In lawsuits challenging state abortion bans, lawyers for abortion rights plaintiffs are employing religious liberty arguments the Christian right has used for decades.For years, conservative Christians have used the principle of religious freedom to prevail in legal battles on issues like contraceptive insurance mandates and pandemic restrictions. Now, abortion rights supporters are employing that argument to challenge one of the right’s most prized accomplishments: state bans on abortion.In the year since Roe v. Wade was overturned, clergy and members of various religions, including Christian and Jewish denominations, have filed about 15 lawsuits in eight states, saying abortion bans and restrictions infringe on their faiths.Many of those suing say that according to their religious beliefs, abortion should be allowed in at least some circumstances that the bans prohibit, and that the bans violate religious liberty guarantees and the separation of church and state. The suits, some seeking exemptions and others seeking to overturn the bans, often invoke state religious freedom restoration acts enacted and used by conservatives in some battles over social issues.The lawsuits show “religious liberty doesn’t operate in one direction,” said Elizabeth Sepper, a law professor at University of Texas at Austin.Aaron Kemper, a lawyer representing three Jewish women who are suing to overturn Kentucky’s abortion ban, said he studied and emulated federal and state religious liberty cases that conservatives won.“We were like, it works for them, so we thought we should use sections from those cases,” he said.Though most lawsuits have not yet yielded court rulings, there are signs the arguments may have some legal traction. In Indiana, a judge issued a preliminary injunction blocking the state’s abortion ban, saying it violated the state’s Religious Freedom Restoration Act adopted in 2015 under then-Gov. Mike Pence, an ardent abortion opponent who is now running for president.Recognizing a potential threat, Oklahoma and West Virginia recently amended their religious freedom restoration acts to explicitly prevent challenges to abortion bans under the acts.Some belief systems, including the United Church of Christ’s, support women making their own decisions in pregnancy. Some, including the Episcopal Church and many branches of Judaism have traditions that abortion should be supported in certain cases, especially where pregnancies threaten women’s physical or mental health or involve serious fetal abnormalities. Some faiths do not define life as beginning with conception.The Indiana case was filed by Hoosier Jews for Choice, three Jewish women and a woman with independent spiritual beliefs. Judge Heather Welch of Marion County Superior Court has certified it as a class-action lawsuit on behalf of “all persons in Indiana whose religious beliefs direct them to obtain abortions in situations prohibited by” the ban.The Rev. Dr. Laurie Hafner, a United Church of Christ pastor, is suing the state of Florida over its abortion bans, saying that according to her faith, “women have the ability and wherewithal to make the decision that’s right for them.”Sydney Walsh for The New York Times“The court has concluded that the plaintiffs’ religious exercise is being substantially burdened, that they are suffering irreparable harm,” Judge Welch wrote in blocking the ban.The state has appealed, arguing that “‘abortion access’ is not religious exercise.” Like other states fighting such lawsuits, Indiana said it has a “compelling interest” to prohibit abortions. “Plaintiffs identify no principle that makes abortion a religious act any more than countless other actions that they believe to affect their well-being,” Indiana’s attorney general wrote, adding, “Other acceptable means for plaintiffs to achieve such ends in the context of childbearing include sexual abstinence, contraceptives, IUDs and natural family planning, just to name a few.”Decades ago, some anti-abortion groups warned that religious freedom arguments might be used to bolster abortion rights. When Congress considered what became the 1993 Religious Freedom Restoration Act, the National Right to Life Committee and the U.S. Catholic Conference raised that concern.“The Act, if passed, will be used to seek access to abortions,” the Catholic Conference’s general counsel wrote in 1992.In Florida, lawsuits filed by Episcopal, Buddhist, Unitarian Universalist, Jewish and United Church of Christ clergy say abortion restrictions violate “clerical obligations and faith” and impose “severe barriers” on religious belief, speech and conduct.Mikayla took mifepristone, the first pill in a two-drug regimen to end a pregnancy.Adria Malcolm for The New York Times“We believe God is the source of all life and has caused us to share in the work of creation,” said one plaintiff, the Rev. Dr. Laurie Hafner, senior pastor of Coral Gables Congregational United Church of Christ. “The privileges and responsibilities of being part of co-creating,” she said, mean “women have the ability and wherewithal to make the decision that’s right for them.”Reverend Hafner said she had counseled parishioners deciding whether to terminate pregnancies, including a 14-year-old girl and a woman whose fetus was nonviable. Florida’s six-week abortion ban is currently on hold, but, she said, “what if it gets to that place where I can no longer sit at the bedside or in the living room or in my office with someone out of fear of what might happen?”Within any faith, there may be varying opinions on abortion. But many of those suing say abortion bans embed conservative Christian ideology into state law.One Kentucky plaintiff, Sarah Baron, a 38-year-old mother of two and a board member of a Louisville synagogue, said, “The Torah teaches us that the fetus does not have the same personhood status as the mother until its first breath.”Ms. Baron, who belongs to Judaism’s conservative denomination, said her age and previous fertility struggles raised risks of pregnancy complications or fetal abnormalities.Under Kentucky’s ban, she said, “I would be unable to make that extremely difficult decision of whether to continue carrying a fetus if the pregnancy is causing severe physical or psychological harm to me or the fetus is nonviable.”“It’s not only cruel,” she said, “but it represents a situation where Jewish law may require the pregnancy to be terminated.”Within Judaism, there are differing views, with some Orthodox Jews supporting only very limited circumstances for abortion. But Mr. Kemper, the Kentucky plaintiffs’ lawyer, said rabbis from every large Kentucky synagogue have supported the lawsuit.Sarah Baron, a Kentucky plaintiff, is a mother of two and a board member of a Louisville synagogue. “The Torah teaches us that the fetus does not have the same personhood status as the mother until its first breath,” she said.Andrew Cenci for The New York TimesThe lawsuits by members of widely known faiths follow a trail blazed by a less conventional religion, the Satanic Temple, which began filing abortion-related lawsuits after the Supreme Court’s 2014 Hobby Lobby decision exempting family-owned corporations from the Affordable Care Act’s mandate that insurance cover contraceptives. The temple, which is recognized by the I.R.S. as a religion and lists 46 American congregations, has lawsuits pending in Idaho, Texas and Indiana, and it recently started the first telemedicine abortion service operated by a religion, with a goal of using it to challenge abortion restrictions.A nontheistic religion that construes Satan not as a New Testament evildoer but as the English literary character who battles oppression, the Satanic Temple often employs a strategy of flamboyant provocation, said Joseph Laycock, a religion scholar at Texas State University and the author of a book about the temple. Its antics make some abortion rights supporters worry that it will stoke anti-abortion sentiment. But some courts have taken its religious freedom claims on various issues seriously, including in a recent preliminary ruling ordering a school district in Hellertown, Pa., to allow its After School Satan Club to meet.Marci Hamilton, a religious freedom expert at the University of Pennsylvania who represents clergy in abortion rights lawsuits in Florida, called the temple’s lawsuits “extremely helpful.”“They are saying, OK, courts, if you’re going to favor the religious right, we’re going to show you a faith whose rights are being violated,” she added.The temple created an abortion ritual, a recitation of tenets about individual control over one’s body and the importance of making decisions based on science. Its general counsel, Matthew Kezhaya, said the ritual strengthens legal claims by linking “abortion and the religion itself” and establishing a practice “interfered with by these particular laws.”The temple’s telemedicine service is currently available in New Mexico, where abortion is legal, but it plans to expand to states with bans and religious freedom laws, temple officials said. It has an intentionally inflammatory name, Samuel Alito’s Mom’s Satanic Abortion Clinic (after the Supreme Court justice who wrote the opinion overturning Roe), but it follows standard medical procedures, employs experienced reproductive health nurses and is listed by a national clearinghouse of legitimate medication abortion services.Mikayla, guided over Zoom by a Satanic Temple minister, participated in the abortion ritual, reciting tenets about autonomy over her body and the importance of science.Adria Malcolm for The New York TimesOne patient, Mikayla, 28, who asked to be identified by her first name to protect her privacy, drove from Texas to an Albuquerque airport hotel to use the service , and allowed The New York Times to observe. During video medical consultations, a nurse practitioner and patient care coordinator discussed effects like cramping and bleeding and urged her to call their 24-hour nurse hotline with questions or concerns.After she received the medication, the process took a different turn. Via Zoom, a minister prompted Mikayla to look in a mirror to reflect on self-empowerment and recite: “One’s body is inviolable, subject to one’s own will alone.” After swallowing the first pill in the two-drug regimen, Mikayla recited a tenet about prioritizing science. The minister advised that after the pregnancy tissue was eventually expelled, Mikayla could recite: “By my body, my blood. By my will, it is done.”Legal experts said some religious freedom lawsuits seeking abortion rights might succeed, given recent Supreme Court decisions that “supported religious exemptions even in cases where there are really strong health and safety issues,” said Elizabeth Reiner Platt, director of the Law, Rights and Religion Project at Columbia University. Arguments for exemptions might also be persuasive because most abortion bans have some exceptions, like rape, experts said.“These should be very strong, compelling cases, but I also acknowledge that this is a highly political issue,” Ms. Platt said.Josh Blackman, a professor at South Texas College of Law Houston who has criticized the lawsuits, questioned the plaintiffs’ legal standing, saying, “A lot of these women are sort of making prospective claims that, One day, I might be pregnant, and one day, I might have this problem and that might require me to have an abortion.”He said some plaintiffs could have religiously sincere “extenuating individual circumstances,” but that allowing widespread exemptions could undermine the law’s larger purpose.Whichever way courts rule could be groundbreaking.“We’re in a completely new landscape,” Ms. Platt said.Adria Malcolm

The law was to take effect on July 1. It is the only state law that specifically outlaws the most common abortion method in the country.A Wyoming judge on Thursday temporarily blocked the first state law specifically banning the use of pills for abortion, the most common method in the country.Just over a week before the ban was scheduled to take effect, Judge Melissa Owens of Teton County District Court granted a temporary restraining order, putting the law on hold pending further court proceedings.Ruling from the bench after a hearing that lasted about two hours, Judge Owens said that the plaintiffs, who include four health care providers, “have clearly shown probable success on the merits and that at least some of the plaintiffs will suffer possible irreparable injury” if the ban were to take effect.Medication abortion is already outlawed in states that have near-total bans, since those bans prohibit all forms of abortion. But Wyoming became the first state to outlaw the use of pills for abortion separate from an overall ban. The law was scheduled to take effect July 1.The ban, passed by the Legislature and signed by Gov. Mark Gordon in March, makes it illegal to “prescribe, dispense, distribute, sell or use any drug for the purpose of procuring or performing an abortion.”Doctors or anyone else found guilty of violating this law would be charged with a misdemeanor, punishable by up to six months in prison and a $9,000 fine. The law explicitly says that pregnant women would be exempt from charges and penalties.In the year since the Supreme Court overturned the national right to abortion, Wyoming’s Republican-controlled Legislature has been trying to ban abortions in the state.Last year, Judge Owens temporarily enjoined a near-total abortion ban, which she said appeared to contradict an amendment to Wyoming’s Constitution that guarantees adults the right to make their own health care decisions. An overwhelming majority of Wyoming citizens voted for that amendment in 2012.In March, the Legislature passed and the governor signed another near-total ban on abortions that tried to circumvent that constitutional amendment by declaring that abortion is not health care. Judge Owens temporarily blocked that law soon after it was signed, saying she questioned the state’s contention that abortion is not health care.The issue of whether abortion is health care was also a significant aspect of Thursday’s hearing on the medication abortion ban. Jay Jerde, a special assistant attorney general for Wyoming, argued that even though doctors and other health providers must be involved in abortions, there are many instances when “getting the abortion doesn’t implicate health care because it’s not restoring the woman’s body from pain, physical disease or sickness.”Judge Owens questioned Mr. Jerde’s argument. “Essentially the government under this law is making the decision for a woman,” she said, “rather than the woman making her own health care choice, which is what the overwhelming majority in Wyoming decided that we should get to do.”The plaintiffs in the case, who are challenging all of the bans in various lawsuits, include the only two abortion providers in Wyoming; an obstetrician-gynecologist who often treats high-risk pregnancies; an emergency room nurse; a fund that gives financing to abortion patients; and a woman who said her Jewish faith requires access to abortion if a pregnant woman’s physical or mental health or life is in danger.A ban on medication abortion would have a substantial impact because pills have been the method used in almost all recent abortions in the state, a lawyer for the plaintiffs, Marci Bramlet, told the court. Nationally, pills are now used in over half of abortions. Only one of Wyoming’s providers offers the other method, surgical abortions.“The ban seeks to only ban medication abortions, not all abortions, completely undermining the state’s stated goal of preserving prenatal life, and allows surgical abortions which are more invasive physically, financially and logistically,” Ms. Bramlet told the court. “The statute tells women, ‘You can have an abortion in Wyoming but not using the safe, effective, F.D.A.-approved medication available.’”

The agency is expected to decide this summer whether to allow the first nonprescription sales of an oral contraceptive in the United States.A panel of advisers to the Food and Drug Administration voted unanimously on Wednesday that the benefits of making a birth control pill available without a prescription outweigh the risks, a significant step in the decades-long push to make oral contraception obtainable over the counter in the United States.If the F.D.A. approves nonprescription sales of the medication, called Opill, this summer, it could significantly expand access to contraception, especially for young women and those who have difficulty dealing with the time, costs or logistical hurdles involved in visiting a doctor, reproductive health experts say. Approval is not a foregone conclusion, however. F.D.A. scientists who analyzed data submitted by the pill’s maker, HRA Pharma, have raised concerns about whether women with medical conditions that should preclude them from taking the pill — primarily breast cancer and undiagnosed vaginal bleeding — would avoid the product.The agency’s reviewers also questioned the reliability of the data from a company study that was intended to show that consumers would follow the label’s directions to take the pill at roughly the same time every day and use another form of contraception or abstain from sex if they happened to miss a dose. The F.D.A. analysts also raised questions about whether younger adolescents and people with limited literacy could follow the directions.“The F.D.A. has been put in a very difficult position of trying to determine whether it is likely that women will use this product safely and effectively at the nonprescription setting,” said Dr. Karen Murry, deputy director of the F.D.A.’s office of nonprescription drugs, during the advisory panel’s discussion session on Wednesday afternoon. “We can’t just approve it based on the experience in the prescription setting without the applicant doing adequate studies to look at what’s likely to happen in the nonprescription setting,” she said. “But I wanted to again emphasize that F.D.A. does realize how very important women’s health is and how important it is to try to increase access to effective contraception for U.S. women.”The advisory committee’s members overwhelmingly said that those concerns were vastly outweighed by the public health need and the long history of safety and efficacy of Opill, which was approved for prescription use 50 years ago. “The panel expresses confidence in the effectiveness, not only in the general population of females, but also in adolescent populations and those with limited literacy,” said Maria Coyle, the chairwoman of the committee, a pharmacist and an associate clinical professor at The Ohio State University. “The panel seems very comfortable with the limited number of risks from the medication itself.” The advisory committee’s members included a wide range of medical professionals: obstetrician-gynecologists, adolescent medicine specialists, a breast cancer specialist and experts in consumer health behavior and health literacy.The F.D.A. had originally scheduled the committee’s public hearing for last November, but postponed it until this spring after asking the company to submit additional information.The birth control medication Opill.Perrigo, via Associated PressSince the Supreme Court overturned the national right to an abortion almost a year ago, the accessibility of contraception has taken on more urgency. The move to make a nonprescription pill available for all ages has garnered a groundswell of support from specialists in reproductive and adolescent health and groups like the American Medical Association, the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians.In a survey by the health care research organization KFF, more than three-quarters of women of reproductive age favored an over-the-counter pill, primarily because of convenience.While some Catholic organizations have spoken out against over-the-counter birth control, most anti-abortion groups have been quiet on the issue. Support was expressed in the vast majority of hundreds of comments submitted before the hearing, which began on Tuesday, and by most of the 37 people who spoke during the hearing’s public comment portion.Opill is known as a “mini pill” because it contains only one hormone, progestin, in contrast to “combination” pills, which contain both progestin and estrogen. A company that makes a combination pill, Cadence Health, has also been in discussions with the F.D.A. about applying for over-the-counter status.Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, spoke in support of the over-the-counter effort in the advisory committee’s hearing on Tuesday. He said in an interview that both types of pills were safe and about 93 percent effective in preventing pregnancy with typical use. Combination pills have been more popular in the United States, but that may be because progestin-only pills, which are widely used in Europe, have not been marketed much in this country, he said.HRA Pharma, which was purchased last year by Perrigo, a Dublin-based maker of over-the-counter pharmaceuticals, already sells a nonprescription progestin-only pill in the United Kingdom.

The panel heard strong support from the company and many doctors but concern from F.D.A. scientists.It was like a tale of two birth control pills.At a hearing Tuesday to consider whether the Food and Drug Administration should authorize the country’s first over-the-counter birth control pill, a panel of independent medical experts advising the agency was left to reckon with two contradictory analyses of the medication called Opill.During the eight-hour session, the manufacturer of the pill, HRA Pharma, which is owned by Perrigo, and representatives of many medical organizations and reproductive health specialists said that data strongly supported approval. They said that Opill, approved as a prescription drug 50 years ago, was safe, effective and easy for women of all ages to use appropriately — and that over-the-counter availability was sorely needed to lower the country’s high rate of unintended pregnancies.In contrast, F.D.A. scientists questioned the reliability of company data that was intended to show that consumers would take the pill at roughly the same time every day and comply with directions to abstain from sex or temporarily use other birth control if they missed a dose. The agency seemed especially concerned about whether women with breast cancer or unexplained vaginal bleeding would correctly choose not to take Opill and whether adolescents and people with limited literacy would use it accurately.“I’m just really quite confused by the level of discrepancy,” one member of the advisory panel, Pamela Shaw, a senior investigator with Kaiser Permanente Washington, saidafter both sides had made presentations.On Wednesday, the panel will take a nonbinding vote on whether the risks of an over-the-counter pill would outweigh its benefits. The F.D.A. is expected to make a final decision this summer.The move to make a nonprescription pill available for all ages has garnered a groundswell of support from specialists in reproductive and adolescent health and groups like the American Medical Association, the American College of Obstetricians and Gynecologists and the American Academy of Family Physicians.In a survey by the health care research organization KFF, more than three-quarters of women of reproductive age favored an over-the-counter pill, primarily because of convenience.Strikingly, at a time of fierce divisions over abortion, including abortion pills, many anti-abortion groups have declined to criticize over-the-counter birth control. Opposition appears to primarily come from some Catholic organizations. Support was expressed in the vast majority of hundreds of comments submitted before Tuesday’s hearing and by most of the 37 people who spoke during the hearing’s public comment portion.“As a teenager I was told by my doctor that I shouldn’t start the birth control pill because it would make me more likely to become sexually active,” said one speaker, Rebecca Heimbrock, a 20-year-old college sophomore. “Of course we know that this is not true, and young people without access to birth control simply have sex without being on birth control.”Opill is called a “mini pill” because it contains only one hormone, progestin, in contrast to “combination” pills, which contain both progestin and estrogen. Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, who spoke in support of the over-the-counter effort in public comments Tuesday, said both types of pills were safe and about 93 percent effective in preventing pregnancy with typical use. He said that compared to progestin-only pills, more medical conditions would preclude women from taking combination pills, which work by blocking the release of eggs from the ovaries and carry a risk of causing blood clots for some women.Progestin-only pills, which thicken cervical mucous to make it difficult for sperm to fertilize eggs and may also disrupt the release of eggs, have virtually no risk of causing blood clots. Data has suggested that it may be more important to take progestin-only pills within the same three-hour period each day, while combination pills allow somewhat greater flexibility, he said.Dr. Pamela Horn, director of an F.D.A. division for nonprescription drugs, said Tuesday that she “cares deeply about women’s health” and would “love to have unambiguous data” to support the application.But she said there were numerous concerns, concluding that “the evidence for likelihood of effectiveness in the nonprescription setting submitted by the applicant is mixed and has many limitations.”The F.D.A. highlighted the fact that about 30 percent of study participants reported taking more pills than they had received, a phenomenon called “overreporting” or “improbable dosing.” Dr. Jeena Jacob, an F.D.A. medical officer, said that raised concerns about those participants as well as the possibility that “other participants who are not part of the improbable dosing group may have incorrectly used or incorrectly reported use.”And Dr. Karen Murry, deputy director of the agency’s Office of Nonprescription Drugs, pushed back on a much-quoted figure that over 100 countries have over-the-counter pills. She said that pharmacists dispense such pills in most of those countries, so Americans’ experience might be different. Here, she said, “if this product is approved, people might get it in a pharmacy, but they also might get it in a gas station or a big box store with no health care professionals around.”Presentations supporting the company made a very different case.“Despite availability of a variety of contraceptive methods, nearly half of the pregnancies are unintended every year,” Dr. Carolyn Westhoff, an obstetrician-gynecologist at Columbia University’s Mailman School of Public Health, testified. She noted that other over-the-counter methods, such as condoms, were less effective than the pill and added, “We need more effective methods to be available without a prescription.”Dr. Westhoff suggested that for most women, there is no advantage to a doctor prescribing the pills because doctors don’t typically monitor patient adherence and often only see such patients once a year. She said it was especially important to make the pill available to adolescents because “these youngest women faced most significant barriers to accessing the more effective methods.”Other speakers, including some who spoke during the public comment session, emphasized that the product would also be helpful for women in low-income, rural and marginalized communities who didn’t have insurance or who found it difficult to see a doctor for a prescription because of the time, transportation or child care costs involved.Dr. Pamela Goodwin, a breast cancer oncologist at Sinai Health System in Toronto, testified that very few breast cancer patients would be at risk, because their doctors would advise them against using it. The company’s study found that 97 percent of breast cancer patients correctly opted not to take the pill.The study reported that participants had taken the pill on 92.5 percent of the days they were supposed to take it, Dr. Stephanie Sober, the U.S. medical liaison for the company. She said that nearly 85 percent of participants had taken a pill on at least 85 percent of the days. Most participants who missed a pill reported that they had followed the label’s directions to take mitigating steps such as abstaining from sex or using a condom, Dr. Sober said, adding that among 955 participants, only six women had become pregnant while using Opill.“Let’s face it — the instructions for Opill use are extremely simple: Take one pill, at the same time every day,” said Dr. Anna Glasier, a British reproductive health expert who testified for the company. “The vast majority of women did just that. And if they made a mistake, most took the appropriate mitigating action. And let’s remember that the women who did miss pills often did so because they could only get a supply from the site where they had enrolled, while in the real world situation, they could have bought a pill from any drugstore.”

The suit by GenBioPro, the generic maker of mifepristone, is the latest strand in the intense legal battle over abortion pills.The company that makes a majority of the abortion pill mifepristone sold in the United States sued the Food and Drug Administration on Wednesday, a new legal volley in a string of recent court maneuverings over the fate of the drug.The lawsuit adds another strand to the intense legal battle underway over a case filed in federal court in Texas in which a consortium of anti-abortion groups are seeking to overturn the F.D.A.’s 23-year-old approval of mifepristone, the first pill used in a two-drug medication abortion regimen.In the new case, GenBioPro, which makes the generic version of mifepristone, seeks to block the F.D.A. from complying if the courts ultimately order mifepristone off the market. The case was filed in the U.S. District Court of Maryland.Earlier this month, the federal judge in the Texas case issued a preliminary ruling invalidating the approval of mifepristone. Last week a federal appeals court panel said the drug could remain on the market while the case was being litigated, but it ordered a reversal of all regulatory actions the F.D.A. has taken on mifepristone since 2016, which include the approval in 2019 of GenBioPro’s generic version of the exact same drug.That order has been briefly paused by the Supreme Court, which is expected to decide by midnight on Friday whether it will extend the stay until the full case can be heard.The GenBioPro lawsuit claims that the F.D.A. has repeatedly failed to stipulate that it would follow a regulatory process established by Congress and afford the drug company due process rights guaranteed by the Constitution if the agency was ordered to suspend or revoke its approval of GenBioPro’s product.By leaving open the possibility that it would immediately obey such a court order, the lawsuit argues, the F.D.A. has “left GenBioPro at risk of severe civil and criminal penalties if it does not cease shipments of mifepristone.”The F.D.A. issued a statement saying: “F.D.A. doesn’t comment on pending litigation.”In testimony Wednesday before the Senate Appropriations Committee, the F.D.A. commissioner, Dr. Robert M. Califf, fielding questions about the Texas lawsuit, said the agency was concerned about the potential implications of the case, “from the well-being of patients who need access to this drug, the pharmaceutical industry and our ability to implement our statutory authority.” He noted that the F.D.A. was fighting the case in court, adding “I’ll just say the FDA intends to comply with any court orders.”Evan Masingill, GenBioPro’s chief executive, said Wednesday that uncertainty about the outcome of the Texas case has led to fewer orders of mifepristone. “The market disruption is already pervasive, impacting orders that include tens of thousands of units,” he said.The case could also have implications for the broader drug industry. The suit claims that it would be unprecedented for the F.D.A. to follow a court order to immediately revoke the approval of a drug. A drug’s approval can only be revoked if the F.D.A. determines that it presents “an imminent hazard to the public health,” the lawsuit says. The F.D.A. has forcefully argued in court that mifepristone is very safe and cited scores of studies showing that serious complications are rare and that less than 1 percent of patients need hospitalization.“People develop drugs in this country and not in others because we’ve typically had a pretty predictable regulatory structure, and with the Texas lawsuit, is that becoming not the case?” said Skye Perryman, a lawyer for GenBioPro and president of Democracy Forward, a center-left legal advocacy organization. “That has industry wide implications.”GenBioPro says that it supplies about two-thirds of the drug sold in the United States and that it sold more than 850,000 units of the drug between 2017 and 2020. GenBioPro’s lawsuit cites filings the F.D.A. submitted to the Supreme Court, in which the agency said that if the appeals court decision were to take effect, “the generic version of the drug would cease to be approved altogether.”The company said in the lawsuit that such statements amounted to a policy decision by the federal agency and that “the F.D.A. decision is erroneous and unlawful.”The suit says that the F.D.A. has declined to say otherwise in response to three letters GenBioPro sent it in March and April. In those letters, GenBioPro asked the agency to clarify that it would adhere to the congressionally mandated process that typically involves a detailed and lengthy review before any decision about withdrawing a drug is made.The company said that the F.D.A. had responded to only the first letter, sent in March before any decision was announced in the anti-abortion groups’ lawsuit, and that it said only that the “F.D.A. will, of course, need to review the Court’s opinion and order before determining what steps may be necessary to comply with it.”“We are not challenging F.D.A.’s scientific or medical judgment,” Ms. Perryman said, “but F.D.A. has failed to confirm it will respect our clients’ rights and so we are seeking a court order.”Christina Jewett

The judges blocked the drug from being sent to patients through the mail and rolled back other steps the government had taken to ease access.A federal appeals court ruled late Wednesday that the abortion pill mifepristone could remain available, but the judges blocked the drug from being sent to patients through the mail and rolled back other steps the government had taken to ease access in recent years.The three-judge panel said its ruling would hold until the full case is heard on appeal.In its order, the U.S. Court of Appeals for the Fifth Circuit, said the Food and Drug Administration’s approval of mifepristone in 2000 could stand because too much time had passed for the plaintiffs, a consortium of groups and doctors opposed to abortion, to challenge that decision.But the court said that it was not too late for the plaintiffs to challenge a set of steps the F.D.A. took beginning in 2016 that lifted restrictions and made it easier for more patients to have access to the pill.Those steps included not requiring that the pill be prescribed only by doctors, approving the pill for use up to 10 weeks into pregnancy instead of seven weeks and allowing the pill to be mailed to patients instead of requiring it to be picked up from a health care provider in person.All of those restrictions were temporarily reinstated. The Justice Department is likely to appeal the order to the Supreme Court.Fifth Court of Appeals Order on Abortion Pill CaseRead Document 42 pagesMike Ives

One invalidated the F.D.A.’s approval of the abortion pill mifepristone. The other ordered the F.D.A. to do nothing to restrict the pill’s availability.The ruling by a federal judge in Texas invalidating the Food and Drug Administration’s approval 23 years ago of the abortion pill mifepristone has the potential to be the most consequential abortion decision since the Supreme Court overturned Roe v. Wade last June.But there are a lot of uncertainties — especially because a federal judge in Washington State issued a contradictory ruling less than an hour later saying the F.D.A. should do nothing to restrict the pill’s availability in most states that allow abortion.So the situation is complicated. Here is what we know and what it could mean.What did the two rulings say?Both rulings are preliminary injunctions, issued before the full cases have been heard. But the dueling injunctions set up a legal showdown that is likely to reach the Supreme Court.The ruling by Judge Matthew J. Kacsmaryk of the U.S. District Court for the Northern District of Texas, a Trump appointee who has written critically about Roe v. Wade, declares the F.D.A.’s approval of mifepristone in 2000 to be invalid. It also suspends the F.D.A.’s subsequent decisions that expanded the use of mifepristone in terminating early pregnancies.Legal experts said Judge Kacsmaryk’s ruling appeared to be the first time that a court had acted to order that an approved drug be removed from the market over the objection of the F.D.A. If it stands, they said, it could have repercussions for the federal government’s authority to regulate other types of drugs.The ruling by Judge Thomas O. Rice of the U.S. District Court for the Eastern District of Washington, an Obama appointee, orders the F.D.A. to maintain the status quo and blocks it from restricting the availability of mifepristone in the states that filed the lawsuit before that court. That lawsuit, filed by Democratic attorneys general, challenged restrictions the F.D.A. still imposes on the prescribing and dispensing of mifepristone.What does this mean for the availability of abortion pills?For now, mifepristone, the first pill in the two-drug medication abortion regimen that is used in over half of pregnancy terminations in the United States, is still available. Judge Kacsmaryk immediately stayed his ruling for seven days to give the Department of Justice, which represents the F.D.A., a chance to appeal it to the U.S. Court of Appeals for the Fifth Circuit, and the Justice Department has already filed notice of its appeal.If the appeals court upholds the judge’s order or declines to put it on pause until the full case is heard, the Justice Department will most likely appeal that decision to the Supreme Court, which could quickly decide whether or not to suspend the injunction. The Supreme Court would also take into account the contradictory ruling by the federal judge in the Washington district court case, legal experts said.Even if the Texas ruling is upheld, several scenarios would allow mifepristone to remain available in the United States, at least for the time being. And if the drug does eventually become unavailable in the United States, patients would probably still be able to get it from overseas. Read on for details.How can a judge withdraw an approval of a drug that has been legal for 23 years?The lawsuit in the Texas district court, filed by a consortium of groups and doctors opposed to abortion, argues that the F.D.A. did not adequately review the scientific evidence or follow proper protocols when it approved mifepristone in 2000 and that it has since ignored safety risks of the medication.The F.D.A. and the Department of Justice have strongly disputed those claims and said that the agency undertook rigorous reviews of mifepristone over the years that repeatedly reaffirmed its decision to approve mifepristone, which blocks a hormone that allows a pregnancy to develop. They point to numerous studies showing that serious complications are rare, with patients needing hospitalization in less than 1 percent of cases.In his ruling, Judge Kacsmaryk, who previously worked for a conservative Christian legal organization, repeatedly used the language of abortion opponents, calling medication abortion “chemical abortion,” calling abortion providers “abortionists” and referring to a fetus as an “unborn human” or “unborn child.”He appeared to agree with virtually all of the anti-abortion groups’ claims, writing: “Here, F.D.A. acquiesced on its legitimate safety concerns — in violation of its statutory duty — based on plainly unsound reasoning and studies that did not support its conclusions. There is also evidence indicating F.D.A. faced significant political pressure to forgo its proposed safety precautions to better advance the political objective of increased ‘access’ to chemical abortion.”The F.D.A. has regulated mifepristone more stringently than many other drugs and applied a special framework of restrictions that is currently used for only 60 drugs in the country. In the case filed in federal court in Washington State, Democratic attorneys general from 17 states and the District of Columbia are seeking to eliminate that special framework of extra restrictions on mifepristone. Judge Rice did not grant that request in his ruling Friday but did order the F.D.A. not to do anything to limit current access to mifepristone.Judge Matthew J. Kacsmaryk, a Trump appointee who has written critically of Roe v. Wade, issued a ruling saying that the F.D.A.’s approval of the abortion pill mifepristone was invalid.U.S. Senate Committee on the JudiciaryWhat are the options for preserving access if the Texas ruling is upheld?If the Texas judge’s injunction stays in place as the full case makes its way through the courts, the F.D.A. will most likely assert that it needs to follow its official process for withdrawing the approval of a drug. That process is lengthy. It requires reviews of extensive studies and data and could involve advisory committee hearings and a public comment period. The process can take months or years, and while it is underway, the drug being reviewed remains available.Legal experts say the F.D.A. also has the authority to decide not to enforce a regulation or prohibition of a drug, if the agency considers the drug to be safe and effective, as it does with mifepristone. The agency could issue a determination saying it had decided not to enforce the ruling, or it could argue that it did not have the resources to try to stop the drug from reaching patients all over the country.Because the judge’s ruling applies only to the F.D.A. and not to abortion providers, several medication abortion services have said they will continue prescribing and dispensing mifepristone unless there is an official F.D.A. decision to withdraw the drug that the agency plans to enforce.It’s also possible that one or both of the companies that make mifepristone in the United States, Danco Laboratories and GenBioPro, could file suit against the F.D.A. to block its enforcement of the Texas judge’s order, legal experts say.Demonstrators gathered in February for a rally organized by Women’s March, which supports abortion rights, outside the federal courthouse in Amarillo, Texas, where anti-abortion groups filed suit against the F.D.A.Meridith Kohut for The New York TimesWhat if efforts to keep mifepristone available fail?Abortion providers and supporters of abortion rights are actively preparing for this possibility. Many of them have developed plans to prescribe only the second medication in the two-drug abortion regimen: misoprostol. This drug, which has been available for decades and is authorized for medical conditions like ulcers, causes contractions that result in a process resembling a miscarriage.The World Health Organization has endorsed a misoprostol-only regimen for abortion, and it is used in many countries, especially where there is limited availability of mifepristone. Studies suggest that using misoprostol on its own may be slightly less effective than the two-drug combination and can cause more side effects like nausea, but it is safe and, in a majority of cases, terminates a pregnancy without requiring a follow-up surgical procedure or other intervention.In the Texas lawsuit, the anti-abortion organizations also seek to ban the use of misoprostol for abortion, but their request for a preliminary injunction focused on mifepristone.Could patients still order pills from abroad?Many patients would probably continue to order both mifepristone and misoprostol from telemedicine abortion services based in other countries, especially Aid Access, an organization based in Europe that for years has provided the two-drug combination to patients in the United States after they complete medical consultation forms.Currently, for patients in states with abortion bans or restrictions, Aid Access has the pills shipped from a pharmacy in India, while patients in states where abortion is legal receive their pills from providers within the United States.If the Texas ruling stands, Aid Access would most likely ship the pills from India to patients in every state, the organization’s founder, Dr. Rebecca Gomperts, a Dutch physician, said in an interview. In 2019, the F.D.A. tried unsuccessfully to get Aid Access to halt overseas shipping. Dr. Gomperts said she would remain committed to supplying patients in the United States.Would revoking the approval of mifepristone have effects beyond abortion?Mifepristone is also frequently used to assist patients who are experiencing miscarriages. It is prescribed along with misoprostol to help expel the tissue from a pregnancy that has failed to develop. So, if access to mifepristone is blocked, miscarriage patients will lose access to that treatment and will either have to undergo surgical removal of the tissue or wait days or weeks until it passes on its own, in a process that can be medically risky for some patients.Revoking the federal approval of mifepristone could also undermine the F.D.A.’s longstanding and previously unquestioned authority — granted by Congress — to regulate virtually any drug. Legal experts say it could lead to challenges over the approval or use of medications involved in other controversial issues, such as vaccines or emergency contraception. In addition, if pharmaceutical companies cannot rely on the F.D.A.’s regulatory authority, that could affect their decisions about which drugs to develop.

The Texas judge’s ruling was quickly contradicted by another federal judge in Washington State who ordered the F.D.A. to keep mifepristone available.A federal judge in Texas issued a preliminary ruling invalidating the Food and Drug Administration’s 23-year-old approval of the abortion pill mifepristone, an unprecedented order that — if it stands through court challenges — could make it harder for patients to get abortions in states where abortion is legal, not just in those trying to restrict it.The drug will continue to be available at least in the short-term since the judge, Matthew J. Kacsmaryk, stayed his own order for seven days to give the F.D.A. time to ask an appeals court to intervene.Less than an hour after Judge Kacsmaryk’s ruling, a judge in Washington state issued a ruling in another case, which contradicted the Texas decision, ordering the F.D.A. to make no changes to the availability of mifepristone in the 18 states that filed that lawsuit.The conflicting orders by two federal judges, both preliminary injunctions issued before the full cases have been heard, appear to create a legal standoff likely to escalate to the Supreme Court. President Biden said his administration would fight the Texas ruling. “This does not just affect women in Texas,” he said in a statement. “If it stands, it would prevent women in every state from accessing the medication, regardless of whether abortion is legal in a state.”The order by Judge Kacsmaryk, a Trump appointee who has written critically about Roe v. Wade, is an initial ruling in a case that could result in the most consequential abortion decision since the Supreme Court overturned Roe v. Wade last June.Read the Court Decision Invalidating F.D.A. Approval of MifepristoneA federal judge in Texas issued a preliminary ruling invalidating the Food and Drug Administration’s 23-year-old approval of the abortion pill mifepristone on Friday, clashing with another court’s ruling in a legal standoff likely to escalate to the Supreme Court.Read Document 67 pagesOn Friday night, the Justice Department filed a notice that it is appealing the Texas ruling.“Today’s decision overturns the F.D.A.’s expert judgment, rendered over two decades ago, that mifepristone is safe and effective,” Attorney General Merrick B. Garland said in a statement, adding that the Justice Department would ask that the decision be stayed while the appeal is pending. He said the department is reviewing the ruling in the Washington case.The lawsuit, filed by a coalition of anti-abortion groups and doctors, seeks to end more than 20 years of legal use of mifepristone, the first pill in the two-drug medication abortion regimen.The lawsuit in Washington State was filed against the F.D.A. by 18 Democratic attorneys general who were challenging the agency’s restrictions on the prescribing and dispensing of mifepristone. In a preliminary injunction in that case that he applied to the states that had sued, Judge Thomas O. Rice, who was appointed by President Barack Obama, blocked the agency from taking “any action to remove mifepristone from the market or otherwise cause the drug to become less available.”Read the Court Decision Ordering the F.D.A. to Keep Mifepristone AvailableA federal judge in Washington State issued a ruling ordering the Food and Drug Administration to make no changes to the availability of the abortion pill mifepristone on Friday, directly contradicting another judge’s ruling in a legal standoff likely to escalate to the Supreme Court.Read Document 31 pagesMedication abortion is the method used in more than half of abortions in the United States. The lawsuit claims that the F.D.A. did not adequately review the scientific evidence or follow proper protocols when it approved mifepristone in 2000 and that it has since ignored safety risks of the medication.The F.D.A. and the Justice Department have strongly disputed the claims in the lawsuit and said that the federal agency’s rigorous reviews of mifepristone over the years had repeatedly reaffirmed its decision to approve mifepristone, which blocks a hormone that allows a pregnancy to develop. In a statement Friday night, the agency said: “F.D.A. stands behind its determination that mifepristone is safe and effective under its approved conditions of use for medical termination of early pregnancy, and believes patients should have access to F.D.A.-approved medications that F.D.A. has determined to be safe and effective for their intended uses.”In the 67-page Texas ruling, Judge Kacsmaryk appeared to agree with virtually all of the claims made by the anti-abortion groups and repeatedly used the language of abortion opponents, calling medication abortion “chemical abortion” and referring to a fetus as an “unborn human” or “unborn child.””The court does not second-guess F.D.A.’s decision-making lightly,” the judge wrote. “But here, F.D.A. acquiesced on its legitimate safety concerns — in violation of its statutory duty — based on plainly unsound reasoning and studies that did not support its conclusions. There is also evidence indicating F.D.A. faced significant political pressure to forgo its proposed safety precautions to better advance the political objective of increased ‘access’ to chemical abortion.”Are Abortion Pills Safe? Here’s the Evidence.The Times reviewed 101 studies of medication abortion, spanning continents and decades. All concluded that the pills are a safe method for terminating a pregnancy.A lawyer for Danco Laboratories, which makes the branded version of mifepristone, called Mifeprex, and had joined the lawsuit on the side of the F.D.A., forcefully disagreed with the judge’s characterizations.“The court’s ruling rewrites the facts and the law to tell its preferred narrative — which is a story line that conflicts with established legal principles and with Mifeprex’s well-established safety profile,” the lawyer, Jessica Ellsworth, said in a statement. Danco filed a notice that it was appealing the ruling.Erik Baptist, a lawyer for the anti-abortion groups that filed the Texas case called the decision “a significant victory for the doctors and medical associations we represent, and more importantly, the health and safety of women and girls.” Mr. Baptist, who is senior counsel for the Alliance Defending Freedom, a conservative Christian legal organization, said, “by illegally approving dangerous chemical abortion drugs, the F.D.A. put women and girls in harm’s way, and it’s high time the agency is held accountable for its reckless actions.”Legal experts said that even if the Texas ruling is ultimately upheld, there would be several legal options that could allow the manufacturers of mifepristone to continue supplying the drug and providers to continue prescribing it to patients.A still taken from a livestream of Judge Matthew Kacsmaryk’s nomination hearing to the federal bench in 2017.U.S. Senate Committee on the JudiciaryShortly after the rulings on Friday night, the chief executive of GenBioPro, one of the two manufacturers of mifepristone in the United States, issued a statement saying the company was reviewing the decisions of both judges.“We will take any steps necessary to lawfully make mifepristone available and accessible to as many people as possible in the country,” the statement from the C.E.O., Evan Masingill, said.And if legal access to mifepristone is blocked, some abortion providers plan to provide only the second abortion medication, misoprostol, which is used safely on its own in many countries where mifepristone is less available. Misoprostol, a drug that is approved for other medical uses, causes contractions similar to a miscarriage and is considered slightly less effective on its own than in combination with mifepristone and more prone to cause side effects like nausea.Where Restrictions on Abortion Pills Could Matter Most in the U.S.A lawsuit is challenging the F.D.A.’s approval of medication abortion. Data shows the consequences could be far-reaching.In the Texas lawsuit, the plaintiffs also seek to ban the use of misoprostol for abortion, but their request for a preliminary injunction focused on mifepristone.Since last year’s Supreme Court ruling overturning the national right to abortion, the pills used in medication abortions have increasingly become the focus of political and legal battles. Some conservative states, in addition to banning or restricting abortion in general, have begun considering legislation that specifically targets abortion pills. And several recent lawsuits have been filed in efforts to preserve or expand access to medication abortion.The lawsuit filed in Washington state was intended to be a direct challenge to the Texas case. The Democratic attorneys general filed the case in late February on the first day that Judge Kacsmaryk could have issued a ruling. While its main claims sought to eliminate a framework of extra restrictions that the F.D.A. has long applied to mifepristone, the suit also asked the judge to declare that the F.D.A.’s “approval of mifepristone is lawful and valid” and to enjoin the F.D.A. “from taking any action to remove mifepristone from the market or reduce its availability.”In a news conference earlier this week, Washington’s attorney general, Bob Ferguson, characterized the lawsuit he and the other attorneys general filed as “the opposite of what’s going on in Texas.” He added “So the potential is there for two decisions or judges that are, in effect, contrary to one another. In other words, one judge in Texas could potentially say ‘Hey I’m issuing a ban on mifepristone nationwide’ and a judge in Washington State in the case with 17 other states could say ‘no, no, not only is it available, you got to expand access to it.’”People marched in Amarillo, Texas, in February to protest the lawsuit seeking to force the withdrawal of the F.D.A.’s approval of mifepristone.Meridith Kohut for The New York TimesThe case has caused a frenzy of concern in the reproductive health community. It was filed by the Alliance for Hippocratic Medicine, an organization that lists five anti-abortion groups as its members and was incorporated in August in Amarillo, Texas, where the case was filed. Judge Kacsmaryk is the only federal judge covering the Amarillo division in the U.S. District Court of the Northern District of Texas. The F.D.A. has regulated mifepristone more stringently than many other drugs and has regularly reviewed evidence for its safety and effectiveness.For a dozen years, the agency has imposed an additional framework of restrictions and monitoring for the drug. Called a Risk Evaluation and Mitigation Strategy, or REMS, that framework has been used for only about 300 other drugs, only 60 of which it currently covers.In recent years, the F.D.A. has extensively reviewed new data on mifepristone and has lifted several of the restrictions, including the requirement that patients obtain the drug in person from a provider.Some of the same anti-abortion organizations that filed the Texas lawsuit had previously filed, in 2002 and 2019, citizen petitions opposing the F.D.A.’s actions on mifepristone. Both were rejected by the agency as unfounded. And a 2008 review by the Government Accountability Office found no irregularities in the F.D.A.’s mifepristone approval.Legal experts said that the ruling appeared to be the first time that a court had acted to order that a drug be removed from the market over the objection of the F.D.A. and that if the ruling stood, it could have repercussions for federal authority to regulate other types of drugs.In his statement, Mr. Biden said, “If this ruling were to stand, then there will be virtually no prescription, approved by the F.D.A., that would be safe from these kinds of political, ideological attacks.”Adam Liptak

A new analysis summarizes the emerging picture of factors that make long-term post-Covid symptoms more likely.Which coronavirus patients are most at risk for developing long Covid?A new analysis of research conducted during the first two years of the pandemic helps crystallize some answers that have been emerging.It found that patients over 40, those with previous health issues and those who had a severe coronavirus infection had greater risk of developing long Covid. And it affirmed a growing consensus that vaccination lowers that risk.The analysis, conducted by a team of researchers in Britain and published in the journal JAMA Internal Medicine, looked at 41 studies published between the beginning of the pandemic and Dec. 5, 2022. The studies, which had all been peer-reviewed, involved a total of 860,783 patients.The report evaluated the patients’ risk of post-Covid symptoms — including shortness of breath, fatigue, brain fog, headache, and loss of taste and smell — more than three months after their infection.People who received two doses of a Covid vaccine before becoming infected were 43 percent less likely to develop long Covid. The analysis did not look at the role of boosters.The authors wrote that the emerging evidence suggested that vaccination reduced the risk of long-term symptoms “even in individuals with other risk factors, such as older age or high B.M.I.”Other studies that were not included in the analysis have also suggested that vaccines can reduce, though not eliminate, the risk of long Covid.Risk factors analyzed in the paper included:Being femaleWomen were one and a half times as likely as men to develop long Covid. The authors and other researchers have suggested several possible reasons for this, including that hormone levels or disruption in hormone production may perpetuate inflammation caused by the initial infection and that higher levels of some antibodies in women might contribute to lingering symptoms.Being over 40The long Covid patients in the analysis were about 20 percent more likely to be older than 40. The analysis found that people 70 and older had the same risk as those who were 40 to 69, but the researchers suggested that might be because people over 70 were more likely to die from their initial infection.Being obesePeople were at increased risk for long Covid if they were obese, the analysis found. Obesity, they wrote, often involves a metabolic inflammatory process that could prolong post-Covid health issues.Being a smokerSmoking was also a risk factor, the researchers found, although they said it was unclear if that was because of the smoking itself or illnesses associated with smoking.Having previous medical conditionsOf the medical issues analyzed in the study, immunosuppressive conditions appeared to lead to the greatest increased risk of long Covid. People with chronic obstructive pulmonary disease, ischemic heart disease or asthma faced the next highest levels of increased risk. There was also elevated risk of long Covid for people with anxiety, depression, chronic kidney disease or diabetes.The sicker people were during their initial infection, the more likely they were to experience lingering health problems. Patients who were hospitalized, whether in intensive care or not, were nearly two and a half times as likely to develop long Covid than patients who were not hospitalized, the analysis found.“Patients with previous critical illness represent a high-risk population, and their follow-up should reflect intensive plans for prevention, rehabilitation and treatment of the ongoing debilitating symptoms,” the authors wrote.However, since a majority of people infected with the coronavirus have not needed to be hospitalized, there are greater numbers of long Covid patients whose initial infection was relatively mild.Other research, not included in the analysis, has focused on more detailed biological characteristics. One study published in 2022 found that people were more likely to develop long Covid if, at the time of their infection, they had factors including certain autoantibodies — antibodies that mistakenly attack tissues in the body as they do in conditions like lupus and rheumatoid arthritis — or reactivated Epstein-Barr virus, a virus that infects most people and then usually becomes dormant.The new analysis involved patients infected during waves of various coronavirus variants, but the authors did not analyze the variants separately.“It is unlikely that the risk factors” associated with long Covid would change with new variants, they wrote.

Wyoming’s Constitution guarantees a right to make individual health care decisions. The new ban attempts to circumvent that right by declaring that abortion is not health care. Abortion will remain legal in Wyoming — at least temporarily — after a judge on Wednesday ordered that a newly enacted ban be blocked until further court proceedings in a lawsuit challenging it.After a three-hour hearing, Judge Melissa Owens of Teton County District Court granted a temporary restraining order, pausing a law that took effect Sunday. The law would make providing almost all abortions a felony punishable by up to five years in prison. The lawsuit — filed by six plaintiffs, including four health care providers — also challenges another law, scheduled to take effect on July 1, that would make Wyoming the first state to explicitly ban the use of pills for abortion. Now, the medication abortion ban and the overall ban will be considered at a hearing where the plaintiffs will seek an injunction to suspend both laws until the full lawsuit can be heard.A central issue is whether Wyoming’s Constitution allows the legislature to ban nearly all abortions, when the Constitution includes an amendment that guarantees adults the right to make their own health care decisions. An overwhelming majority of Wyoming citizens voted for the amendment in 2012.Similar battles over the constitutionality of state abortion plans have been playing out in other conservative states. In South Carolina and North Dakota, courts have ruled that abortion bans violate those states’ constitutions. In Idaho, courts have upheld the state’s abortion ban.Last year, Judge Owens blocked a previously enacted abortion ban, and a hearing on that is scheduled for December. The new ban, enacted earlier this month, was the legislature’s attempt to circumvent the constitutional guarantee of freedom in health care choices by declaring in the law that abortion is not health care.On Wednesday, Judge Owens questioned that assertion. “I’m just still hung up on abortion not being health care,” she said to the lawyer defending the laws for the state, Jay Jerde, a special assistant attorney general for Wyoming. “An abortion can only be performed by a licensed medical professional, so what authority does the legislature have to declare that abortion is not health care when our laws only allow a licensed medical professional to administer one?” she asked.Regarding medication abortion, she noted that abortion pills are regulated by the Food and Drug Administration. “How is a doctor actually prescribing those pills not health care?” she asked.Mr. Jerde said the legislature’s premise was that “intentional killing of an unborn child cannot be considered to be health care.” “I would concede that if you focus just on the pregnant woman, it becomes a little bit easier to say, well, this has to be health care,” he continued. “But if you view it from that other perspective, it clearly is not.”The plaintiffs include Dr. Giovannina Anthony, an obstetrician-gynecologist at the only clinic in Wyoming that has been providing abortions, and Wellspring Health Access, a clinic that plans to offer abortions when it opens this year. The other plaintiffs are another obstetrician-gynecologist who often treats high-risk pregnancies; an emergency room nurse; a fund that gives financing to abortion patients; and a woman who said her Jewish faith requires access to abortion if a pregnant woman’s physical or mental health or life is in danger.John Robinson, a lawyer for the plaintiffs, told Judge Owens that both the overall ban and the medication abortion ban violate several constitutional provisions because they “attempt to strip women of their rights to equality, health care and religion during a very specific life cycle, from conception to birth.” He said the laws signal that during pregnancy “the legislature does not consider the woman an equal member of the human race and Wyoming.”Mr. Jerde argued that the laws did not violate the constitutional provisions that the plaintiffs cited. He also said the implications of the plaintiffs’ arguments would be that a person with a health condition that might be treated with marijuana “would be free to possess and consume marijuana, regardless of the state laws that prohibit it and criminalize it.”Judge Owens said that only courts can decide whether the laws are constitutional.“To declare abortion is not health care when there may be evidence to show that it is — the legislature cannot make an end run around essentially providing a constitutional amendment,” she said, adding “the state cannot legislate away a constitutional right. It’s not clear if abortion is or isn’t health care, and the court has to then decide that.”