A federal case challenging the safety of mifepristone, used to treat miscarriages and to induce abortions early in pregnancy, is being transferred out of Texas to a federal court in Missouri.
The lawsuit demands the federal government restore its previous restrictions on mifepristone by requiring three in-person doctor visits, reducing the gestational period during which the medication can be taken from 10 weeks to seven and rolling back recent federal policy that allowed for the mailing of mifepristone and allowed for prescriptions to be made online or through pharmacies.
“This case has always been about ideology, not patient safety,” Emily Wales, president and CEO of Planned Parenthood Great Plains said in a statement Wednesday, “It’s no surprise it has now been transferred to a district where nearly half the bench was elevated to the judiciary after undermining abortion rights at the Missouri attorney general’s office.”
Four of the court’s nine judges were appointed in May by President Donald Trump. Two, Josh Divine and Maria Lanahan, worked on the mifepristone case before their appointments.
“This order ensures Missouri’s case will be heard where it belongs: in Missouri,” the Missouri Attorney General’s Office said in a statement Wednesday. “We will continue protecting the health and safety of women and children in our state and continue fighting to hold the Biden Administration and its allies accountable for unlawfully loosening safeguards on chemical abortion drugs.”
The initial lawsuit was filed in Texas by a group of anti-abortion doctors and medical organizations. In June 2024, the U.S. Supreme Court rejected the original lawsuit after concluding the plaintiffs did not have standing to sue because they couldn’t show they had been harmed. Erin Morrow Hawley argued the case in front of the nation’s highest court on behalf of the initial plaintiffs. She is the wife of U.S. Sen. Josh Hawley of Missouri.
Soon after, the attorneys general from Missouri, Kansas and Idaho refiled the litigation. The defendants in the case — the FDA and mifepristone’s manufacturer — asked that the latest case be thrown out.
On Tuesday, Texas federal judge Matthew Kacsmaryk declined that request and transferred the case to the Eastern District of Missouri in St. Louis. Kacsmaryk wrote that he had no jurisdiction over the remaining plaintiffs.
“Instead of returning this years-long case to square one,” Kacsmaryk wrote that it made sense to transfer the case to “avoid the costs and delay” that would surely come from dismissing the case only to have a plaintiff re-file it in another jurisdiction.
Kacsmaryk said he chose Missouri among the states suing because “the Eastern District of Missouri is an accessible district with a major city.”
In his ruling, Kacsmaryk seemed reluctant to give up the case. He wrote that precedent “led every jurist who assessed this case to conclude that the original plaintiffs had a jurisdictionally valid case.”
But the Supreme Court didn’t agree, he noted, and “it is not the province of lower courts to defy the Supreme Court.”
Had Texas Attorney General Ken Paxton sought to intervene earlier, Kacsmaryk noted, he could have kept the case in his court as jurisdictional issues “would have easily been satisfied.”
Right now, medication abortion is inaccessible through Planned Parenthood clinics in Missouri.
Last November, voters codified the right to abortion in the state constitution. Now, a Jackson County judge is weighing whether to keep in place two state regulations that Planned Parenthood says are preventing its providers from performing medication abortions in Missouri.
The Missouri Attorney General’s Office has argued in court filings that the lawsuit was filed to re-establish “long-standing safety requirements” for mifepristone. In ongoing court cases surrounding regulations around abortion in Missouri, the attorney general’s office has repeatedly painted mifepristone as a dangerous medication.
“The FDA has enabled online abortion providers to mail FDA-approved abortion drugs to women in states that regulate abortion — dispensing abortion drugs with no doctor care, no exam and no in-person follow-up care,” the attorneys general wrote in the amended lawsuit last year. “These dangerous drugs are now flooding states like Missouri and Idaho and sending women in these states to the emergency room.”
They also argued that current regulations around mifepristone make it impossible to track and prevent medication abortions.
“All of this makes it difficult for state law enforcement to detect and deter state law violations and to give effect to state abortion laws,” the attorneys general wrote.
According to the FDA, mifepristone is safe to use if taken as directed.
Cramping and bleeding are common side effects of the medication. Those prescribed mifepristone are urged to call their doctor if they experience heavy bleeding, abdominal pain or a fever. The same guidance applies to those who recently underwent surgical abortions, experienced miscarriages or delivered a baby.
Since the medication was approved for use 28 years ago, 32 deaths have been reported associated with mifepristone, according to the FDA. The report evaluates data from 5.9 million women who took mifepristone between 2000 and 2022. Of the three dozen deaths, 11 were the result of sepsis, 20 were homicides and two were suicides.
Last year, while arguing in court records that mifepristone harms Missouri and therefore the state has the standing to sue, former Missouri Attorney General Andrew Bailey contended access to mifepristone lowered “birth rates for teenaged mothers,” contributing to a population loss along with “diminishment of political representation and loss of federal funds.”
“Younger women are more likely to navigate online abortion finders or websites ordering mail-order medication to self-manage abortions,” the filing reads.
Abortion rights advocates and medical professionals continue to argue that mifepristone is safe.
“In Missouri, we are all too familiar with the attacks on medication abortion not grounded in science,” Margot Riphagen, president and CEO, Planned Parenthood Great Rivers, said in a statement Wednesday. “And continue to witness the detrimental public health outcomes as a result of politically motivated lawsuits, misinformation, and restrictions.”
This story was originally published by the Missouri Independent, part of the States Newsroom.
