An abortion pill case has moved to appeals court, one step closer to the Supreme Court.

Since the overturning of Roe v. Wade in 2022, fourteen states have entirely banned abortion from conception to birth and more either have adopted or are debating major restrictions.

Mifepristone, the oft-called abortion pill, is a part of medication abortion, the most common method used. Taken before 10 weeks along with misoprostol, it blocks progesterone, halting the development of the embryo and placenta while the other drug triggers a period. It has been in use for over twenty years, and is considered safe. Since it was approved in 2000, the FDA has responded to trials by extending the time it can be used and reducing the necessary doses. It is currently considered safe enough to be taken without medical oversight, meaning people seeking abortion can get pills by mail.

In November, anti-abortion activists in Texas filed a federal lawsuit seeking to revoke FDA approval of mifepristone. U.S. District Judge Matthew Kacsmarky, a Trump appointee, ruled in April to do exactly that, but his ruling has been stayed during appeals.

A first appeal only narrowed Kacsmaryk’s ruling, saying that the time limit for revoking an approval had passed, but reimposing requirements for physician visits and in-person prescriptions only. The Supreme Court put a hold on that ruling as well, leaving access to the abortion pill unchanged so far.

Now the case has come to the 5th Circuit courts, which is dominated by Republican-nominated judges with a history of supporting abortion restrictions. Hearings began on Wednesday, and the ruling is expected to take several weeks. If they uphold the initial ruling, the Biden administration, activist groups, and Danco Laboratories who make the abortion pill will push their appeal further.

If anti-abortion forces succeed in having mifepristone banned, health care providers have said they can switch to using misoprostol alone, but it is less effective in ending pregnancies, which means a greater risk of complications.

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