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The attorneys general of Kansas and Missouri are trying, once again, to restrict access to medication abortion, the most commonly-used form of abortion nationally.

The Republican-led states, along with Idaho, filed a complaint earlier this month to prohibit mifepristone’s use after seven weeks of pregnancy instead of 10 and require three in-person doctor visits. The request would reinstate requirements that were in effect before the U.S. Food and Drug Administration relaxed them in 2016 and 2021.

The complaint, filed against the FDA, comes after the U.S. Supreme Court ruled in June that a group of doctors couldn’t sue to ban the drug, upholding nationwide access to the drug. But Missouri and Kansas were allowed to intervene in the lawsuit, empowering the Republican-led states to keep the legal challenge alive.

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They claim in their filing that the FDA is putting women at risk by allowing mifepristone to be mailed to them with “no doctor care, no exam, and no in-person follow-up care.”

“We are moving forward undeterred for the safety of women across the country,” Missouri Attorney General Andrew Bailey said in a statement. Bailey also took aim at President Joe Biden’s administration, saying it removed requirements “for doctors to provide care to women adversely affected by mifepristone.”

The renewed legal challenge comes as the FDA has regularly touted mifepristone’s safety and eased restrictions, which has been a focal point for abortion opponents who argue that the requirements should be reinstated.

“Even the FDA’s own label says that roughly 1 in 25 women who take this drug will end up in the emergency room,” Kansas Attorney General Kris Kobach said in a statement. “The FDA’s data also showed that hospitalizations from using mifepristone increased by 300% when taken without in-person doctor’s visits.”

Medical experts say serious complications to pill abortions are exceedingly rare. Significant infection, excessive blood loss and hospitalization occur in less than 0.32% of patients, the American College of Obstetricians and Gynecologists said in its own legal brief.

If granted, the request could mark a major change to abortion access nationwide. After the Supreme Court overturned Roe v. Wade in 2022, states such as Missouri have enacted total or near-total abortion bans. The medications have offered a way for individuals to access abortion despite state-level bans.

Kansas abortion rights advocacy groups say the legal challenge is out of step with the will of residents who voted overwhelmingly to reject the nation’s first post-Roe ballot measure in 2022 that would have given state lawmakers the power to restrict or ban abortion.

“What this basically is is an attempt by the AGs to ignore the majority of the residents of Kansas and Missouri and to impose their own will about reproductive rights on women in Kansas and Missouri, despite the fact that we know in Kansas the electorate supports it and we believe in Missouri that will be the case in a few weeks,” said Teresa Wood, a member of Kansas Women Attorneys for Freedom.

She said the legal challenge amounts to government overreach and a waste of taxpayer money.

“Medication abortion is one of the safest procedures there is,” Woody said. “It has been scientifically found to be that way time and time again, and the FDA has found it to be so. That’s why they loosened the restrictions on it.”

Emily Wales, the president and CEO of Planned Parenthood Great Plains, pointed to mifepristone’s safety, saying that restrictions on the drug serve no medical purpose other than to “restrict access to safe abortion care.”

“It is especially frustrating to see Attorney General Kobach participating in this lawsuit, seeking to subvert the will of Kansans who voted to protect the right to abortion care more than two years ago,” Wales said. “We should all be wary when politicians use their elected offices to intimidate patients, harass medical providers, and undermine evidence-based medicine.”

Some Democrats on social media and the abortion rights advocacy group Abortion Action Missouri have also seized on a line in the legal filing that cites a study arguing that the use of medication abortion was decreasing expected birth rates for teenage mothers in Kansas, Missouri and Idaho.

“A loss of potential population causes further injuries as well: the States subsequent ‘diminishment of political representation’ and ‘loss of federal funds,’” the filing said.

Mallory Schwarz, the executive director of Abortion Action Missouri, criticized Bailey, saying his “latest baseless and political weaponization of the courts” argues Missourians “have been harmed by the lack of teen pregnancies.”

“For these anti-abortion, anti-democracy politicians, it’s only about power and control by any means necessary; regardless of the impact on Missouri children and families,” Schwarz said.

Even in states where abortion is not banned, medication abortion is key for access to the procedure. If the drug’s access were curtailed, more individuals would likely have to seek abortions at clinics, which have faced a surge of patients since 2022.

Abortion medications were used in roughly 63% of all abortions in 2023, according to the Guttmacher Institute, a research organization that supports abortion rights.

The filing also comes as Missourians are gearing up for a historic vote on Nov. 5 over whether to enshrine abortion rights in the state constitution, effectively overturning the state’s ban on abortion.

This story was originally published October 18, 2024 1:34 PM.

A reporter for The Kansas City Star covering Missouri government and politics, Kacen Bayless is a native of St. Louis, Missouri. He graduated from the University of Missouri with an emphasis in investigative reporting. He previously covered projects and investigations in coastal South Carolina. In 2020, he was awarded South Carolina’s top honor for assertive journalism.
Matthew Kelly is The Kansas City Star’s Kansas State Government reporter. He previously covered local government for The Wichita Eagle. Kelly holds a political science degree from Wichita State University.