The Morning: Challenging abortion, again

Plus, the Moscow concert attack, Gazan children and Cape Town.

View in browser|nytimes.com Continue reading the main story March 25, 2024 Good morning. We're covering the Moscow concert attack, Gazan children and Cape Town. In Carbondale, Ill. Erin Schaff/The New York Times An important abortion case By Emily Bazelon Staff Writer, NYT Magazine How safe is it to take abortion pills? The F.D.A., the nation's authority on drug regulation, says that it's very safe. But the agency's judgment is the topic of a sweeping challenge that the Supreme Court will hear tomorrow. The case could curtail Americans' access to mifepristone, the first pill taken in a two-drug regimen for a medication abortion. Pills now account for most abortions in the United States. Increasingly, people take the medications at home. About 14,000 medication abortions per month are now prescribed online, with pills sent through the mail. In today's newsletter, I'll explain how the suit against the F.D.A. seeks to shut down this form of access and impose other restrictions. A decision in the plaintiff's favor would change the landscape of abortion not state by state, like the effects of the 2022 ruling that overturned Roe v. Wade, but across the country. Post-Roe America The abortion opponents who sued the government in tomorrow's case, F.D.A. v. Alliance for Hippocratic Medicine, are frustrated by how common abortion has remained. Since the high court struck down Roe, 16 states have banned or severely restricted the procedure. In those places, some women who would have ended their pregnancies are carrying them to term, as my colleagues Margot Sanger-Katz and Claire Cain Miller have explained. But the total number of abortions across the country has not fallen. It may actually have increased. That's in large part because of abortion pills, which the F.D.A. first approved in 2000. "In the six months after the Supreme Court overturned Roe, the rise in the supply of pills outside of clinics significantly made up for the reduction in abortions otherwise," said Abigail Aiken, a professor of public affairs at the University of Texas at Austin with a new study on the topic. In some states, CVS and Walgreens recently started dispensing mifepristone along with misoprostol, the second abortion pill, in stores with a prescription. Outside the Supreme Court in June.  Haiyun Jiang for The New York Times The F.D.A. laid the foundation for these changes. In 2016, it let nurses and others prescribe mifepristone. It also permitted patients to take the pill 10 weeks into pregnancy, extending the limit from seven weeks. In 2021, the F.D.A. allowed providers to send mifepristone by mail, lifting a rule that had required an in-person medical visit. "Study after study has shown that when mifepristone is taken in accordance with its approved conditions of use, serious adverse events are exceedingly rare," the F.D.A. said in its Supreme Court brief. The F.D.A.'s judgment The plaintiffs in today's case, a coalition of anti-abortion physicians and medical groups, say the F.D.A. is wrong. They fault the agency's collection of data and argue that some complications go unreported, creating an incomplete picture of risk. Last year, the U.S. Court of Appeals for the Fifth Circuit agreed, ruling that the F.D.A.'s database of adverse events was "insufficient" and thus its decisions in 2016 and 2021 were invalid. The F.D.A. says that it is using its standard system for reporting drug complications — and that it has reviewed extensive research showing that mifepristone is safe, including to take at home. Its job, the agency argues, is not to "act based on perfect data, which seldom exists" but rather to "act reasonably based on the information available." (And in February, a journal retracted two studies highlighting purported risks of mifepristone.) Because the F.D.A. followed its standard approval process, a victory for abortion opponents could undermine its authority to determine whether any drugs are safe. The case has unsettled the pharmaceutical industry. Congress intended the F.D.A., not the courts, to be the "expert arbiter of drug safety," drug companies and investors argued in a brief. They said the Fifth Circuit created "an impossibly rigid new standard for drug approval." Another question is whether the plaintiffs are even allowed to challenge the F.D.A. As a rule, litigants have to show that they have been harmed by an action to sue over it. The anti-abortion physicians say they may have to provide emergency care to women with incomplete abortions or other complications from taking mifepristone. The Fifth Circuit ruled this was enough, based on the likelihood that it could happen. But Supreme Court precedent rejects a statistical conception of standing. The plaintiffs also argue that they would be harmed by feeling that they had to help complete an abortion against their conscience. The government says that this conception of harm is hypothetical. The F.D.A.'s regulations for mifepristone, after all, don't require any doctor to do anything. What happens next? If the F.D.A. loses, it's unclear what will happen. Providers in the U.S. could still prescribe and ship misoprostol, the second abortion pill. Taken in higher doses without mifepristone, misoprostol is 88 percent effective, according to one study; the two-drug regimen is 95 percent effective or more. Misoprostol-only abortions also tend to include more hours of pain and cramping, with more side effects like nausea and diarrhea. So the upshot could be more physical discomfort for American women. Packages of medical abortion pills in Peabody, Mass.  Sophie Park for The New York Times Another possibility is that more people will order the standard combination of mifepristone and misoprostol from foreign suppliers, though that market isn't really legal. Whatever the court decides, the future of medication abortion is in the hands of the voters as well. The president decides who runs the F.D.A. The agency has continued or expanded access to mifepristone under the past five presidents. That includes Donald Trump. But with Roe overturned and control of the F.D.A. up for grabs in 2024, there's much more pressure to restrict abortion pills than there was before. Related: In states where abortion is legal, doctors are sending abortion pills to tens of thousands of women in states where it is illegal. Continue reading the main story ADVERTISEMENT THE LATEST NEWS Russia Concert Attack At a district court in Moscow.  Alexander Zemlianichenko/Associated Press Russia charged four men from Tajikistan with terrorism. They are suspected of killing at least 137 people in an attack at a concert hall near Moscow. The men looked battered in their court appearances, and one arrived in a wheelchair. Videos of the officials torturing them spread on social media. "They shot at everything that moved": Survivors recounted a scene of chaos and terror. ISIS claimed responsibility. But Russian state media has pushed the idea that Ukraine was behind the attack. ISIS-K, an ISIS affiliate that American officials have linked to the attack, has global ambitions. Read more about the group. Israel-Hamas War In Bologna, Italy.  Nariman El-Mofty for The New York Times The Times joined 16 injured Gazan children and their families as they traveled to Italy for treatment. See the photos. Al-Shifa, Gaza's largest hospital, is under a siege by the Israeli military. Israel says the operation is targeting Hamas leaders; patients and doctors are still inside. More International News Ready, set, garçon! Dimitar Dilkoff/Agence France-Presse — Getty Images Ahead of the Olympics, Paris revived a tradition: a race for waiters. The dominance of the iPhone in China appears to be waning as consumers turn to Chinese rivals like Huawei. Pope Francis skipped a Palm Sunday speech. The decision added to concerns about his health. An 80-year-old academic who has never held public office wants to challenge the Venezuelan president, Nicolás Maduro, in July's election. The Wall Street Journal spoke with her. The police in Brazil arrested three men in connection with the notorious assassination of Marielle Franco, a gay Black councilwoman who fought corruption in Rio de Janeiro. Senegal voted in an election that its president, Macky Sall, tried to call off. Politics President Biden has promised to raise taxes on corporations and the wealthy. In office, he has actually cut taxes overall. Donald Trump is expected to appear in a Manhattan courtroom today to seek another delay to his hush-money criminal trial. Tammy Murphy, New Jersey's first lady, dropped out of the race for Robert Menendez's Senate seat. Senator Lisa Murkowski, a veteran Republican from Alaska, told CNN that she would not vote for Trump and did not rule out the possibility of leaving the party. Other Big Stories A 21-gun salute in Columbus, Ga. Alyssa Pointer for The New York Times Albert King, a Black soldier killed by a white military police officer, was buried in an unmarked grave in 1941. Yesterday, he received a full military funeral. Karen Bass, the mayor of Los Angeles, has cleared homeless encampments and moved thousands of people into motels. Read more about her efforts. Opinions As a professional rock climber, Beth Rodden embraced pain. After injuries, she learned how to rest, she writes. Israel must confront and defeat Hamas in Rafah. But the country still needs a welfare strategy for Palestinians, David Brooks writes. Gail Collins and Bret Stephens discuss political fatigue and immigration. Here are columns by David French on how politics is different online and Maureen Dowd on a politically incorrect Democratic strategist. For readers of The Morning, enjoy exceptional savings for a limited time. Take advantage of the complete Times experience with our sale. Save on your first year of unlimited access to news, Games, Cooking and more. Subscribe now. MORNING READS At an Ethiopian restaurant in Cape Town. Samantha Reinders for The New York Times 36 Hours in Cape Town: Visit a restaurant in the Black township of Khayelitsha and explore a contemporary African art museum. Underwater: New technology and climate change have ushered in a golden age of shipwreck discoveries. A Great Read: A five-year stay at the New Yorker hotel cost him only $200.57. Now it might cost him his freedom. Cut to the chase: Some couples, aware of how difficult conception can be, are opting to do I.V.F. first. Metropolitan Diary: A cabby's cameo. Lives Lived: Shani Mott was a scholar of Black studies at Johns Hopkins University whose examinations of race and power in America extended to her city and even to her own home. She died at 47. SPORTS Men's tournament: Texas A&M hit a buzzer-beater to reach overtime against No. 1 seed Houston, but Houston pulled away and won 100-95. See the shot. Top seeds advance: All four No. 1 and No. 2 seeds reached the men's Sweet Sixteen. That has happened only four times since 1985. Women's tournament: Top-seeded South Carolina continued to roll, beating North Carolina 88-41. Two other favorites, Iowa and UConn, both play tonight. Continue reading the main story ADVERTISEMENT ARTS AND IDEAS John Galliano  MUBI, via Associated Press Back in fashion: The former Dior designer John Galliano fell from grace in 2011 after a drunken antisemitic rant. Thirteen years later, as the creative director for Maison Margiela, his work is again being celebrated. The documentary "John Galliano, High & Low" charts his rise and fall. It appears to represent the end of Galliano's time in the wilderness, the Times critic Vanessa Friedman writes, and reflects "a shift away from the era of outrage, particularly in fashion." More on culture Zendaya in "Dune: Part Two." Warner Bros. Language constructors for the "Dune" movies created an extensive vocabulary and specific grammar rules. Kevin Hart received the Mark Twain Prize for American Humor. THE MORNING RECOMMENDS … Armando Rafael for The New York Times Skip the broth for this spicy take on ramen with mushrooms and tofu. Live in harmony with your messy partner. Work out at your desk with a treadmill. Take our news quiz. GAMES Here is today's Spelling Bee. Yesterday's pangram was cordial. And here are today's Mini Crossword, Wordle, Sudoku and Connections. Thanks for spending part of your morning with The Times. See you tomorrow. P.S. David Leonhardt is off this week. Sign up here to get this newsletter in your inbox. Reach our team at themorning@nytimes.com. Continue reading the main story Editor: David Leonhardt Deputy Editor: Adam B. Kushner News Editor: Tom Wright-Piersanti Associate Editor: Lauren Jackson News Staff: Desiree Ibekwe, Sean Kawasaki-Culligan, Brent Lewis, German Lopez, Ian Prasad Philbrick, Ashley Wu News Assistant: Lyna Bentahar Saturday Writer: Melissa Kirsch Need help? Review our newsletter help page or contact us for assistance. You received this email because you signed up for the Morning newsletter from The New York Times, or as part of your New York Times account. To stop receiving The Morning, unsubscribe. To opt out of other promotional emails from The Times, including those regarding The Athletic, manage your email settings. To opt out of updates and offers sent from The Athletic, submit a request. Subscribe to The TimesGet The New York Times app Connect with us on: Change Your EmailPrivacy PolicyContact UsCalifornia Notices The New York Times Company. 620 Eighth Avenue New York, NY 10018