June 3, 2025 • 38 mins
Mifepristone is the first (and extremely safe) in two medications that people will take during a medication abortion—and access to it is under blatant attack in the courts. Dr. Ushma Upadhyay, Public Health Scientist based at University of California San Francisco, and Julia Kaye, Senior Staff Attorney with the ACLU’s Reproductive Freedom Project, sit down to talk with us about recent anti-abortion propaganda and how it could be used to shape the FDA’s regulations of medication abortion.
A past case, Alliance for Hippocratic Medicine v. FDA, was brought by anti-abortion groups to a federal judge in Texas known to have a hostile record against abortion with the goal of challenging the FDA’s mifepristone regulations. The Supreme Court ruled that these groups could not challenge the regulations in June 2024. Anti-abortion Attorneys General of Missouri, Kansas, and Idaho are now attempting to revive this litigation, called Missouri v. FDA. Meanwhile, a new report from a Project 2025-backed organization falsely states that 11% of people who have a medication abortion have a serious adverse event. Sec. Kennedy has cited this report as a basis for conducting a “complete review” of the FDA’s mifepristone regulations.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jennie (00:03):
Welcome to rePROs Fight Back, a podcast on all things
related to sexual andreproductive health rights and
justice. [music intro]Hi rePROs.
How's everybody doing?
I'm your host, Jennie Wetter,and my pronouns are she/ her.
So y'all, I'm going to do alittle bit of crowdsourcing
today.
There's a podcast that's amovie podcast that's interested
(00:24):
in having me come on to talkabout movies and talk about a
movie with abortion in it, andmy brain is struggling at the
moment, so I would love to hearsome of y'all's favorite movies
that have abortion storylines.
The one that obviously comes tomy mind is Dirty Dancing, but
they've already done DirtyDancing.
So, I would just really love tohear some more options.
(00:48):
And I would really like to keepit realistic and maybe
current-ish.
The other thing that I'm hopingto avoid is one where, like,
Revolutionary Road, where thepregnant person died.
So ideally, not that, but...
definitely open.
It's something I can have aconversation about on the
(01:10):
podcast, even if the pregnantperson does die.
But I really want to keep it alittle bit more true to what we
see right now.
So if anybody has any greatideas, I would love, love, love
to hear them.
What is your favorite moviethat has an abortion storyline?
I would love to hear all aboutit.
You can reach out to me onsocial media.
(01:31):
I'm on Blue Sky and sometimesstill on Twitter, mostly just to
share episodes, but you canstill find me there it's @Jennie
in DC and that's Jennie with anIE or you can feel free to shoot
me an email it'sjennie@reprosfightback.com.
Always love to hear from y'allbut yeah if you could shoot me
(01:52):
what your favorite movie with anabortion storyline is I would
really appreciate it— like Isaid my brain is like struggling
at the moment and I'm surethere are lots of great ones and
I will also be checking out theamazing resource that ANSIRH
has that has movies and TV showsthat have abortion in it, but I
still would love to hear whatall of y'all's favorite is.
(02:13):
So, shoot me a note.
I would really love that.
Let's see.
What else?
I don't know.
I've been not baking as muchlately.
And I don't know why that isI've just like not been in the
mood I had for so long I hadbeen really you know making what
(02:34):
I was gonna eat for breakfastthat week on Sunday and I just I
don't know if I'm just not beenfeeling making bread because I
feel like the last couple thingsI made were like lemon bars or
some deserty thing or somethingelse that was quick and so I
feel like I need to get back onon the baking what I want for
(02:58):
breakfast train and I just Ihaven't been there right now and
so if anybody has any recipesthat are like inspiring them to
to bake at the moment I wouldlove to hear them.
Like I said, I just I don'tknow.
I feel like Sunday rollsaround, and I have the best of
(03:18):
intentions of baking somethingfor the week, and I've just
been, like, I don't want to.
So, I feel like I need to getstarted again.
I feel like once I start, it'llbe better, but maybe I'll start
small and shoot for muffinsthis weekend or something like
that, something quick and easybefore I tackle a yeasted bread
(03:39):
or something.
I don't know.
I've just not been in the mood.
Yeah, I don't know why.
I'm going to have to work onthat.
Let's see.
I don't know if I have anythingelse too exciting that's been
going on.
Like I said, I haven't been inthe mood to bake.
I've still been doing a lot ofreading, which, as you know, is
a big hobby and one of myfavorites.
I have been kind of all over onmy reading, though, and...
(04:03):
mostly I've been I- so I dolove reading but I also love
looking for books to read and mybuying them and downloading
them on my my Nook account hasgotten out of hand y'all and so
I've been trying really hard tonot buy anything new and just
(04:25):
read down what I already haveand I've been doing pretty good
about it I think I bought somenew stuff for the trip I took
but I That was a while ago, butI had bought them, like, way in
advance of the trip.
So I'm really, my goal is to,like, really read down what I
(04:46):
have on my e-reader at themoment.
And it's hard because I keepseeing books I want to read.
So, my wish list is gettingreally long again.
And what always happens is Ithen break and buy a bunch of
books.
And then my reading down thelist is shot to hell because I
(05:07):
buy more than I had read.
I need to not do that.
So, that is my goal for thesummer—no new books. Just read
down what I already have on mye-reader.
So, that is going to be my goalfor the summer.
We'll see what happens.
But I'm going to try.
I'm going to try to make a realdent because there are so many
I already have on there that Ijust need to get it under
(05:31):
control.
Okay.
I think, like, let's turned tothis week's interview.
I'm very excited about it thereis a lot happening around
Mifepristone right now andaccess to Mifepristone between
lawsuits and possible action atthe FDA so I thought it was
really important to talk aboutwhat is going on and talk about
this new "study"— and that issaid with the world's largest
(05:56):
air quotes around it —talkingabout how medication abortion is
unsafe (06:00):
spoiler it is not and that study is a bunch of junk.
But let's talk about it thisweek so that you can be up to
date on what is happening.
And I could not think of twobetter advocates to come on and
talk about it.
I'm so excited to have with methis week, Dr.
Ushma Upadhyay with theUniversity of California, San
(06:21):
Francisco, and Julia Kaye withthe ACLU.
And with that, let's go to myconversation with Dr.
Upadhyay and Julia.
Hi, Julia and Dr.
Upadhyay.
Thank you so much for beinghere today.
Ushma (06:35):
Thanks for having us.
Julia (06:36):
Thanks so much for having us on.
Jennie (06:38):
So before we get started, would you like to take
a minute and introduceyourselves?
Dr.
Upadhyay, would you like to gofirst?
Sure.
Ushma (06:45):
I'm Ushma Upadhyay, and you can call me Ushma.
I'm a public health scientistbased at University of
California, San Francisco, and Iprimarily do research on
abortion access and abortionpolicy and abortion safety.
Julia (07:01):
I'm Julia Kaye.
My pronouns are she/ her.
I am a senior staff attorneywith the ACLU's Reproductive
Freedom Project, and I lead ourlitigation relating to
medication abortion.
Jennie (07:12):
I'm so excited to talk to both of you about everything
happening around medicationabortion right now because I
feel like there is so muchhappening.
Maybe we'll take like a quicksecond and do just like a little
bit of background before we getinto like what is happening at
the moment.
Ushma, do you want to talk alittle bit about, we're going to
talk about Mifepristone a lot,so maybe just, like, take a
(07:32):
quick second and make sureeverybody's on the same page of
what we're talking about when wetalk about Mifepristone.
Ushma (07:38):
Sure.
Mifepristone is the first ofthe two medications that a
person will take during amedication abortion.
Sometimes it's called theabortion pill, which is kind of
a misnomer because there'smultiple pills, but it's fine to
call it the abortion pill.
Mifepristone actually stops apregnancy from growing.
(08:00):
And then misoprostol, which istaken about 24 to 48 hours after
the mifepristone, causesuterine contractions and causes
the uterus to empty.
Jennie (08:11):
Awesome, I always just love to make sure everybody's on
the same page when we getstarted.
Julia, there has been a lawsuitgoing around, and I feel like
people have probably heard aboutit, especially because the
administration took actionrecently that got reported all
over the place in ways that Ithink, if you're not steeped in
this stuff like we are, couldhave been confusing.
So, maybe we can talk a littlebit about the legal challenges
(08:34):
we've seen.
Julia (08:35):
Yeah, I think that it does make sense to start with
the attacks on medicationabortion moving through the
courts.
So, your listener's may recalla case called Alliance for
Hippocratic Medicine v.
FDA.
And this was a lawsuit that agroup of anti-abortion
organizations and doctorsbrought shortly after the Dobbs
(08:57):
decision over ruling Roe v.
Wade.
And they filed it in Amarillo,Texas, where they could
guarantee that it would be heardby a
particular federal judge with a record of hostility on abortion. Theseanti-abortion groups and
doctors asked the court to undovirtually every single
regulatory decision the FDA hadmade relating to mifepristone,
(09:21):
going all the way back to theFDA's original approval of
mifepristone in 2000.
And the Texas judge, as theyhad hoped and expected,
rubber-stamped all of theirrequests.
The case ultimately went up tothe U.S.
Supreme Court.
And last June of 2024, theSupreme Court held that these
(09:45):
anti-abortion organizations andgroups did not have legal
standing to challenge the FDA'sMifepristone regulations.
And that is because theseplaintiffs did not use
mifepristone themselves, theydid not prescribe mifepristone,
and they had absolutely noconnection to the FDA's
regulation of mifepristone otherthan their desire to see all
(10:06):
abortion banned everywhere.
So, the Supreme Court kickedthe case on that standing
question.
But the extremist anti-abortionattorneys general of three
states, were not to be deterredfrom their quest to restrict abortion access nationwide and so they basically picked up the baton. And now
(10:49):
we have the states of Missouri, Kansas, and Idaho attempting to revive this litigation and specifically they want to continue the attacks on medication abortion in the courtroom of the same Texas judge who previously ruled to take mifepristone off the market nationwide. So, this case is calledMissouri v.
FDA, but it is taking place inAmarillo, Texas.
So shortly before DonaldTrump's inauguration, the Biden
administration's Department ofJustice filed something called a
motion to dismiss.
And in that motion, they raiseda range of procedural and
(11:12):
technical defects with the case.
And now, this is a prettystandard thing for defendants in
litigation to file.
This is your first opportunityas a defendant to try to make a
case go away.
But the procedural defects inMissouri's case are hit you over
the head obvious.
For one thing, it ispreposterous that Missouri,
(11:36):
Kansas, and Idaho should be ableto sue the federal government
in Texas, where they have noconnection, just because they
want to guarantee that the caseis heard by a judge with a
record ofhostility on abortion. On top of
that, the states lack legalstanding for the same reasons
that the original plaintiffs inthis case lacked legal standing.
(12:00):
They are past the statute oflimitations for some of the
challenges they are bringing tothe FDA's regulatory updates in
2016.
And the bottom line is they aretrying to revive a case that
the US Supreme Court held wasdefective from the start.
This case, it is as though itnever existed because the
(12:23):
Supreme Court said that theoriginal plaintiffs never had a
right to sort of walk throughthe courthouse doors in the
first instance.
So it is just glaringly obviousthat Missouri and co.
should not be able to try topiggyback on this defective case
in order to stay in court inTexas.
So that's what theBiden Department of Justice argued before they left office. Then
(12:49):
in March, it was time for theTrump Department of Justice to
weigh in for the first time.
And many folks were watching tosee, would the Trump
administration change course?
Ultimately, the TrumpDepartment of Justice continued
to make the same technicalarguments on this motion to
dismiss that the BidenDepartment of Justice had.
(13:09):
But I want to be very clearthat the Trump administration
continued said absolutelynothing about the merits of the
case, about the validity of theFDA's decisions to lift certain
of its regulations onmifepristone, nothing on the
merits at all.
It really was not a motionabout abortion at all.
(13:31):
They were just raising thesepreliminary technical questions.
And so, I'm really glad youasked about this because I think
that some reporters were takenby surprise to see the Trump
administration file a motion todismiss a case that one would
expect the Trump administrationto be sympathetic to, and
(13:53):
interpreted this as a reallysignificant decision to defend
access to Mifepristone, when infact, it was just the Trump DOJ
making the same proceduraldefenses that they have raised,
will be raising, want to raisein many of the other cases the
(14:14):
Trump administration iscurrently defending.
Jennie (14:16):
Yeah, I feel like I got a lot of questions about it of
like, are you excited?
And like, isn't this greatnews?
And it was just like, I mean, Ijust assume it's because they
have something else plannedthat's probably worse.
And like, that this isnot something to celebrate. I mean, the bar is so low for celebration but like... no?
Julia (14:39):
Yeah, I think you were very right to be wary.
And as I'm sure we will get toshortly, it is now clear that
the Trump administration isteeing up new nationwide
restrictions on medicationabortion.
Jennie (14:53):
I'm not really sure the best place to start on what's
next because they kind of happensimultaneously.
Maybe, Ushma, we'll go to youand talk about this study that
is being used to try and attackmedication abortion with the
FDA, and we'll get to the FDApart after we talk about the
(15:16):
study and all of the greatresearch.
Ushma (15:18):
Yeah, I don't you know to call it a study would be very
generous so we'll go with likereport.
Jennie (15:25):
Yeah, it felt like there should be air quotes.
Ushma (15:27):
[chuckles] Yeah there's you know we call it the the new
EPPC report that has come out uhthe issue is that they have
they've come out and they haveestimated that 11% of people who
have a medication abortion havea serious adverse event.
(15:49):
And when you take a deep dive,and it's actually, you can
hardly even take a deep divebecause it is a report.
It is not a study.
It's very thin on details andvery thin on the methodology.
It was published on theirwebsite.
It's not peer-reviewed, and itwas not published in a journal.
(16:11):
So , those are the makings of astudy when it is...
Jennie (16:16):
Those all feel real important.
Ushma (16:18):
Yeah.
I mean, it's...
part of the vetting process,the standard medical vetting
process that any study goesthrough.
Julia (16:26):
I think it might be helpful to give it a little
context for who the Ethics andPublic Policy Center is that
published this report.
This is a Project 2025 sponsororganization whose stated
mission is to inject religiousideology into law and policy.
One of the reports toco-authors recently published a
(16:49):
book entitled Abortion HarmsEverything.
So you can't make this up.
So it is very clear that theyhad an overt ideological goal in
publishing this paper and thatthe timing of the publication
was not a coincidence.
They are...
(17:09):
the anti-abortion folks likeEPPC, they are desperate to get
the FDA to reverse some of itsupdates to its mifepristone
regulations.
And they took this opportunityas part of a coordinated attack
to release this junk sciencewhite paper and then have
(17:33):
members of Congress like SenatorJosh Hawley wave it around and
say to Secretary Kennedy, HHSSecretary Kennedy and FDA
Commissioner Marty McCary, whatare you going to do about
Mifepristone?
Look at this.
Look at these alarming numbers.
What are you going to do?
And reporting from Politicorecently connected all of these
(17:56):
dots.
And in fact, there is acampaign name.
This is called OperationMifepristone, Rolling Thunder,
which is truly hilarious.
Truly hilarious if what they'retrying to do weren't so...
seriously scary.
Ushma (18:13):
Yeah, it uses a lot of the same methods that another
paper authored by Studnicki fromthe Lozier Institute used in a
previous paper, which wasretracted.
And so, that is why I thinkthat they chose not to publish
it in a peer reviewed journal,because it would certainly, if
(18:35):
it got through a peer reviewprocess, it would certainly get
retracted as well.
Jennie (18:39):
I feel it's worth taking the time— we don't need to
debunk it point by point—butobviously, as somebody who
researches medication abortion,do you maybe want to tackle some
of the safety claims at least alittle bit?
Ushma (18:54):
Yeah.
I mean, I have a 10-pointdocument if anyone wants to read
it.
Jennie (19:00):
Oh, I read it.
It was good.
Ushma (19:01):
I can get to that.
But I think overall, the topthree issues that I have with it
is number one—and I want toshare these top three issues
because as you hear aboutabortion safety, these are the
red flags that you should be onthe lookout for—number one is
they classify any emergencydepartment visit that was within
45 days after an abortion as asa serious adverse event.
(19:26):
And everyone knows people go tothe emergency department when
they can't get a regular sourceof care.
We have research that showsthat when people live further
away from their originalabortion provider, they'll go to
an ER to ask questions aboutside effects: is this amount of
bleeding normal?
The other thing is people willgo a few weeks after their
(19:48):
abortion pills- taking theabortion pills to find out: am I
still pregnant or not?
Because a pregnancy test won'twork until about four or five
weeks after the abortion becausethe pregnancy hormone is still
in the system.
And so, they'll want anultrasound: is my abortion
complete?
Can I get back to my life?
And just any questions aboutbleeding.
(20:10):
So that is number one.
The second issue is that wealso know that after a
medication abortion, about threeto five percent of all people
who take abortion pills willneed a little more treatment.
It just, they just don'tresults in a complete abortion
for three to five percent ofpeople.
And those individuals may needa procedure to complete the
(20:33):
abortion, or they may needanother round of medications,
misoprostol, to complete theabortion.
And so anyone who had anadditional procedure was
classified as a serious adverseevent.
Now, it's not serious.
It doesn't even have to be donein an emergency room.
But even if somebody had thatprocedure within 45 days at
(20:54):
their OBGYN, that was classifiedas a serious adverse event.
And then third, it's reallyopaque about how they identified
the index abortion, theabortion, the medication
abortion.
They talk about using pharmprescriptions for mifepristone.
There's a lack of clarity onwhether they picked up
(21:17):
mifepristone that might havebeen prescribed to treat
miscarriage.
Sometimes people will, ifthey're pregnant, pregnant
people, they're experiencingbleeding, they might go to an
emergency room, be diagnosedwith a miscarriage and receive
mifepristone and misoprostolright then and there to treat
the miscarriage.
This is not a complication ofabortion, but yet that
(21:40):
situation, that case would havebeen classified as a serious
adverse event.
So there's a lot of, you know,in a normally peer-reviewed
scientific paper, all of thiswould be very clear in the
methods section.
And sometimes the methodssections are longer than the
results.
And so because you have tospecify the procedures that you
(22:00):
took so that the study can bereplicated by others.
Oh, and the other big, hugestissue is that they do not say
what database they use.
They say it's the largeall-payer insurance claims
database, and they don't revealwhich one.
So that also means we can'treplicate it.
Jennie (22:22):
And am I misremembering, but they didn't even classify
like what you went to theemergency room for?
Like you could have gotten intoa car accident and like...
unrelated to your abortion andthat got counted?
Ushma (22:35):
They said abortion related, but they counted, you
know, and we learn about alittle bit more because they
subsequently released an FAQdocument.
And they said, no, if somebodybroke their leg, that was not
classified, but any infection.
So if somebody had a UTI,right, which is common in among
(22:57):
people who were sexually active.
If anyone had an STI, asexually transmitted infection,
which was not caused by theabortion, it was caused by the
sex that caused the abortion andthe STI.
Those were all classified asserious adverse events.
So yes, absolutely lots ofunrelated conditions, you know,
(23:19):
conditions unrelated to theabortion were classified as
serious adverse events.
Jennie (23:23):
And we'll definitely make sure to include that
10-point breakdown in our shownotes so people can look at it
because I found it reallyhelpful to read through.
Julia (23:31):
The other thing that jumped out at me from a policy
perspective is that the reportstarts with a series of policy
changes that FDA allegedlyshould make based on the paper's
findings.
But there's actually no logicalconnection between the policy
(23:53):
changes they want to see— thesame policy changes that were
called for in Project 2025— andthe study's findings, even if
you take this pseudo-study'sresults at face value.
So for instance, they arguethat their report is a basis for
reinstating the FDA's formerrequirement that mifepristone be
(24:18):
dispensed only on site at ahospital clinic or medical
office.
And they call on the FDA toblock the use of telemedicine
for medication abortion toprevent patients from filling
their prescription by mail or ata local pharmacy.
But the paper says absolutelynothing about how mifepristone
(24:39):
was dispensed in the cases wherethey claim to have identified
serious adverse events.
It just provides no informationat all on whether those
patients obtained care in personor through telemedicine,
whether the medication wasdispensed by mail or at a clinic
on site or at a pharmacy, andyet somehow they take their
(24:59):
nonsense propaganda findings asa basis for this wish list of
policy changes that have nothingto do with even the
complications they claim to havefound.
Ushma (25:10):
I'll add to that.
The study was from 2017 to2023.
And yes, it was legal during,you know, after 2021, there was
telehealth medication abortion.
However, the vast, vastmajority of providers of
telehealth abortion between 2021and 2023 did not accept health
(25:32):
insurance.
They are largely the telehealthproviders that are virtual
clinics, like Hey Jane, Abortionon Demand.
They primarily during thisperiod, they did not accept
health insurance.
So, there is no way thatthere's any reasonable
proportion of the patients inthe data set.
So, there is minimal chancethat there's a reasonable number
(25:57):
of patients who had atelehealth abortion that is
represented in this data set.
Jennie (26:02):
Okay, so the next part that we need to talk about is
what is going on with the FDAand how this is being, honestly,
how this is being coordinated,because this all came out in a
very coordinated manner, like...
starting with, I think it wasKennedy's testimony and being
(26:24):
like, well, you know, if I hadmore information, we could take
action type thing.
So maybe let's talk a littlebit about some of the stuff
that's happening at FDA.
Julia (26:33):
A few weeks ago on the Hill at a Senate hearing,
Secretary Kennedy revealed thathe has directed the FDA to
undertake, in his words, "acomplete review of its
mifepristone regulations." Andhe cited this propaganda from
the Ethics and Public PolicyCenter as a basis for and the
(26:56):
focus of this review.
This is extremely troubling onmany levels.
Let me start by saying that ifFDA were going to undertake a
good faith review of theextensive data confirming
Mifepristone's exceptionalsafety record, we would be all
(27:18):
for that because actually FDAshould take a closer look at its
regulations on mifepristone andon the basis of mifepristone's
exceptional safety record, liftits remaining medically
unjustified and burdensomerestrictions on mifepristone.
That is what the nation'sleading medical associations
(27:39):
like the American MedicalAssociation, like the American
College of Obstetricians andGynecologists, they have long
been calling for FDA toeliminate its uniquely
burdensome and unjustifiedrestrictions on this very safe
and effective medication.
But that is not what we expectto see here.
And really, the tell is thatthis propaganda from this
(28:07):
Project 2025 sponsororganization is the apparent
motivation for the review.
There is every reason tobelieve that this FDA review is
ordered by HHS Secretary Kennedyis a precursor to imposing
greater nationwide restrictionson medication abortion that will
(28:31):
severely reduce accesseverywhere in the country,
including in states whereabortion access is legally
protected.
We should be very, veryconcerned about the likely
outcome here.
And the other piece of it thatI want to lift up is that
Secretary Kennedy said at thishearing that it was going to be
(28:53):
President Trump's decisionultimately whether the FDA
changes its policy here.
So, if we had any doubt thatthis was not going to be a
review and a policy decisiongrounded in scientific
expertise.
There's no reason to doubt anylonger because Secretary Kennedy
(29:14):
told us this is going to be apolitical decision.
In his words, it's going tocome through the White House.
We should all be very scared ifour access to safe, effective
FDA approved medications isbased not on medical expertise,
but on President Trump's gutinstinct.
Jennie (29:32):
I just, like, bigger than the abortion part, I just
think of, like, the loss oftrust that this could cause.
Like, people trust if thingsare FDA approved, that they are
safe.
And if they see thispoliticization, like, really
seeping into the system...
sorry, cat took out mynotebook.
(29:52):
It could present greater harmsin the future.
Ushma (29:57):
Yeah, I think what troubles me is that we're so
focused on holding back, keepingthe status quo when my energy
as a researcher should befocused on studies that are
proactive— that test, you know,gestational limit of 12 weeks
(30:18):
and 13 weeks for medicationabortion.
We should be pushing thescience forward, not replicating
the same safety studies to showwhat we already know so that
it's more current and that wecould defend the currently
overly restricted regulations onmifepristone.
(30:38):
So, I worry that this is adistraction that's keeping us
busy when we could be moreproactive and make this
medication even more accessiblethan it already is.
Jennie (30:50):
I think the other thing I really worry about is what
this would mean to access tocare.
So, like, if the FDA tookaction, I mean, there's a whole
range of things they could do,but even putting back in place
the in-person requirements,like, what this would mean for
the system providing abortionright now.
Ushma (31:08):
A lot of my research focuses on telehealth abortion.
I just completed a very largestudy on the safety of
telehealth abortion, and wefound that the safety rate and
the effectiveness rate wasexactly the same as in-person
care (31:24):
98% of people had a complete abortion, and then it
was a quarter of 1% had aserious adverse event, even
without any contact with anabortion provider and any
in-person contact.
And there's asynchronoustelehealth care available now
(31:47):
that many people prefer becauseit allows people autonomy and
the ability to access thistelehealth medical care through
an app or online or whilethey're at work or while they
are taking care of theirchildren And in our study, in
our research, we found thatpeople who face the most health
inequities, including youngerpeople, people living on lower
(32:09):
incomes, people living in ruralareas, and those who lived
further away from abortionclinics, were more likely to say
that telehealth enabled them tohave an abortion sooner and at
all.
So, it really made thedifference for people who are
most marginalized from healthcare.
Julia (32:28):
Right now, more than 20% of all U.S.
abortions are provided viatelehealth with the patient
receiving the medication by mailor at a local pharmacy.
So we are not talking aboutsome small sliver of care.
We are talking about potentialagency action that would upend
(32:51):
the way abortion care isdelivered and across the
country, and that's justfocusing on the risk that the
in-person pill pickuprequirement will be reinstated.
We do not know if the FDA isgoing to restrict which
qualified healthcareprofessionals are permitted to
prescribe this medication,whether they are going to
(33:15):
withdraw approval for thegeneric version of mifepristone
that comprises two-thirds of themarket, withdraw approval from
mifepristone altogether.
At this point, it seems likeeverything could be on the
table.
And so, the threat here is verygrave.
Jennie (33:33):
Okay.
So I don't like to end withjust like, here's what's
happening and things are bad.
Let's do a little bit of whatcan our audience do?
How can they get involved inthe fight for some of this
stuff?
Ushma (33:49):
Well, Telehealth is really expanding access right
now, as I mentioned previously.
One thing we didn't talk aboutare shield laws that are in
several states across thecountry that reduce legal risks
for providers who offertelehealth abortion for people
living in states with abortionbans.
(34:11):
These have been critical toexpanding access to enabling
people to get abortion care andreally it has been a lifesaver
for so many people.
And so , these providers,oftentimes people don't have the
ability to pay for theseabortion pills, as well as
people who are traveling verylong distances to obtain
(34:34):
in-person care.
So, I think the number onething that people could do is
support their local abortionfunds, support abortion funds
that help people living inbanned states get connected to
care.
So, that is one thing.
Julia (34:49):
Yeah, absolutely echo that supporting abortion funds
is a critical way for folks toget involved, specifically on
the question of the FDA's reviewand this threat of new
nationwide restrictions onmedication abortion.
The FDA's decision here shouldbe based purely on science, on
the mountain of safety data thatwe have for mifepristone over
(35:13):
25 years.
But it appears that it isinstead going to be based on
politics.
So, I think this is a moment tomake sure that your political
representatives know where youstand on abortion access.
That includes your members ofCongress, President Trump, we
need to be loud about howimportant it is to protect
(35:35):
access to medication abortion.
We should be calling ourmembers of Congress and
demanding that they do what theycan to protect medication
abortion access, to protecttelehealth access in particular,
to hold the FDA accountable andmake sure that the FDA is
following the science.
And I want to just, again,state that what the FDA should
(35:58):
be doing here is liftingmedically unnecessary
restrictions on this very safeand effective medication, not
imposing greater barriers tocare.
The other thing I wouldencourage your listeners to do
is sign up for the ACLU'svolunteer network, which is
called People Power.
If you just Google ACLU andPeople Power, you will find a
(36:20):
website there.
And that is how we will connectyou with opportunities to make
your voice heard to agencieslike HHS and FDA, to members of
Congress.
There are a variety of actionsthat we will be encouraging
folks to take on abortionaccess, including and beyond
medication abortion.
And then you can also be tappedinto the full range of work
(36:43):
that the ACLU is doing at thiscritical moment, including with
respect to trans justice andprotecting access to gender
affirming medical care, attackson immigrants, on free speech,
on so much more.
So, People Power, ACLU, and wewould love to have you as part
of our community and actionpower.
Jennie (37:05):
Well, Julia, Ushma, thank you so much for being
here.
It was so lovely to talk toboth of you.
100%.
Julia (37:11):
Thanks so much for having us, Jennie.
Ushma (37:13):
Thank you.
Thanks for addressing thistopic.
I think it's something thatpeople should know about
proactively, even before theyhear what happens with the
ongoing cases.
Jennie (37:24):
Okay, y'all, I hope you enjoyed my conversation with Dr.
Upadhyay and Julia.
It was so great talking to themabout everything happening
around Mifepristone right now.
And with that, I will seeeverybody in two weeks.
[music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all!
Welcome to rePROs Fight Back, a podcast on all things
related to sexual andreproductive health rights and
justice. [music intro]Hi rePROs.
How's everybody doing?
I'm your host, Jennie Wetter,and my pronouns are she/ her.
So y'all, I'm going to do alittle bit of crowdsourcing
today.
There's a podcast that's amovie podcast that's interested
(00:24):
in having me come on to talkabout movies and talk about a
movie with abortion in it, andmy brain is struggling at the
moment, so I would love to hearsome of y'all's favorite movies
that have abortion storylines.
The one that obviously comes tomy mind is Dirty Dancing, but
they've already done DirtyDancing.
So, I would just really love tohear some more options.
(00:48):
And I would really like to keepit realistic and maybe
current-ish.
The other thing that I'm hopingto avoid is one where, like,
Revolutionary Road, where thepregnant person died.
So ideally, not that, but...
definitely open.
It's something I can have aconversation about on the
(01:10):
podcast, even if the pregnantperson does die.
But I really want to keep it alittle bit more true to what we
see right now.
So if anybody has any greatideas, I would love, love, love
to hear them.
What is your favorite moviethat has an abortion storyline?
I would love to hear all aboutit.
You can reach out to me onsocial media.
(01:31):
I'm on Blue Sky and sometimesstill on Twitter, mostly just to
share episodes, but you canstill find me there it's @Jennie
in DC and that's Jennie with anIE or you can feel free to shoot
me an email it'sjennie@reprosfightback.com.
Always love to hear from y'allbut yeah if you could shoot me
(01:52):
what your favorite movie with anabortion storyline is I would
really appreciate it— like Isaid my brain is like struggling
at the moment and I'm surethere are lots of great ones and
I will also be checking out theamazing resource that ANSIRH
has that has movies and TV showsthat have abortion in it, but I
still would love to hear whatall of y'all's favorite is.
(02:13):
So, shoot me a note.
I would really love that.
Let's see.
What else?
I don't know.
I've been not baking as muchlately.
And I don't know why that isI've just like not been in the
mood I had for so long I hadbeen really you know making what
(02:34):
I was gonna eat for breakfastthat week on Sunday and I just I
don't know if I'm just not beenfeeling making bread because I
feel like the last couple thingsI made were like lemon bars or
some deserty thing or somethingelse that was quick and so I
feel like I need to get back onon the baking what I want for
(02:58):
breakfast train and I just Ihaven't been there right now and
so if anybody has any recipesthat are like inspiring them to
to bake at the moment I wouldlove to hear them.
Like I said, I just I don'tknow.
I feel like Sunday rollsaround, and I have the best of
(03:18):
intentions of baking somethingfor the week, and I've just
been, like, I don't want to.
So, I feel like I need to getstarted again.
I feel like once I start, it'llbe better, but maybe I'll start
small and shoot for muffinsthis weekend or something like
that, something quick and easybefore I tackle a yeasted bread
(03:39):
or something.
I don't know.
I've just not been in the mood.
Yeah, I don't know why.
I'm going to have to work onthat.
Let's see.
I don't know if I have anythingelse too exciting that's been
going on.
Like I said, I haven't been inthe mood to bake.
I've still been doing a lot ofreading, which, as you know, is
a big hobby and one of myfavorites.
I have been kind of all over onmy reading, though, and...
(04:03):
mostly I've been I- so I dolove reading but I also love
looking for books to read and mybuying them and downloading
them on my my Nook account hasgotten out of hand y'all and so
I've been trying really hard tonot buy anything new and just
(04:25):
read down what I already haveand I've been doing pretty good
about it I think I bought somenew stuff for the trip I took
but I That was a while ago, butI had bought them, like, way in
advance of the trip.
So I'm really, my goal is to,like, really read down what I
(04:46):
have on my e-reader at themoment.
And it's hard because I keepseeing books I want to read.
So, my wish list is gettingreally long again.
And what always happens is Ithen break and buy a bunch of
books.
And then my reading down thelist is shot to hell because I
(05:07):
buy more than I had read.
I need to not do that.
So, that is my goal for thesummer—no new books. Just read
down what I already have on mye-reader.
So, that is going to be my goalfor the summer.
We'll see what happens.
But I'm going to try.
I'm going to try to make a realdent because there are so many
I already have on there that Ijust need to get it under
(05:31):
control.
Okay.
I think, like, let's turned tothis week's interview.
I'm very excited about it thereis a lot happening around
Mifepristone right now andaccess to Mifepristone between
lawsuits and possible action atthe FDA so I thought it was
really important to talk aboutwhat is going on and talk about
this new "study"— and that issaid with the world's largest
(05:56):
air quotes around it —talkingabout how medication abortion is
unsafe (06:00):
spoiler it is not and that study is a bunch of junk.
But let's talk about it thisweek so that you can be up to
date on what is happening.
And I could not think of twobetter advocates to come on and
talk about it.
I'm so excited to have with methis week, Dr.
Ushma Upadhyay with theUniversity of California, San
(06:21):
Francisco, and Julia Kaye withthe ACLU.
And with that, let's go to myconversation with Dr.
Upadhyay and Julia.
Hi, Julia and Dr.
Upadhyay.
Thank you so much for beinghere today.
Ushma (06:35):
Thanks for having us.
Julia (06:36):
Thanks so much for having us on.
Jennie (06:38):
So before we get started, would you like to take
a minute and introduceyourselves?
Dr.
Upadhyay, would you like to gofirst?
Sure.
Ushma (06:45):
I'm Ushma Upadhyay, and you can call me Ushma.
I'm a public health scientistbased at University of
California, San Francisco, and Iprimarily do research on
abortion access and abortionpolicy and abortion safety.
Julia (07:01):
I'm Julia Kaye.
My pronouns are she/ her.
I am a senior staff attorneywith the ACLU's Reproductive
Freedom Project, and I lead ourlitigation relating to
medication abortion.
Jennie (07:12):
I'm so excited to talk to both of you about everything
happening around medicationabortion right now because I
feel like there is so muchhappening.
Maybe we'll take like a quicksecond and do just like a little
bit of background before we getinto like what is happening at
the moment.
Ushma, do you want to talk alittle bit about, we're going to
talk about Mifepristone a lot,so maybe just, like, take a
(07:32):
quick second and make sureeverybody's on the same page of
what we're talking about when wetalk about Mifepristone.
Ushma (07:38):
Sure.
Mifepristone is the first ofthe two medications that a
person will take during amedication abortion.
Sometimes it's called theabortion pill, which is kind of
a misnomer because there'smultiple pills, but it's fine to
call it the abortion pill.
Mifepristone actually stops apregnancy from growing.
(08:00):
And then misoprostol, which istaken about 24 to 48 hours after
the mifepristone, causesuterine contractions and causes
the uterus to empty.
Jennie (08:11):
Awesome, I always just love to make sure everybody's on
the same page when we getstarted.
Julia, there has been a lawsuitgoing around, and I feel like
people have probably heard aboutit, especially because the
administration took actionrecently that got reported all
over the place in ways that Ithink, if you're not steeped in
this stuff like we are, couldhave been confusing.
So, maybe we can talk a littlebit about the legal challenges
(08:34):
we've seen.
Julia (08:35):
Yeah, I think that it does make sense to start with
the attacks on medicationabortion moving through the
courts.
So, your listener's may recalla case called Alliance for
Hippocratic Medicine v.
FDA.
And this was a lawsuit that agroup of anti-abortion
organizations and doctorsbrought shortly after the Dobbs
(08:57):
decision over ruling Roe v.
Wade.
And they filed it in Amarillo,Texas, where they could
guarantee that it would be heardby a
particular federal judge with a record of hostility on abortion. Theseanti-abortion groups and
doctors asked the court to undovirtually every single
regulatory decision the FDA hadmade relating to mifepristone,
(09:21):
going all the way back to theFDA's original approval of
mifepristone in 2000.
And the Texas judge, as theyhad hoped and expected,
rubber-stamped all of theirrequests.
The case ultimately went up tothe U.S.
Supreme Court.
And last June of 2024, theSupreme Court held that these
(09:45):
anti-abortion organizations andgroups did not have legal
standing to challenge the FDA'sMifepristone regulations.
And that is because theseplaintiffs did not use
mifepristone themselves, theydid not prescribe mifepristone,
and they had absolutely noconnection to the FDA's
regulation of mifepristone otherthan their desire to see all
(10:06):
abortion banned everywhere.
So, the Supreme Court kickedthe case on that standing
question.
But the extremist anti-abortionattorneys general of three
states, were not to be deterredfrom their quest to restrict abortion access nationwide and so they basically picked up the baton. And now
(10:49):
we have the states of Missouri, Kansas, and Idaho attempting to revive this litigation and specifically they want to continue the attacks on medication abortion in the courtroom of the same Texas judge who previously ruled to take mifepristone off the market nationwide. So, this case is calledMissouri v.
FDA, but it is taking place inAmarillo, Texas.
So shortly before DonaldTrump's inauguration, the Biden
administration's Department ofJustice filed something called a
motion to dismiss.
And in that motion, they raiseda range of procedural and
(11:12):
technical defects with the case.
And now, this is a prettystandard thing for defendants in
litigation to file.
This is your first opportunityas a defendant to try to make a
case go away.
But the procedural defects inMissouri's case are hit you over
the head obvious.
For one thing, it ispreposterous that Missouri,
(11:36):
Kansas, and Idaho should be ableto sue the federal government
in Texas, where they have noconnection, just because they
want to guarantee that the caseis heard by a judge with a
record ofhostility on abortion. On top of
that, the states lack legalstanding for the same reasons
that the original plaintiffs inthis case lacked legal standing.
(12:00):
They are past the statute oflimitations for some of the
challenges they are bringing tothe FDA's regulatory updates in
2016.
And the bottom line is they aretrying to revive a case that
the US Supreme Court held wasdefective from the start.
This case, it is as though itnever existed because the
(12:23):
Supreme Court said that theoriginal plaintiffs never had a
right to sort of walk throughthe courthouse doors in the
first instance.
So it is just glaringly obviousthat Missouri and co.
should not be able to try topiggyback on this defective case
in order to stay in court inTexas.
So that's what theBiden Department of Justice argued before they left office. Then
(12:49):
in March, it was time for theTrump Department of Justice to
weigh in for the first time.
And many folks were watching tosee, would the Trump
administration change course?
Ultimately, the TrumpDepartment of Justice continued
to make the same technicalarguments on this motion to
dismiss that the BidenDepartment of Justice had.
(13:09):
But I want to be very clearthat the Trump administration
continued said absolutelynothing about the merits of the
case, about the validity of theFDA's decisions to lift certain
of its regulations onmifepristone, nothing on the
merits at all.
It really was not a motionabout abortion at all.
(13:31):
They were just raising thesepreliminary technical questions.
And so, I'm really glad youasked about this because I think
that some reporters were takenby surprise to see the Trump
administration file a motion todismiss a case that one would
expect the Trump administrationto be sympathetic to, and
(13:53):
interpreted this as a reallysignificant decision to defend
access to Mifepristone, when infact, it was just the Trump DOJ
making the same proceduraldefenses that they have raised,
will be raising, want to raisein many of the other cases the
(14:14):
Trump administration iscurrently defending.
Jennie (14:16):
Yeah, I feel like I got a lot of questions about it of
like, are you excited?
And like, isn't this greatnews?
And it was just like, I mean, Ijust assume it's because they
have something else plannedthat's probably worse.
And like, that this isnot something to celebrate. I mean, the bar is so low for celebration but like... no?
Julia (14:39):
Yeah, I think you were very right to be wary.
And as I'm sure we will get toshortly, it is now clear that
the Trump administration isteeing up new nationwide
restrictions on medicationabortion.
Jennie (14:53):
I'm not really sure the best place to start on what's
next because they kind of happensimultaneously.
Maybe, Ushma, we'll go to youand talk about this study that
is being used to try and attackmedication abortion with the
FDA, and we'll get to the FDApart after we talk about the
(15:16):
study and all of the greatresearch.
Ushma (15:18):
Yeah, I don't you know to call it a study would be very
generous so we'll go with likereport.
Jennie (15:25):
Yeah, it felt like there should be air quotes.
Ushma (15:27):
[chuckles] Yeah there's you know we call it the the new
EPPC report that has come out uhthe issue is that they have
they've come out and they haveestimated that 11% of people who
have a medication abortion havea serious adverse event.
(15:49):
And when you take a deep dive,and it's actually, you can
hardly even take a deep divebecause it is a report.
It is not a study.
It's very thin on details andvery thin on the methodology.
It was published on theirwebsite.
It's not peer-reviewed, and itwas not published in a journal.
(16:11):
So , those are the makings of astudy when it is...
Jennie (16:16):
Those all feel real important.
Ushma (16:18):
Yeah.
I mean, it's...
part of the vetting process,the standard medical vetting
process that any study goesthrough.
Julia (16:26):
I think it might be helpful to give it a little
context for who the Ethics andPublic Policy Center is that
published this report.
This is a Project 2025 sponsororganization whose stated
mission is to inject religiousideology into law and policy.
One of the reports toco-authors recently published a
(16:49):
book entitled Abortion HarmsEverything.
So you can't make this up.
So it is very clear that theyhad an overt ideological goal in
publishing this paper and thatthe timing of the publication
was not a coincidence.
They are...
(17:09):
the anti-abortion folks likeEPPC, they are desperate to get
the FDA to reverse some of itsupdates to its mifepristone
regulations.
And they took this opportunityas part of a coordinated attack
to release this junk sciencewhite paper and then have
(17:33):
members of Congress like SenatorJosh Hawley wave it around and
say to Secretary Kennedy, HHSSecretary Kennedy and FDA
Commissioner Marty McCary, whatare you going to do about
Mifepristone?
Look at this.
Look at these alarming numbers.
What are you going to do?
And reporting from Politicorecently connected all of these
(17:56):
dots.
And in fact, there is acampaign name.
This is called OperationMifepristone, Rolling Thunder,
which is truly hilarious.
Truly hilarious if what they'retrying to do weren't so...
seriously scary.
Ushma (18:13):
Yeah, it uses a lot of the same methods that another
paper authored by Studnicki fromthe Lozier Institute used in a
previous paper, which wasretracted.
And so, that is why I thinkthat they chose not to publish
it in a peer reviewed journal,because it would certainly, if
(18:35):
it got through a peer reviewprocess, it would certainly get
retracted as well.
Jennie (18:39):
I feel it's worth taking the time— we don't need to
debunk it point by point—butobviously, as somebody who
researches medication abortion,do you maybe want to tackle some
of the safety claims at least alittle bit?
Ushma (18:54):
Yeah.
I mean, I have a 10-pointdocument if anyone wants to read
it.
Jennie (19:00):
Oh, I read it.
It was good.
Ushma (19:01):
I can get to that.
But I think overall, the topthree issues that I have with it
is number one—and I want toshare these top three issues
because as you hear aboutabortion safety, these are the
red flags that you should be onthe lookout for—number one is
they classify any emergencydepartment visit that was within
45 days after an abortion as asa serious adverse event.
(19:26):
And everyone knows people go tothe emergency department when
they can't get a regular sourceof care.
We have research that showsthat when people live further
away from their originalabortion provider, they'll go to
an ER to ask questions aboutside effects: is this amount of
bleeding normal?
The other thing is people willgo a few weeks after their
(19:48):
abortion pills- taking theabortion pills to find out: am I
still pregnant or not?
Because a pregnancy test won'twork until about four or five
weeks after the abortion becausethe pregnancy hormone is still
in the system.
And so, they'll want anultrasound: is my abortion
complete?
Can I get back to my life?
And just any questions aboutbleeding.
(20:10):
So that is number one.
The second issue is that wealso know that after a
medication abortion, about threeto five percent of all people
who take abortion pills willneed a little more treatment.
It just, they just don'tresults in a complete abortion
for three to five percent ofpeople.
And those individuals may needa procedure to complete the
(20:33):
abortion, or they may needanother round of medications,
misoprostol, to complete theabortion.
And so anyone who had anadditional procedure was
classified as a serious adverseevent.
Now, it's not serious.
It doesn't even have to be donein an emergency room.
But even if somebody had thatprocedure within 45 days at
(20:54):
their OBGYN, that was classifiedas a serious adverse event.
And then third, it's reallyopaque about how they identified
the index abortion, theabortion, the medication
abortion.
They talk about using pharmprescriptions for mifepristone.
There's a lack of clarity onwhether they picked up
(21:17):
mifepristone that might havebeen prescribed to treat
miscarriage.
Sometimes people will, ifthey're pregnant, pregnant
people, they're experiencingbleeding, they might go to an
emergency room, be diagnosedwith a miscarriage and receive
mifepristone and misoprostolright then and there to treat
the miscarriage.
This is not a complication ofabortion, but yet that
(21:40):
situation, that case would havebeen classified as a serious
adverse event.
So there's a lot of, you know,in a normally peer-reviewed
scientific paper, all of thiswould be very clear in the
methods section.
And sometimes the methodssections are longer than the
results.
And so because you have tospecify the procedures that you
(22:00):
took so that the study can bereplicated by others.
Oh, and the other big, hugestissue is that they do not say
what database they use.
They say it's the largeall-payer insurance claims
database, and they don't revealwhich one.
So that also means we can'treplicate it.
Jennie (22:22):
And am I misremembering, but they didn't even classify
like what you went to theemergency room for?
Like you could have gotten intoa car accident and like...
unrelated to your abortion andthat got counted?
Ushma (22:35):
They said abortion related, but they counted, you
know, and we learn about alittle bit more because they
subsequently released an FAQdocument.
And they said, no, if somebodybroke their leg, that was not
classified, but any infection.
So if somebody had a UTI,right, which is common in among
(22:57):
people who were sexually active.
If anyone had an STI, asexually transmitted infection,
which was not caused by theabortion, it was caused by the
sex that caused the abortion andthe STI.
Those were all classified asserious adverse events.
So yes, absolutely lots ofunrelated conditions, you know,
(23:19):
conditions unrelated to theabortion were classified as
serious adverse events.
Jennie (23:23):
And we'll definitely make sure to include that
10-point breakdown in our shownotes so people can look at it
because I found it reallyhelpful to read through.
Julia (23:31):
The other thing that jumped out at me from a policy
perspective is that the reportstarts with a series of policy
changes that FDA allegedlyshould make based on the paper's
findings.
But there's actually no logicalconnection between the policy
(23:53):
changes they want to see— thesame policy changes that were
called for in Project 2025— andthe study's findings, even if
you take this pseudo-study'sresults at face value.
So for instance, they arguethat their report is a basis for
reinstating the FDA's formerrequirement that mifepristone be
(24:18):
dispensed only on site at ahospital clinic or medical
office.
And they call on the FDA toblock the use of telemedicine
for medication abortion toprevent patients from filling
their prescription by mail or ata local pharmacy.
But the paper says absolutelynothing about how mifepristone
(24:39):
was dispensed in the cases wherethey claim to have identified
serious adverse events.
It just provides no informationat all on whether those
patients obtained care in personor through telemedicine,
whether the medication wasdispensed by mail or at a clinic
on site or at a pharmacy, andyet somehow they take their
(24:59):
nonsense propaganda findings asa basis for this wish list of
policy changes that have nothingto do with even the
complications they claim to havefound.
Ushma (25:10):
I'll add to that.
The study was from 2017 to2023.
And yes, it was legal during,you know, after 2021, there was
telehealth medication abortion.
However, the vast, vastmajority of providers of
telehealth abortion between 2021and 2023 did not accept health
(25:32):
insurance.
They are largely the telehealthproviders that are virtual
clinics, like Hey Jane, Abortionon Demand.
They primarily during thisperiod, they did not accept
health insurance.
So, there is no way thatthere's any reasonable
proportion of the patients inthe data set.
So, there is minimal chancethat there's a reasonable number
(25:57):
of patients who had atelehealth abortion that is
represented in this data set.
Jennie (26:02):
Okay, so the next part that we need to talk about is
what is going on with the FDAand how this is being, honestly,
how this is being coordinated,because this all came out in a
very coordinated manner, like...
starting with, I think it wasKennedy's testimony and being
(26:24):
like, well, you know, if I hadmore information, we could take
action type thing.
So maybe let's talk a littlebit about some of the stuff
that's happening at FDA.
Julia (26:33):
A few weeks ago on the Hill at a Senate hearing,
Secretary Kennedy revealed thathe has directed the FDA to
undertake, in his words, "acomplete review of its
mifepristone regulations." Andhe cited this propaganda from
the Ethics and Public PolicyCenter as a basis for and the
(26:56):
focus of this review.
This is extremely troubling onmany levels.
Let me start by saying that ifFDA were going to undertake a
good faith review of theextensive data confirming
Mifepristone's exceptionalsafety record, we would be all
(27:18):
for that because actually FDAshould take a closer look at its
regulations on mifepristone andon the basis of mifepristone's
exceptional safety record, liftits remaining medically
unjustified and burdensomerestrictions on mifepristone.
That is what the nation'sleading medical associations
(27:39):
like the American MedicalAssociation, like the American
College of Obstetricians andGynecologists, they have long
been calling for FDA toeliminate its uniquely
burdensome and unjustifiedrestrictions on this very safe
and effective medication.
But that is not what we expectto see here.
And really, the tell is thatthis propaganda from this
(28:07):
Project 2025 sponsororganization is the apparent
motivation for the review.
There is every reason tobelieve that this FDA review is
ordered by HHS Secretary Kennedyis a precursor to imposing
greater nationwide restrictionson medication abortion that will
(28:31):
severely reduce accesseverywhere in the country,
including in states whereabortion access is legally
protected.
We should be very, veryconcerned about the likely
outcome here.
And the other piece of it thatI want to lift up is that
Secretary Kennedy said at thishearing that it was going to be
(28:53):
President Trump's decisionultimately whether the FDA
changes its policy here.
So, if we had any doubt thatthis was not going to be a
review and a policy decisiongrounded in scientific
expertise.
There's no reason to doubt anylonger because Secretary Kennedy
(29:14):
told us this is going to be apolitical decision.
In his words, it's going tocome through the White House.
We should all be very scared ifour access to safe, effective
FDA approved medications isbased not on medical expertise,
but on President Trump's gutinstinct.
Jennie (29:32):
I just, like, bigger than the abortion part, I just
think of, like, the loss oftrust that this could cause.
Like, people trust if thingsare FDA approved, that they are
safe.
And if they see thispoliticization, like, really
seeping into the system...
sorry, cat took out mynotebook.
(29:52):
It could present greater harmsin the future.
Ushma (29:57):
Yeah, I think what troubles me is that we're so
focused on holding back, keepingthe status quo when my energy
as a researcher should befocused on studies that are
proactive— that test, you know,gestational limit of 12 weeks
(30:18):
and 13 weeks for medicationabortion.
We should be pushing thescience forward, not replicating
the same safety studies to showwhat we already know so that
it's more current and that wecould defend the currently
overly restricted regulations onmifepristone.
(30:38):
So, I worry that this is adistraction that's keeping us
busy when we could be moreproactive and make this
medication even more accessiblethan it already is.
Jennie (30:50):
I think the other thing I really worry about is what
this would mean to access tocare.
So, like, if the FDA tookaction, I mean, there's a whole
range of things they could do,but even putting back in place
the in-person requirements,like, what this would mean for
the system providing abortionright now.
Ushma (31:08):
A lot of my research focuses on telehealth abortion.
I just completed a very largestudy on the safety of
telehealth abortion, and wefound that the safety rate and
the effectiveness rate wasexactly the same as in-person
care (31:24):
98% of people had a complete abortion, and then it
was a quarter of 1% had aserious adverse event, even
without any contact with anabortion provider and any
in-person contact.
And there's asynchronoustelehealth care available now
(31:47):
that many people prefer becauseit allows people autonomy and
the ability to access thistelehealth medical care through
an app or online or whilethey're at work or while they
are taking care of theirchildren And in our study, in
our research, we found thatpeople who face the most health
inequities, including youngerpeople, people living on lower
(32:09):
incomes, people living in ruralareas, and those who lived
further away from abortionclinics, were more likely to say
that telehealth enabled them tohave an abortion sooner and at
all.
So, it really made thedifference for people who are
most marginalized from healthcare.
Julia (32:28):
Right now, more than 20% of all U.S.
abortions are provided viatelehealth with the patient
receiving the medication by mailor at a local pharmacy.
So we are not talking aboutsome small sliver of care.
We are talking about potentialagency action that would upend
(32:51):
the way abortion care isdelivered and across the
country, and that's justfocusing on the risk that the
in-person pill pickuprequirement will be reinstated.
We do not know if the FDA isgoing to restrict which
qualified healthcareprofessionals are permitted to
prescribe this medication,whether they are going to
(33:15):
withdraw approval for thegeneric version of mifepristone
that comprises two-thirds of themarket, withdraw approval from
mifepristone altogether.
At this point, it seems likeeverything could be on the
table.
And so, the threat here is verygrave.
Jennie (33:33):
Okay.
So I don't like to end withjust like, here's what's
happening and things are bad.
Let's do a little bit of whatcan our audience do?
How can they get involved inthe fight for some of this
stuff?
Ushma (33:49):
Well, Telehealth is really expanding access right
now, as I mentioned previously.
One thing we didn't talk aboutare shield laws that are in
several states across thecountry that reduce legal risks
for providers who offertelehealth abortion for people
living in states with abortionbans.
(34:11):
These have been critical toexpanding access to enabling
people to get abortion care andreally it has been a lifesaver
for so many people.
And so , these providers,oftentimes people don't have the
ability to pay for theseabortion pills, as well as
people who are traveling verylong distances to obtain
(34:34):
in-person care.
So, I think the number onething that people could do is
support their local abortionfunds, support abortion funds
that help people living inbanned states get connected to
care.
So, that is one thing.
Julia (34:49):
Yeah, absolutely echo that supporting abortion funds
is a critical way for folks toget involved, specifically on
the question of the FDA's reviewand this threat of new
nationwide restrictions onmedication abortion.
The FDA's decision here shouldbe based purely on science, on
the mountain of safety data thatwe have for mifepristone over
(35:13):
25 years.
But it appears that it isinstead going to be based on
politics.
So, I think this is a moment tomake sure that your political
representatives know where youstand on abortion access.
That includes your members ofCongress, President Trump, we
need to be loud about howimportant it is to protect
(35:35):
access to medication abortion.
We should be calling ourmembers of Congress and
demanding that they do what theycan to protect medication
abortion access, to protecttelehealth access in particular,
to hold the FDA accountable andmake sure that the FDA is
following the science.
And I want to just, again,state that what the FDA should
(35:58):
be doing here is liftingmedically unnecessary
restrictions on this very safeand effective medication, not
imposing greater barriers tocare.
The other thing I wouldencourage your listeners to do
is sign up for the ACLU'svolunteer network, which is
called People Power.
If you just Google ACLU andPeople Power, you will find a
(36:20):
website there.
And that is how we will connectyou with opportunities to make
your voice heard to agencieslike HHS and FDA, to members of
Congress.
There are a variety of actionsthat we will be encouraging
folks to take on abortionaccess, including and beyond
medication abortion.
And then you can also be tappedinto the full range of work
(36:43):
that the ACLU is doing at thiscritical moment, including with
respect to trans justice andprotecting access to gender
affirming medical care, attackson immigrants, on free speech,
on so much more.
So, People Power, ACLU, and wewould love to have you as part
of our community and actionpower.
Jennie (37:05):
Well, Julia, Ushma, thank you so much for being
here.
It was so lovely to talk toboth of you.
100%.
Julia (37:11):
Thanks so much for having us, Jennie.
Ushma (37:13):
Thank you.
Thanks for addressing thistopic.
I think it's something thatpeople should know about
proactively, even before theyhear what happens with the
ongoing cases.
Jennie (37:24):
Okay, y'all, I hope you enjoyed my conversation with Dr.
Upadhyay and Julia.
It was so great talking to themabout everything happening
around Mifepristone right now.
And with that, I will seeeverybody in two weeks.
[music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com or you can find us on social media. We're at @RePROsFightBack on Facebook and Twitter or @reprosfb on Instagram. If you love our podcast and wanna make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you wanna make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all!
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