Georgia doctors on mifepristone rulings: 'This is not going away. It is just changing'

A federal judge in Amarillo, Texas, on Friday ordered the Food and Drug Administration to rescind its approval for the abortion drug, mifepristone. 

The ruling was set to go into effect on Friday, but it could be put on hold while litigation plays out after the Justice Department and a manufacturer of the drug filed an appeal on Monday. 

The case is likely headed to the Supreme Court. 

• RELATED: Judges' dueling decisions put access to a key abortion drug in jeopardy nationwide

If the Texas ruling is upheld, all abortions, mostly illegal in Georgia around six weeks into pregnancy, will be likely harder to get. 

What does the ruling out of Texas mean right now for people in Georgia? 

Sara Redd teaches at Emory University in Atlanta and studies reproductive health policy as a member of the Center for Reproductive Health Research in the Southeast. 

She found that 88% of abortions between 2007 to 2017 would have been illegal under Georgia’s current law, House Bill 481. 

“Then add a removal of one of the main medications used in medication abortion, that is only going to further decimate access in the state, only going to further decimate options,” Redd said. 

That study also found minority groups are likely more affected by abortion restrictions than others, especially in states with restricted access. 

For now, abortion access in Georgia hasn't changed. 

“Immediately, there is no impact for people in Georgia or elsewhere in the United States on the ability to access medication abortion,” said Allison Whelan, who teaches at Georgia State University’s College of Law and studies FDA law.  

Guidance or a statement from the FDA likely hinges on further action in the courts. A response to Monday’s appeal, filed in the U.S. 5th Circuit Court of Appeals, will likely come by Thursday. 

“There's a lot of unknowns in terms of what's coming next beyond just knowing that there is something coming next from other courts,” Whelan said. 

Even if the Texas ruling is upheld, Whelan said the FDA could apply enforcement discretion. 

Under enforcement discretion, the agency could choose not to enforce actions against manufacturers, distributors or prescribers of what would be considered an unapproved drug. It’s a move the agency applied temporarily to certain manufacturers of infant formula to help stabilize supply during last year’s shortage. 

Plus, people could still take mifepristone as long as it's accessible somewhere else, Whelan said, like getting it shipped from another country. The FDA has said multiple times that mifepristone is safe and effective since mifepristone was approved for use in 2000. 

At that point, it would be up to the states to regulate use of the drug.  

“If anti-abortion states start to crack down on actual users themselves and start to prosecute the actual user of medication abortion, that is something that would deter people from using the drug,” Whelan added.

How will people access the medication in Georgia?

Rachel Neal is an OB-GYN and abortion provider in Atlanta. If there’s one thing she wants her patients to know about the ruling, it’s this: 

“You can and will still be able to safely access medication abortion, even if mifepristone is no longer available,” Neal said. “This is not going away. It is just changing.”

Neal said she plans to continue providing medication abortion without mifepristone by prescribing just one drug instead, misoprostol, the other medication used for abortions that’s still effective on its own. 

“I don't want people to think that this means that medication abortion is no longer an option or that it is somehow dangerous or unsafe or second rate,” Neal said about the ruling. “But you know, the harm of this is really that people are no longer able to choose the regimen they want and they're no longer able to make that choice by themselves.”

• RELATED: Under HB 481's 6-week abortion ban, many people will realistically have just 2 weeks to seek one

What about doctors?

It’s a far cry from last year after Georgia’s abortion law was enacted without a waiting period, forcing providers to hastily cancel appointments and leaving patients scrambling to travel across state lines for procedures in states with easier access. 

Neal said there’s still some ambiguity in the state law that doctors like her have to interpret individually, a result of legislation written without consulting healthcare experts, she says. 

If providers in Georgia get that interpretation wrong, they’re subject to a felony charge. 

Redd said she sees no difference in the message sent by lawmakers in Georgia and by federal Judge Matthew Kacsmaryk in Texas, whose ruling contains language derived from anti-abortion groups, such as the primary plaintiff in the lawsuit against the FDA. 

“All of these things are tied in with a stigma around abortion care and pieces of misinformation and disinformation around accessing abortion,” Redd said. 

In 2021, medication abortions accounted for more than half of all abortions in the country.