As France makes abortion a constitutional right, UK women see sharp rise in abortion convictions

As France enshrines abortion access in its constitution, the UK is facing a sharp rise in abortion convictions. A law dating from 1861 is being used to prosecute women in England and Wales, in at least one case leading to incarceration.

France has become the only country in the world to protect the right to terminate a pregnancy in its constitution after abortion access was officially added to the freedoms guaranteed in the French constitution on Monday. The move was a direct reaction to the rollback of abortion rights in the United States and elsewhere.

But across the English Channel, women are still at risk of prosecution for having the procedure because abortion in the UK has not been decriminalised. Britain is facing a sharp rise in abortion convictions, with a law dating from 1861 being used to prosecute women and in at least one case leading to incarceration.   

Between 1967 and 2022, three women were convicted of having an illegal abortion in England and Wales. But in the last 18 months alone, six women have been prosecuted over suspected abortion offences.

Of the six prosecutions, three cases were dropped and two cases are awaiting trial, according to the British Pregnancy Advisory Service (BPAS). One woman was sent to prison.

Illegal abortion and life imprisonment

According to legislation passed 163 years ago, abortion is still a crime in England and Wales.

The Offences Against the Persons Act of 1861 states that it is illegal for a woman to procure her own abortion or provide the means for another woman to terminate a pregnancy.  

What makes abortions accessible today is the Abortion Act, passed by parliament in 1967. The law allows doctors to perform abortions and allows women access to them, but only if they have authorisation from two registered medical practitioners and meet at least one of a specific set of circumstances: These include potential injury to the physical or mental health of the pregnant woman or any existing children in her family, any substantial risk to her life, and any serious physical or mental abnormality the unborn child could have.   

A time limit of 24 weeks was added in 1990 but with exceptions, for example, if a woman faces the risk of death or “permanent damage” to her physical or mental health, or if there is a serious foetal abnormality.

But outside of these restrictions, women can still face a sentence of life imprisonment – one of the harshest penalties for having an illegal abortion in Europe.  

Many countries in Europe will punish you for performing your own abortion or getting an abortion outside of the healthcare system, says Mara Clarke, co-founder of Supporting Abortions for Everyone (SAFE), a pan-European charity for providing access to abortion.

“But none of [the punishments] is life in prison.”  

Read moreThe long and winding history of the war on abortion drugs

Doctors in England, Wales and Scotland have the final say on whether or not a woman can access an abortion. They determine whether a risk to health is serious enough to call for terminating a pregnancy, whether an abortion is necessary to avoid “grave permanent injury” to a woman’s mental or physical health, and can even opt out of providing abortion care if they object for reasons of conscience.

A woman in England or Wales can even be prosecuted if they purchase abortion pills online without the authorisation of the two required doctors, or if they terminate their pregnancy beyond the 10-week limit for at-home medical abortions or the 24-week limit for abortions at a vetted healthcare facility.   

Other health care professionals, including nurses, are not authorised to sign off on an abortion, with the necessary double approval restricted only to doctors.  And there is “no consideration of the reasons why a woman might want to end a pregnancy”,  according to a UK abortion rights campaign group run by healthcare professionals called Doctors for Choice.

“The law prevents nurses and midwives from having a full role in abortion care despite being more than capable of doing so,” the group says on its website.

The Independent newspaper reported that Dr Jonathan Lord, the co-chair of the British Society of Abortion Care Providers, knows of at least 60 criminal inquiries into suspected illegal abortions in England and Wales since 2018.

‘An aberration’

“We really have better things to be doing with our time and money,” sighs Clarke from SAFE. “There are 60 investigations, yes, but out of how many abortions – 200,000?” She feels frustrated by the fact that public attention is turned to the prosecutions rather than the safe and guaranteed provision of abortion care for all.

“How many times did Carla Foster have to turn up in court before her case was overturned?” For Clarke, the answer is “too many”.

Carla Foster is a mother of three who ended her pregnancy outside the legal 24-week legal limit in the early weeks of the Covid-19 pandemic. She took mifepristone – a medical abortion pill – after the limit expired during lockdown.  

Read moreUS Supreme Court ruling on abortion pill could ‘tie the hands of every state’

She received a 28-month custodial sentence in June 2023 and was sent to Foston Hall prison in Derbyshire, where she was incarcerated for 35 days.

Foster took her case to a court of appeal to reduce her sentence and won. A judge deemed the 46-year-old needed “compassion, not punishment” and reduced her punishment to a 14-month suspended sentence. She was released in July.

“UK public opinion is very liberal on abortion and is quite strongly pro-choice,” says Sally Sheldon, a professor at University of Bristol specialising  in healthcare law. “It’s relatively easy for people with access to the NHS (National Health Service) to receive abortion care. In that context, these cases are really an aberration.”

Nevertheless, the legal remedies – when applied – are severe.

“Most of these women are having their laptops and phones taken away … There have been reports of women having their children taken into care because they were seen as a risk to their kids,” says Sheldon. “It impacts the whole family. The impact is enormous.”

Sheldon surmises that the sudden uptick in prosecutions could be connected to an increased awareness of abortion pills. “Since the pandemic … women can have an online consultation and have the pills sent to them,” she says. “I think that has led to a climate of much greater suspicion around unexplained later pregnancy loss or premature delivery. It seems like most cases are being reported by healthcare professionals … who report it to the police.”

Earlier this year, the Royal College of Obstetricians and Gynaecologists released new guidance for abortion care. Stating their “concern at the increasing number of police investigations following later gestation abortion and pregnancy loss, and the impact this can have on women”, it urged healthcare professionals to “abide by their professional responsibility to justify any disclosure of confidential patient information”.

Labour MP Diana Johnson this month is expected to introduce an amendment to the UK’s Criminal Justice Act that would end prosecutions of women for terminating pregnancies after the 24-week limit.

“If that amendment gets selected for debate, I would hope it’s got a good chance of being passed,” says Sheldon. “But it’s very difficult to know.”

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US Supreme Court ruling on abortion pill could ‘tie the hands of every state’

The US Supreme Court is set to decide the fate of a pill essential for medical abortions. Access to mifepristone, once called the “pill of Cain” by the Vatican, may be heavily restricted across all states if the highest court upholds a lower-court ruling limiting access to the drug. Expert on abortion pills Dr. Sydney Calkin speaks to FRANCE 24 about what’s at stake.  

Issued on:

5 min

The ruling on mifepristone is the most important abortion case to reach the US Supreme Court since it struck down Roe vs Wade in June 2022, overturning the constitutional right to end a pregnancy.

Taking mifepristone in combination with another pill called misoprostol is the most effective way to have a medication abortion. And medication abortions account for more than half of all pregnancy terminations in the US.

On Wednesday, justices agreed they would make a decision on the restrictions on mifepristone set out in a ruling made by a three-judge panel of the New Orleans-based 5th Circuit Court of Appeals. The case stems from an earlier ruling by a conservative US District Court judge in Texas that would have banned mifepristone, but all restrictions have been frozen since late April

If these restrictions are passed, pregnant people would only have seven weeks instead of 10 to use the pill. Approval would also block mifepristone from being distributed by mail and would require the drug to be prescribed by a doctor, as opposed to other health care professionals like nurses or midwives.

Read moreThe long and winding history of the war on abortion drugs

Oral arguments on the abortion pill will be heard by the Supreme Court next year, and a decision is expected to be issued by the end of June 2024. It will come just four months before the US presidential election, when abortion will undoubtedly make headlines.

Until then, access to mifepristone will remain unchanged.

Dr. Sydney Calkin, a senior lecturer at Queen Mary University of London who has carried out extensive research on how abortion pills have transformed reproductive care, explains what is at stake.

Why is mifepristone being targeted in this ruling?

Dr. Sydney Calkin: The anti-abortion movement sees it as the next step after the 2022 ruling in Dobbs v. Jackson Women’s Health Organization overturned Roe and removed constitutional protections for abortion in the US.

That ruling didn’t make abortion illegal across the whole country, it just said that it’s a question for each state. What we’re seeing right now is that states can ban abortion if they want to, but they can also keep abortion if they want to. And obviously, the anti-abortion movement isn’t happy with that. They don’t want abortion to be legal anywhere in the US.

Anybody who thought that the Dobbs decision was the final word on abortion and anybody who thought it just meant states are free to do what they want, well… I think we can really see that was never the case. The Dobbs decision was just one step in the anti-abortion strategy, which counts on going much further.

Rules on what medicines are approved and how those medicines can be used are set at the federal level. If more restrictions are put on mifepristone at the federal level, that would tie the hands of every state. Even states that want to keep abortion legal.

This is really important because, before the Dobbs decision, medication abortion accounted for the majority of abortions in the US. It’s a method that’s both widely used and a lot easier for people to access.

What are the real-life consequences of restricting access to mifepristone?

If the Supreme Court passes the restrictions, the length of time the pill can be used would be reduced from ten to seven weeks. Pregnancy in the US is dated from the last menstrual period, not the date of conception. By the time somebody notices they’ve missed their period, they might already be four weeks pregnant, giving them only three weeks to carry out a medical abortion. That really narrows the window.

As it stands, there is a range of health care providers who can prescribe mifepristone. The restrictions would also limit the providers to physicians, meaning there are fewer people licensed to prescribe the drug. And there’s already a shortage of abortion providers across the country.

Under the 2016 Food and Drug Administration (FDA) revised regulations around mifepristone, it was decided that a lower dosage of the drug could be used than was previously agreed. The restrictions would remove that requirement, increasing the amount of mifepristone used and therefore making it more expensive.

The 2016 revision also allowed for people to use the pills at home and it stated that it wasn’t necessary for a patient to come back in person for a follow-up appointment with their doctor. That would be scrapped.

But most importantly, restrictions would prevent telemedicine abortion services and mail order abortion pill services from operating. In 2021, during Covid, the FDA made it easier to get the pills through the mail. Since then, many services have popped up to offer this solution in states where abortion is legal. Taking that away would really harm access.

If you live in Texas for example, you can’t just go online and order abortion pills from California or Massachusetts. It’s illegal to access medication abortion in states where abortion is illegal. But mail order and telemedicine services are really changing the landscape. Some operate out of states with shield laws for their doctors, meaning doctors are protected from prosecution if they provide abortion pills to people in states where it’s illegal. These services are really useful for people whose neighbouring state allows abortion. Someone living in Texas can drive to New Mexico and order abortion pills to a post box there and collect them later.

What solutions could people turn to?

Access to abortion has changed so dramatically thanks to the mobility of pills. These rulings matter because they will restrict access to some extent. But in another sense, they don’t really have as much impact as the anti-abortion movement thinks they will.

The availability of medication abortion online means that governments and courts have less control over the matter than they used to, when abortion was only a surgical procedure carried out in hospitals and clinics. Now, abortion pills are available online, manufactured across the world and relatively cheap.

Of course it would be really, really grave if the Supreme Court decides to impose all these restrictions, but there are already a lot of people who are accessing pills through other channels that won’t necessarily be impacted by the ruling.

People in the US get medication abortion pills from international organisations like Aid Access, which is affiliated with the Dutch group Women on Web. They get pills from online pharmacies. A group called Plan C in the US do a lot of work to look for those pharmacies and provide information about the price, reliability and speed by which the pills can be delivered. Cross-border networks between the US and Mexico have become more formalised.

Regardless of this case, people are still going to be getting abortion pills. But there is a risk of people being criminalised for getting those pills. 

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Spotlight on family planning as India surpasses China as world’s most populous country

India is set to become the world’s most populous country on April 14, a title China has held for decades. Faced with a large – and growing ­– population of more than 1.4 billion, India’s family planning service is under pressure to maintain a decreasing fertility rate.

A UN forecast predicts that on April 14 the Indian population will reach 1,425,775,850 – a number that dethrones China from its long-held position as the world’s most populous country.  

The exact population of India today is unknown ­(a 2021 update on the decade-old census was indefinitely delayed by the pandemic) but all signs point to exponential growth. While China’s formerly steep rate of population increase is starting to plateau, India’s curve is still forging upwards. 

It is estimated that India has added 210 million – almost the number of people in Brazil – to its population since the last census 12 years ago. As of 2020, it has gained roughly 1 million inhabitants each month.

>> Read more: China faces demographic crisis as population shrinks for first time in 60 years

The population of India – and China – is now equivalent to the entire continent of Africa, and dwarfs that of Europe and the Americas. 


How India’s population compares globally © Worldometer


But over the same decades that population growth in India has soared, fertility rates have been falling. In 1964 Indian women had six children on average, today they have closer to two, in part, due to the state family planning service, which India claims it was the first country to provide when it launched in 1952.

“The primary goal was to slow population growth as a means of supporting the economic development of the country, which was only a few years old at that point,” says Anita Raj, Professor of Global Public Health, Director of the Center on Gender Equity and Health, University of California at San Diego.

The scheme has had some successes: India’s 2022 family heath survey found that almost 100% of married women and men aged 15-49 are aware of at least one method of contraception. The public health sector is the provider for 68% of people who use modern contraceptives (products or medical procedures used to prevent pregnancy such as condoms, the pill and IUDs, as opposed to traditional methods such as the withdrawal or rhythm methods or abstinence).

Yet, faced with a soaring population there is work to do. “Total fertility rates have declined for years,” says Raj. “However, if the goal was truly reproductive choice and women’s reproductive autonomy, then more should be done.”


The most used form of pregnancy prevention in India is female sterilisation, which accounts for 38% of all contraception used. “The emphasis of the national family planning programme historically was on family size, and consequently, sterilisation was the focus,” says Raj.

Yet, male sterilisation rates account for just 0.3% of all contraception methods. This is partly due to a patriarchal society – the family heath survey found more than a third of men regard contraception as “women’s business”.

Contraceptive methods used by married women in India
Contraceptive methods used by married women in India © NFHS India Report, 2021

But there is also resistance to male vasectomy due to lingering “stigma and taboos”, says Debanjana Choudhuri, a gender rights specialist based in India.

In the 1970s, economic and social stagnation led the Indian government to launch a mass drive to sterilise men as a population control method. Heavy-handed enforcement saw men pressured into having vasectomies on pain of having their salaries docked or losing their jobs. Poor men risked being picked up by police from railway and bus stations before being sent for sterilisation.

The result in modern India is that “no scalpel vasectomies have a very poor uptake”, Choudhuri says. “Men aren’t doing enough.”

State efforts still shy away from diversifying contraceptive methods. Sterilisation for men and women is incentivised with payment, and some states have introduced a two-child policy with penalties such as bans on holding government jobs for those who do not comply. The private health sector is the main provider of contraceptive of pills, injectables and condoms.

Recent public health provision of UDIs could be a “game changer in achieving method mix”, says Choudhuri, “but it will take 5-10 years to become popular. There is an immediate need for a healthier method mix, sensitisation, and awareness of long-acting reversible contraception and other short-term methods.”

Contraceptive control

Aside from placing the burden on women, reliance on female sterilisation limits women’s options. “Sterilisation does not support birth spacing, which is important for maternal and infant health and survival. It also is not a solution to ensure women’s control of timing of pregnancies, only limiting of them,” says Raj.

“If sterilisation is the women’s choice and supports women’s health, then that is fine; but too often these decisions are built on family and community expectations.”

Socio-economic conditions also define many women’s choices around family planning. The 2022 family health survey found poorer, less educated women living in rural areas are likely to have more children at younger ages and have less exposure to family planning messages than their wealthier, educated and urban counterparts.

Geography also plays a role, with women in the poorest parts of east India less likely to use any contraceptive methods at all, and especially less likely to use modern contraceptive methods.

“Evidence from all over the world shows when women are given the choice to control their fertility and the opportunities around it [such as education and economic opportunity] you’re always going to see family sizes coming down,” says Alistair Currie, campaign manager from Population Matters, a UK-based charity that addresses population size.

Lowering the fertility rate

Forecasts predict that India’s population will continue to increase for decades to come. The UN’s “medium variant” projection puts the peak of growth at 1.7 billion people in 2064. “Low variant” projections would see the growth curve start to flatten in 2047.

As they are, efforts from the Indian government are slowing population growth at an increasingly rapid rate, but data indicates family planning has a greater role to play. There remains a significant gap between the wanted fertility rate (number of children women want to have) of 1.6, and the actual fertility rate of 2.

“We would hope to see a situation in which all pregnancies are wanted and that people have the capacity to make a choice [to get pregnant],” Currie says. “If that were the case, then we would see a lower fertility rate in India.”

In addition, a population growth spurt looms: nearly half of the Indian population is below the age of 25, likely to have children of their own in coming years.

At the moment, many of this demographic lacking vital information about contraceptives, Choudhuri says. “There’s a prejudice that comes with the family planning programme – because it’s called family planning many people feel that it is not aimed at them. The adolescent population needs to be brought into the contraception conversation. Right now, they are excluded, and that’s alarming.”

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Jay Inslee: Send Me Your Trans Kids And Women Needing Abortions, But Not Your AR-15s

Sometimes it’s easy to forget that Jay Inslee is still the governor of Washington, what with all the competence and the just generally not making a lot of waves. But damn, he and Democrats in the state Lege have done some good governing lately. This week, the state Senate passed a “shield law” to protect transgender people in Washington, including people fleeing the increasingly awful anti-trans laws in other states. It now goes to Inslee for his signature. That will make Washington the 10th state with a law or an executive order protecting people — especially trans minors and their families — who cross state lines to receive gender- affirming medical care.

But wait! There’s more! Like some other shield laws, Washington HB 1469 will also protect people who travel to Washington seeking abortion services, since it’s written to include both gender-affirming care and “reproductive health care services that are lawful in the state of Washington” under the umbrella of “protected healthcare services.” So it’s a twofer of protection against the most extreme laws being passed in other states.

As the indispensable indy journalist Erin Reed reports, the bill even goes a little further than some other states’ already good safe haven laws and EOs. Where some, like Minnesota’s executive order, authorize the governor to refuse extradition to other states that want to punish healthcare providers or parents for “aiding and abetting” the provision of gender-affirming care, HB 1469 actually prohibits Washington’s governor from cooperating with such requests. (That’s why a law is better than an EO — Minnesota Gov. Tim Walz can’t prevent future governors from acting against trans folks.) Here’s that bit from the Washington law:

The governor of this state shall not surrender any person described in subsection (1) of this section where the charge against the person is based on the provision, receipt, attempted provision or receipt, assistance in the provision or receipt, or attempted assistance in the provision or receipt of protected health care services as defined in section 2 of this act that are lawful in the state of Washington.

For instance, if someone is charged under Idaho’s stupid new “abortion trafficking” law, which prohibits anyone but parents from assisting a minor in getting abortion services, Washington will refuse to extradite Aunt Nora or her Subaru Outback.

Further, the law prohibits state agencies from cooperating with data requests from states investigating people for providing or using protected health services — even under subpoena from another state.

The day before Idaho Gov. Brad Little signed that “abortion trafficking” bill, Inslee sent Little a letter to very politely tell him what a shitty idea the law was. Inslee wrote,

I question the constitutionality of this law and I know you are aware of the costly legal challenges that await should you choose to sign this bill, but, as the governor of a neighboring state, I am also deeply concerned about the impacts that (Engrossed House Bill) 242 will have on Washington residents traveling to and from Idaho.

Inslee also warned Little against any attempt to punish Washington healthcare providers under the new Idaho law, which includes a bizarre provision allowing lawsuits for no less than $20,000 to be brought against medical providers on the behalf of an aborted fetus by a relative of said nonbaby. Inslee wrote,

But, make no mistake, Governor Little, the laws of another state that seek to punish anyone in Washington for lawful actions taken in Washington will not stand. We will protect our providers, and we will harbor and comfort your residents who seek health care services that are denied to them in Idaho.

Even before a federal judge in Texas cancel-cultured the decades-old FDA authorization of the abortion pill mifepristone, Inslee took steps to stockpile a four-year supply, a total of 40,000 doses. Inslee managed that with One Weird Trick, as the Seattle Times explains:

Inslee ordered the Department of Corrections, which has a pharmacy license, to buy 30,000 doses of mifepristone last month. UW Medicine also obtained 10,000 doses of the drug. Between the two entities, Inslee said, the state now has about a four-year supply. […]

State lawmakers introduced Senate Bill 5768 to authorize the Department of Corrections to sell or distribute the drug to licensed providers in Washington.

In a statement last week, Inslee called the Texas lawsuit “a clear and present danger to patients and providers” not only in Washington, but all across the US, saying that Washington is “a pro-choice state and no Texas judge will order us otherwise.”

Finally, over the weekend, the state Senate passed a ban on assault weapons that Inslee had pushed for; the bill had already been passed by the state House, but since the Senate added some amendments, it has to get final passage in the House before it goes to Inslee to be signed. The bill will ban the sale, manufacture, and import of assault weapons, but doesn’t ban their possession because that would be a whole ‘nother pile of lawsuits.

“Passing an assault weapon ban will be a momentous step forward for Washington state,” Inslee said. “Time and again, we’ve seen the carnage these weapons allow people to unleash on communities. Time and again, we’ve watched the NRA and politicians defend, normalize, and even celebrate these weapons. But now the time is here when the majority’s will prevails, and we put the lives of our children first.”

Inslee appeared on MSNBC’s “All In With Chris Hayes” last night to take several victory laps on abortion, trans rights, and guns, and to invite people to move to Washington. Enjoy the video!

Guest host Ali Velshi, who’s Canadian, had to get his two cents in and make a pitch for people moving to Canada, and honestly that sounds good too, especially to those of us watching from godforsaken Idaho.

[Erin in the Morning / Washington HB 1469 / Idaho Reports / Seattle Times / Jay Inslee on Substack / KIRO-TV]

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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.”


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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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