are blocking access to medicine.

Activist Justyna Wydrzynska was sentenced to eight months of community service on Tuesday, after Polish courts found her guilty of helping another woman to have an abortion.   

Poland has some of Europe’s most restrictive abortion laws, with termination only allowed in cases of rape, incest or threat to the mother’s life or health.  

Wydrzynska, who plans to appeal the ruling, was arrested in April 2022 for providing abortion pills to a woman named Anna who was around 12-weeks pregnant and a suspected victim of domestic violence.  

“It happened in 2020 during the Covid crisis,” says Mara Clarke, co-founder of Supporting Abortions for Everyone (SAFE), a group that defends access to abortions in Europe.  “The postal service wasn’t working as normal and we didn’t know if the medicine would arrive in time to help this woman if it was delivered from overseas.” 

The World Health Organization (WHO) advises that medical abortions – carried out using tablets sometimes called abortion pills – can be safely self-managed at home in the first 12 weeks of pregnancy.  

“Anna’s husband initially prevented her from going to get an abortion in Germany, and then confiscated her abortion pills after reading her messages,” says Clarke. He reported Wydrzynska to the police, who then conducted a search of her home.  

The maximum penalty in Poland for providing help to carry out an abortion is three years in prison – this makes Wydrzynska’s case “the first time in Europe that an activist has risked being sent to prison for helping a woman who wanted to have an abortion”, says Clarke. 

“The fact that Justyna Wydrzynska risked three years in prison for responding to a plea for help from a woman and from a mother who was trying to escape an abusive relationship is a crime in itself against human rights and the right to bodily autonomy.” 

‘No other way’ 

“I’m not feeling guilty at all,” Wydrzynska said in a press conference on Wednesday. “I know I did right. When your reproductive rights are restricted in a country like Poland… there was no other way to help than to share the pills.” 

The WHO recommends the use of two abortion pills, Mifepristone and Misoprostol, as an accessible and affordable means of terminating a pregnancy which can be taken anywhere, for example at home instead of in a hospital. (Misoprostol can also be used as a stand-alone drug.)

In addition, the pills can also be taken without direct supervision from a medical supervisor. As such, global usage surged during the Covid pandemic when access to normal health procedures was disrupted.   

In France, the US, medical abortions now account for more than 50 percent of total terminations. In the UK and India almost all terminations are now carried out using abortion pills. 

The safety and relative ease of taking the medicine also makes abortion pills a useful asset to women seeking abortions in countries where the law limits access. 

In Poland, where there are severe restrictions on procedural abortions conducted by medical practitioners, abortion pills offer a discreet lifeline to safe terminations. Typically, activist groups purchase the tablets to be sent by post from external countries via third-party organisations in order to avoid legal consequences. 

In the US (which, along with Poland, is one of only four countries to make abortion legislation more restrictive in the past three decades) the national postal service has emerged as a key channel to providing abortion pills in states where legislation has blocked access to terminations.   

‘Fear and intimidation’ 

Yet, this channel is now under new threat. On Wednesday, a US judge in Amarillo, Texas heard arguments to ban sales of Mifepristone across the country – even in states where abortion is legal. This would mean that activists could no longer purchase the drug in states with more permissive laws to send to women facing restrictions. 

Anti-abortion activists who brought the case to federal court hope that banning the prescription drug would move the country closer to a total ban on the practice, especially as the presiding judge, Matthew Kacsmaryk, is a deeply conservative Christian with a personal history of opposition to abortion and a court record of favoring right-wing causes.

The United States Food and Drug Administration has urged the judge to reject the request on the grounds that it would force women to have unnecessary surgical abortions and greatly increasing wait times at already overburdened clinics. 

 “The public interest would be dramatically harmed by effectively withdrawing from the marketplace a safe and effective drug that has lawfully been on the market for 22 years,” it said. Current US laws allow use of Mifepristone up to 10 weeks of pregnancy. 

At the same time in Texas, another case has been brought by a man suing three women who he says helped his wife obtain abortion pills.  

He alleges the three women texted his former partner information about Aid Access, a group that provides abortion medication by mail, and that one of the women dropped off the pills to his ex-wife. 

It is the first such lawsuit to be brought in the US since the Supreme Court overturned laws enshrining abortion as a fundamental right. 

As in Poland, the case is a “terrifying example of how anti-abortion extremists use the judicial system as an instrument of fear and intimidation”, says Irene Donadio spokesperson for the International Planned Parenthood Federation European Network. 

‘I would have done the same’ 

In Poland, Anna, the pregnant woman Wydrzynska gave abortion pills to, was never able to take the medicine. Days after her husband confiscated the pills, she miscarried. Yet, in an open letter published on March 2 she wrote to Wydrzynska to express her thanks.  

“It was an expression of humanity. Because in a situation where people who had a moral obligation, and in some cases a legal obligation, to help me stood up and washed their hands, only you gave me a hand.” 

For Donadio, it is no surprise that abortion pills are at the heart of legal challenges against abortion on both sides of the Atlantic. The fact that they can be taken without medical supervision, and even be bought in pharmacies in many countries, makes them an unprecedented channel for female empowerment. 

“Medical abortion is clearly the result of medical progress that can be used to emancipate women and to protect their health,” says Donadio. “It is revolutionary. That’s why it’s so disturbing for certain forces because it allows women control over their body, over reproduction, and over their life.” 

As well as opposition, there is also support for access to the medicine. In the US, if the federal judge does rule for a temporary ban on Mifepristone, the FDA would likely immediately appeal it, on the basis of the drug’s history and its own authority to regulate pharmaceuticals. 

In Poland, politicians seem to be hearing the message. On March 6, Wydrzynska spoke in front of MPs from Poland’s centre-left party, Nowa Lewica, to defend her actions. The next day a law aiming to criminalise communicating information about abortion failed to pass after being rejected by a large majority in parliament. 

Activists are also unlikely to drop the cause. When Wydrzynska has appeared in court in Warsaw dozens of women have gathered holding banners bearing the message: “I would have done the same as Justyna”.  

This article was adapted from the original in French.

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The challenge of enshrining abortion rights in the French constitution

During a speech given on International Woman’s Day, French President Emmanuel Macron announced the decision to put forward a bill enshrining abortion rights in the country’s constitution. Despite being lauded by women’s rights groups, changing the constitution may be more difficult than it appears.

Perhaps in an attempt to divert attention from the backlash his government is facing over the recent pension reform proposal, Emmanuel Macron on Wednesday, March 8 announced his intention to cement abortion rights in the French constitution as he paid tribute to feminist activist Gisèle Halimi, who greatly influenced the passing in 1975 of the Veil Act granting women the right to abortion and contraception.

“Progress made through parliamentary talks initiated by the National Assembly and informed by the Senate would allow, I hope, to inscribe this freedom in our founding text through a bill amending our constitution  introduced in the coming months,” Macron said at the Palais de Justice courthouse in Paris.

The two parliamentary chambers both recently voted – the National Assembly in November, the Senate in February – on adding abortion rights to the constitution, though in different terms.

While the news was warmly welcomed by women’s rights groups, which saw the move as a “victory”, consecrating the right to abortion in the Constitution is still far from reality.

On one hand, a bill put forward by the government is voted on by parliament in a joint session and passes with a three-fifths majority, contrary to a bill submitted by legislators, which is voted on via referendum and seen as more risky.

On the other hand, contrary to the legislators’ proposal, Macron’s government is opting for a bill that looks to bring about wider change in current institutions instead of one that is specifically targeted at consecrating abortion rights.

The draft law is expected to include changes such as the redrawing of current regional borders and the redefining of elected officials’ mandates, according to people close to the president.

Macron has himself evoked the possibility of returning to a seven-year presidential mandate with mid-term elections to uncouple presidential and legislative elections, according to an interview with Le Point magazine given in April 2022.

Conditions for amending the constitution have “never been less favorable since 1962”

But burying abortion rights in a myriad of other institutional reforms is largely criticised by the opposition, which cites fears of being coerced.

“Emmanuel Macron is starting to take some steps and it’s a good thing. But it’s doomed to fail if he wants to make us agree to things that are inacceptable, such as the return of the seven-year term and the proportionality feature,” left-wing political party La France Insoumise (France Unbowed) head legislator Mathilde Panot said, adding that the failure of the project would then be entirely the president’s fault.

Indeed, with a fractured National Assembly and no absolute majority, it appears quite implausible for Emmanuel Macron to obtain the 60% of parliamentary votes needed to amend the constitution.

“It seems completely unrealistic,” said Benjamin Morel, a public law professor at the University of Paris-Panthéon-Assas. “The conditions for amending the constitution have never been less favourable since 1962. The Senate and the National Assembly currently exhibit different political colours, and the presidential party doesn’t even have an absolute majority in the Assembly. When Nicolas Sarkozy amended the constitution in a significant way in 2008, despite having a relatively large majority in the Senate and Assembly on his side, the bill passed by a single vote.”

Emmanuel Macron already had a taste of defeat during his first term as president when he submitted a constitutional amendment bill in 2018. This bill included the “dose of proportionality” feature regarding legislative elections, in which the parties would potentially be awarded a number of legislators in line with their results at the national level in addition to the legislators elected in each district, as well as a 30% reduction in legislators, a limit on accumulated mandates, and the abolishment of the Republic’s Court of Justice. The Benalla affair that came to light in the summer of 2018 put a stop to the reform. It was reintroduced in 2019 before being buried once and for all by the Covid-19 crisis.

Has Macron learned his lesson? At a meeting in early February with his presidential predecessors François Hollande and Nicolas Sarkozy, he evoked the subject of amending the constitution. According to our information, he aims to create a cross-party commission on the subject of reform, which had already been mentioned during the last presidential campaign. This commission would aim at “reaching a consensus along the lines of what currently exists on abortion rights”, the Élysée Palace indicated.

“Freedom” instead of “right”

Macron’s strategy, however, is unlikely to convince the opposition, especially given that the political left doesn’t present a united front on abortion.

The Senate, with its right-wing majority, has voted in favour of enshrining “women’s freedom” to access abortion in the constitution. This wording leaves out the idea that it is a “right” to access abortion, which the political left in the National Assembly prefers. It is thus the Senate’s wording that Macron adopted in his  speech on Wednesday.

This clash over semantics is anything but trivial. While Emmanual Macron seeks to appease Senators from the conservative party Les Républicains, the use of the word “freedom” instead of “right” has legal consequences, according to Mathilde Panot.

“It’s a pity and dangerous that Emmanuel Macron is choosing the Senate’s version,” she said. “The National Assembly had a strong desire to reaffirm that abortion is a fundamental right for women. By using the word ‘freedom’, they weaken the text,” she added.

Benjamin Morel, however, does not share this view, and considers that access to abortion is guaranteed by either of the wordings. “The difference between ‘right’ and ‘freedom’ is the fact that the Senate’s version leaves the various methods of access to abortion for the Parliament to decide, while the ‘right’ to access abortion as written in the National Assembly’s proposal would hand this power to the Constitutional Council”, he explained.

Still, the whole debate could very well be a show in political manoeuvring, taking into account the unlikelihood that the constitution will actually be amended. When asked for more information, the Élysée Palace had little to say on the exact content of the future constitutional amendment bill, as well as on the timing and the way in which the cross-party commission on the subject would be organised.

This article is a translation of the original in French.

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A childbirth myth is spreading on TikTok. Doctors say the truth is different | CNN



CNN
 — 

Ashley Martinez has four sons and is pregnant with the daughter she’s wanted for years.

Last month, she posted a video online imploring doctors to prioritize her life, not the life of her unborn baby, if complications arise when she is in labor and it comes down to that choice.

The San Antonio, Texas, resident is due in May and is one of a number of pregnant people who have recently posted “living will” videos on TikTok.

Martinez had an emergency C-section during her last pregnancy after her umbilical cord came out before her baby, a rare but dangerous condition known as an umbilical cord prolapse that can deprive a baby of vital blood flow and oxygen.

Martinez described her last delivery as terrifying. Eight months after the Supreme Court reversed Roe v. Wade, ending a constitutional right to abortion, she said she worries about what would happen if she faced similar challenges again.

Since the ruling in June, a number of US states have criminalized abortions, leading to some fears that doctors would prioritize the life of the unborn child during a medical emergency.

Martinez lost her mother to non-Hodgkin’s lymphoma at a young age, and the thought of her children going through a similar tragedy terrifies her.

“Having to go into another delivery where I’m going to have a C-section, it’s scary for me,” said the 29-year-old. “My fourth pregnancy was my only C-section. I’ve always thought about not being here for my kids just because of what I went through growing up without my mom.”

More than a dozen US states have banned or severely restricted access to abortions following the Supreme Court’s decision eight months ago. The abortion bans have led to legal chaos as advocates take the fight to courtrooms.

Even so, several ob/gyns told CNN that a hard choice between saving a mother and baby’s lives at childbirth, like the one outlined in the TikTok videos, is highly unlikely.

This trend on TikTok has sparked a flurry of dueling videos among pregnant women and other people. Some have posted videos telling doctors in such situations to prioritize their unborn babies first, and criticizing those who expressed a different view.

Martinez concedes that her mother, who died at 25, would likely have chosen to save her child first if she could.

“My mother, she didn’t have a choice, you know?” Martinez said. “The message that I want to send is just basically nobody is wrong or right in this situation. In both situations, it is a hard decision to pick your children over your unborn baby.”

In Texas, where Martinez lives, abortions are banned at all stages of pregnancy – unless there’s a life-threatening medical emergency.

Dr. Franziska Haydanek, an ob/gyn in Rochester, New York, who shares medical advice on TikTok, said she’s noticed many “living will” videos in recent months.

In most of the videos, a woman appears alongside a written message saying something like, “If there are complications during childbirth, save me before the baby.” Some people, including Martinez, reference their children in their decision and even show them in the video.

One was posted by Tuscany Gunter, 22, a woman whose baby is due in April. Abortion after 20 weeks of pregnancy is illegal in her home state of North Carolina, and Gunter told CNN she filmed her message in solidarity with others who said they would choose themselves first.

“I wanted to make it known where I stand and to stand up with other women who are getting bashed online for saying they would rather be saved first over their baby,” said Gunter, who lives in Fayetteville.

“As a mother to three young children, I cannot dump the emotional trauma of losing their mother on them as children and expect them to cope. While I would be crushed to lose a baby, I need to think of my other living children as well … And I know the baby that passed would be safe without ever having to experience any pain or sadness.”

Another woman, Leslie Tovar of Portland, Oregon, said that even though her state has no legal restrictions on abortion, she posted her video because she feared doctors would prioritize saving her unborn child to avoid legal ramifications in the post-Roe v. Wade era.

“I have two other kids at home who need mom. I can’t bear the thought of my two young boys ages 6 and 4 without their mom,” she said.

All three women said they’ve had these conversations with their partners, who agreed they should be saved first.

Of her husband, Tovar said, “His exact words were, ‘We could always have another baby later in life but there is never replacing the mother of my boys, I couldn’t do this without you.’”

It’s true that complications occasionally come up during a pregnancy that lead doctors to recommend delivery to save the mother’s life, medical experts said.

If this is done before a fetus is viable – under 24 weeks – the chances of the baby’s survival are low, said Dr. Elizabeth Langen, a maternal-fetal medicine physician at the University of Michigan Von Voigtlander Women’s Hospital.

Roe v. Wade’s reversal did make terminating such pregnancies more complicated, Langen and Haydanek say.

In cases involving a baby that’s not viable, it could mean that even when the baby is unlikely to survive and the mom’s health is at risk, the priority will be on saving the baby due to fear of legal ramifications, Langen said.

But both doctors say these scenarios don’t occur during the birth of a viable baby. In that instance, Roe v. Wade is “less involved,” Haydanek said.

“We do everything in our efforts to save both (mother and baby),” she said. “I can’t think of a time where the medical team has had to make a decision about who to save in a viable laboring patient. It’s just not a real scenario in modern medicine – just one we are seeing played out on TV.”

Hospitals have enough resources – obstetrics and neonatal intensive care unit teams, for example – to meet the needs of both the mother and the baby, Haydanek and Langen said.

“We’re usually doing our best to take care of both the mom and the baby. And there’s very rarely a circumstance where we will do something to harm the mom in order to have the benefit of the baby,” added Langen.

“If mom’s health is deteriorating, ultimately, she’s not going to be able to support baby’s wellbeing,” Langen said. “And so generally, what we encourage folks to do is really support mom’s health, because that’s in the best interest of both mother and baby.”

Abortion rights demonstrators hold signs outside the US Supreme Court in Washington after the court overturned Roe v. Wade in June 2022.

Both doctors said it’s important for patients to talk to their health care providers about their medical concerns and share their “living will” wishes with loved ones in case there are complications during labor that require partners to make medical decisions.

However, those decisions will not involve doctors asking your partner whose life should come first, they said.

“Before getting in a fight with your partner about who they choose to save, know that there isn’t a situation where we will ask them that,” said Haydanek, who has called the TikTok trend “horribly anxiety inducing.”

She said it’s come up so many times in recent months that she made her own TikTok video to reassure expectant parents.

“Please don’t feel like you have to make this choice,” she says in the video. “I know firsthand how much anxiety there can be in pregnancy … but it’s just not a situation that you’re gonna find yourself in.”

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