For more on this issue, listen to NHPR Health and Equity Reporter Paul Cuno-Booth's conversation with All Things Considered Host Julia Furukawa using the player above. Their interview was produced by NHPR's All Things Considered Producer Michelle Liu.
Abortion providers in New Hampshire say nothing has changed, for now, in the wake of competing court rulings on a widely used abortion pill.
“We are being very clear in our messaging that medication abortion is still available,” said Jinelle Hobson, executive director of Equality Health Center in Concord. “As of today, it is still available. And we will continue to see patients that are seeking that care.”
On Friday, a federal judge in Texas issued a ruling suspending the longstanding approval of mifepristone — which is widely used as part of a two-drug regimen for medication abortions. The Biden administration is appealing that ruling, which isn’t set to take effect until the end of the week.
Adding to the legal uncertainty, another judge in Washington state temporarily blocked the federal government from taking the drug off the market in some states, after a coalition of Democratic state attorneys general asked the court to weigh in.
In New Hampshire, abortion providers say they’re making appointments as usual. At the same time, they’re preparing to switch to an alternative protocol that would allow them to continue offering medication abortions if and when the Texas order takes effect.
“For now, approval of mifepristone remains protected, and there has been no change to our delivery of abortion care,” Nicole Clegg, the acting CEO of Planned Parenthood of Northern New England, said on a call with reporters Monday.
New Hampshire isn’t directly involved in either lawsuit. In a statement provided by his office Monday afternoon, Gov. Chris Sununu said his administration is monitoring the potential impact of the Texas decision.
“It is extremely concerning that an FDA-approved drug that has been used for decades can be taken off the market unilaterally by one judge in Texas,” Sununu said. “Since the issuance of the Dobbs decision, issues surrounding abortion should be left to the states and not an unelected judge.”
The governor did not say whether he is considering any kind of executive action to protect access to abortion medication in New Hampshire. At least three governors — in Massachusetts, California and Washington — have said they plan to stockpile abortion pills.
Mifepristone is the first of two drugs used in most medication abortions in the U.S. It’s been approved since 2000, and studies have shown mifepristone in combination with a second drug, misoprostol, is safe and highly effective for ending pregnancies before about 10 weeks.
In recent years, medication abortion has accounted for more than half of all abortions nationally, according to the Guttmacher Institute, a research organization that supports abortion rights. There’s been a push to expand access to abortion pills via telehealth and the mail, to reduce barriers for people who have trouble getting to a clinic in person.
If the ruling out of Texas does take effect, local abortion providers say New Hampshire patients will still be able to access abortion medication. They’re preparing to switch to a different protocol, which uses only misoprostol.
Misoprostol on its own is a safe and effective method of abortion, though medical experts say it’s slightly less effective at ending a pregnancy. The side effects can also be more unpleasant, including nausea and cramping and bleeding that lasts longer than with the current two-drug regimen.
“It certainly is less patient-friendly than our current mifepristone and misoprostol option,” said Alison Bates, the director of medication abortion, sedation and ultrasound at Planned Parenthood of Northern New England.
Still, Bates stressed that both protocols — with or without mifepristone — are safe, and studies have found the rates of serious complications are below 1%.
If a ban on mifepristone does take effect, she said, “we would be poised to make that change [to misoprostol-only abortions] immediately.”
The Lovering Health Center in Greenland is also prepared to switch to misoprostol-only abortions if needed, according to Executive Director Sandi Denoncour.
“If/when that happens, we will communicate about the change in protocol both to patients via one-on-one outreach and to our community using all of our outreach tools,” including social media, Denoncour said in an email Monday.
The Reproductive Freedom Fund of New Hampshire — which provides financial assistance for abortions — said it plans to expand its network of volunteer doulas, to prepare for the possibility that misoprostol-only abortions become the only option. The organization said it recognizes patients might need more support through that process.
“Even if Mifepristone becomes unavailable, it’s important to note that this does not mean abortion is no longer available via medication, but that providers will switch to a Misoprostol-only method,” Executive Director Josie Pinto said in a statement.
Clegg, of Planned Parenthood, said the legal developments are causing uncertainty for patients, even if nothing has taken effect yet.
“The first thing we're seeing — and this is not unlike when the Dobbs decision was released — is confusion,” she said. “People don't know what this means for them. They don't know what this means for their ability to access care.”
