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The future availability of abortion pills remains uncertain after conflicting rulings

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A conflicting and confusing set of federal court rulings Friday is leaving abortion providers in the U.S. uncertain about the future availability of abortion pills.

A MART?NEZ, HOST:

Two federal judges issued a pair of conflicting rulings on Friday, creating uncertainty for future access to abortion pills.

LEILA FADEL, HOST:

A federal appeals court is expected to weigh in soon, possibly within days. Meanwhile, providers and patients are trying to prepare for whatever comes next.

MART?NEZ: NPR's Sarah McCammon joins us now to talk about this. Sarah, so what's this mean for someone who wants access to abortion pills right now?

SARAH MCCAMMON, BYLINE: Well, at the moment, A, nothing, but the impact is likely to become a lot clearer very soon, maybe this week. What happened first on Friday was that a federal judge in Texas issued a ruling ordering the Food and Drug Administration to suspend its approval of the abortion pill mifepristone nationwide. That's scheduled to go into effect this coming Friday. David Donatti is an attorney with the ACLU of Texas, and he says the judge didn't give a lot of detail about what that means.

DAVID DONATTI: So, for example, if medication is already in pharmacies and has already been prescribed, can those prescriptions be filled? These are questions that the lowest court's order just does not answer.

MCCAMMON: But an appeals court could answer that question, and the Justice Department has appealed to the Fifth Circuit. We may hear from them this week. But if we don't, the judge's order would take effect.

MART?NEZ: Yeah. And I mentioned earlier that other abortion pill case in play. That's a decision from a federal judge in Washington state. How does that factor into this?

MCCAMMON: Right. Eighteen Democratic attorneys general sued the FDA to try to protect access to mifepristone. The federal judge in that case ruled also on Friday that, yes, the FDA should preserve access. His decision may offer at least some protection for access for people in those 17 states and the District of Columbia. But ultimately, this case probably ends up at the Supreme Court. And that, by the way, is where anti-abortion rights groups tell me they want it to go. They want to see this resolved at a national level. And they're optimistic that the high court will agree with the judge in Texas.

MART?NEZ: And abortion providers have got to be wondering what to do after these decisions. I mean, what are you hearing from them?

MCCAMMON: They're talking to their lawyers. They're preparing for multiple possible scenarios. And, you know, they've been doing that for months, really, since anti-abortion groups filed the lawsuit in Texas last year. The guidance these providers get could be different depending on where they are, whether they're in one of those states that was part of that Washington case I mentioned. Melissa Grant is CEO of Carafem, which provides abortion pills at three clinics and through telehealth. Over the weekend, she told me they're looking really closely at what might still be legal after that seven-day waiting period is up.

MELISSA GRANT: It's going to be working closely with legal advisers in a really rapidly and changing environment. That's what I foresee in the next seven days and likely beyond that.

MCCAMMON: Grant says Carafem is also poised to increase capacity for surgical abortion, if necessary, at its clinics, but they only have so much capacity. A spokeswoman for another company called Wisp, which provides abortion pills over telehealth, told me they're rushing to put together a plan to let patients stock up on mifepristone in advance of whatever might happen in court. And both of these companies, Carafem and Wisp, and many other providers also have been preparing to switch to a different regimen if mifepristone becomes unavailable.

Most medication abortions in this country use mifepristone plus a second drug called misoprostol. But misoprostol alone is used around the world, and many U.S. providers are looking at switching to that approach if they need to. But some advocates tell me they worry misoprostol could be the next target for anti-abortion groups.

MART?NEZ: Sarah, if the FDA has to take the pills off the market, will patients have any other options?

MCCAMMON: You know, right now many people are using alternative sources to get abortion pills, often online, from overseas. And already, more than a dozen states, including Texas, where this lawsuit started, have banned all types of abortion in most cases. You know, I talked to Elisa Wells with the group Plan C that provides information about some of those alternative sources. She says tens of thousands of people are getting pills this way, and she says that's likely to escalate depending on the outcome of this case.

MART?NEZ: That's NPR's Sarah McCammon. Sarah, thanks for providing clarity.

MCCAMMON: Thank you.