US clinic charts course through abortion pill chaos

Tammi Kromenaker is a seasoned fighter in the grinding battle over reproductive rights in America—but even she has to admit that the latest front, over access to a widely used abortion pill, is a "mess."

Kromenaker, the director of an abortion clinic in the northern US state of Minnesota, strategized with her lawyers Thursday as she charts a course through the legal imbroglio over mifepristone, used in more than half of abortions in the United States.

"It's a mess," she told AFP in her office at the Red River Women's Clinic ahead of the meeting with her legal advisers. But "we'll adapt. We'll figure it out."

Mifepristone has been at the center of a legal standoff since April 7, when a federal judge in Texas temporarily suspended approval of the drug granted two decades ago by the Food and Drug Administration (FDA) while he heard a lawsuit by anti-abortion activists seeking a permanent ban.

On Wednesday an appeals court partially overturned that decision, ensuring that the pill remains legal for now—but it also reinstated restrictions on the drug's use, including that it can no longer be distributed by mail and can only be used up to seven weeks gestation, down from 10.

The pill's fate is likely to be settled by the Supreme Court where the Justice Department has already appealed the recent restrictions.

In the meantime, the ping-ponging rulings have caused confusion among patients and uncertainty in clinics as they try to keep up with the pill's legal status.

"Almost every call or Zoom that I've been in, people have said this could change even while we're talking, just because there's so many moving parts and so many parties," Kromenaker told AFP.

'Back to the Dark Ages'

Kromenaker's clinic had only just settled into a rhythm after another tumultuous period that began a year ago, when news leaked that the Supreme Court was preparing to overturn the right to abortion that had been enshrined for nearly 50 years.

Until last summer, the Red River Women's Clinic was based across state lines in Fargo, North Dakota, only a short drive from its current location.

It was the only clinic performing abortions in the Republican-run state.

But in May 2022, the media outlet Politico revealed that the conservative-dominated Supreme Court was readying to strike down Roe v. Wade, the 1973 ruling granting nationwide abortion rights.

Kromenaker began a frantic search for a new office space outside North Dakota, where trigger laws banning abortion were ready to take effect once Roe was overturned.

She signed the papers for the new building on June 23, a day before the Supreme Court finally issued its ruling, and moved to Minnesota's small town of Moorhead a few weeks later.

After a long struggle, abortion ultimately remains legal in North Dakota—but Kromenaker has no regrets about leaving.

Her old clinic in Fargo is just five minutes down the road from her new one in Moorhead, but the difference between the two cities is "beyond night and day," she said.

People sometimes ask if she will set up in North Dakota again—but she tells them no.

"Because now that we have been here, and we see how you get to provide abortion care, we're not going back to the Dark Ages," she told AFP.

"I don't think mifepristone is going to go away any time soon," she added, confident in the legal outcome—though she did foresee more potential restrictions.

Whatever is coming, she felt ready. "As a clinic who's been involved in a lot of litigation and a lot of risk, and we know we have a target on our back, we're able to flip on a dime," she said.

After she met with her lawyers Thursday, she messaged AFP to say that—for now—she is staying the course.

"We feel confident and comfortable providing mifepristone in MN (Minnesota) and will continue to provide it as we have been," she wrote.

That is, until a final decision is reached.

© 2023 AFP