Voters must stay vigilant on abortion rights

Opinion editor's note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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After the Supreme Court overturned abortion rights, Minnesotans elected a DFL state government trifecta in November that moved at lightning speed once in office to pass the PRO Act, legislation codifying abortion rights here.

Regrettably, voters who understand the importance of this medical procedure for women's health cannot relax their vigilance. A Texas judge's decision to revoke federal approval of an abortion pill — one used safely and effectively for more than two decades — serves alarming notice that the battle over abortion continues on multiple levels, with the impact potentially impeding access and choice here despite the commendable work by state legislators this session.

Congressional action is urgently needed to safeguard reproductive health care no matter which state you live in. While that's currently unlikely with the U.S. House controlled by Republicans, the work begins now to pave the way for when the politics turn more favorable. It's fortunate that Minnesota's Sen. Tina Smith is at the forefront of shouldering this important responsibility.

The Texas judge's controversial decision had long been anticipated but became public last Friday. It involves the drug mifepristone, which is typically given in combination with another drug to end a pregnancy. More than half of the abortions in Minnesota involve medication vs. more invasive alternatives, the Star Tribune reported this week.

The case culminating in the judge's decision was brought by a little-known anti-abortion group that appears to have incorporated in the Texas judge's district last year after the Supreme Court overturned Roe v. Wade. Shopping for this judge, a Trump appointee less known for his legal scholarship than religious zealotry, paid off.

U.S. District Judge Matthew Kacsmaryk's ruling takes issue with regulators' approval. The drug was first cleared in the United States for nonsurgical abortions in 2000. Kacsmaryk concludes the process was not rigorous enough. But his ruling also defies common sense by ignoring reality: This is drug has been used safely for decades.

"As of June 2021, the FDA reports that 26 women, out of approximately 4.9 million, have died after taking mifepristone for medication abortion," according to a brief from a University of California, San Francisco (UCSF) reproductive health research program.

Correlation does not equal causation, however, with 13 of those deaths appearing to be unrelated to the abortion, such as three cases of suspected or confirmed homicide. "If only the cases that appear to be related to the abortion are included, the mortality rate is 0.27 deaths per 100,000 medication abortions," the research program's analysis calculated.

Yes, there is risk involved in having a medication abortion. But context is critical.

There's greater risk, for example, in bearing and delivering a child. "Nationally, the pregnancy-related mortality ratio is 18 deaths per 100,000 live births," the UCSF research program noted.

Penicillin, an antibiotic standby, can cause a fatal allergic reaction, with 2 deaths per 100,000 people given the drug. More than 600 deaths occur annually from overdosing on acetaminophen, better known as Tylenol. Viagra and other drugs used for erectile dysfunction carry a "fatality rate of 4 deaths per 100,000 users," the program brief states.

If the FDA approval process for mifepristone were as deeply flawed as Kacsmaryk concluded, wouldn't the risk for its use be far higher — not far lower — than these other common drugs?

Sen. Smith has presciently been concerned about mifepristone access. She is the lead author on S. 237, the "Protecting Access to Medication Abortion Act of 2023." Two members of Minnesota's U.S. House delegation — Reps. Ilhan Omar and Betty McCollum — are cosponsors on their chamber's version.

The bill would expand access to medication abortion, though it would not protect access if Kacsmaryk's decision is upheld, invalidating the FDA's approval of this drug. Still, legislation like this can help galvanize abortion supporters and inspire other solutions.

It's important to note that the other medication, misoprostol, typically used in combination with mifepristone, can be used alone to terminate pregnancy. "Research has shown the misoprostol-only regimen to be a safe and highly effective method of pregnancy termination; however, it may result in a higher incidence of side effects, particularly diarrhea, fever and chills," according to a Kaiser Family Foundation report.

That offers little comfort, however. How long before the same organization taking aim at mifepristone attacks access to this drug as well?

The Biden administration is appealing this lamentable ruling. Higher courts should see through its dubious legal reasoning, but there are no guarantees. Some abortion proponents have urged the administration to simply ignore the Texas decision, but that creates a dangerous precedent.

Elections have consequences. Voters who understand how critical this health care is for women should elect those who can work swiftly and surely within the system to protect it.