Boxes of the drug mifepristone sit on a shelf at the West Alabama Women's Center in Tuscaloosa, Ala., on March 16, 2022. Attorney generals in 20 conservative-led states warned CVS and Walgreens on Wednesday, Feb. 1, 2023, that they could face legal consequences if they sell abortion pills by mail in those states. Credit: Allen G. Breed / AP

AUGUSTA, Maine — Maine is among the states most reliant on an abortion drug that could be banned as part of a court case awaiting a ruling from a conservative federal judge in Texas.

The drug, mifepristone, is part of a regimen used increasingly to terminate pregnancies in the U.S. Medication abortions have risen in the country during the COVID-19 pandemic and ahead of changes made by the administration of President Joe Biden to make the pills more available. They amounted to just over half of abortions nationally and 61 percent in Maine in 2021.

Maine was largely unaffected by the U.S. Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization to end federal abortion rights and allow states to ban them. That is largely due to one of the country’s most liberal sets of access laws and Democratic control of state government here.

But this newer case is an example of how federal courts could reach around those kinds of laws and make abortion access harder in permissive states, although medication abortions would not stop under the decision and providers may make other adjustments to increase services.

“It’s basically a pretty coarse insertion of politics into a perfectly safe medical procedure that has been used for over 20 years,” said George Hill, the CEO of Maine Family Planning, an abortion provider with 18 sites across the state.

Only six states reported a larger share of medication abortions than Maine did in 2020, according to federal data analyzed by The New York Times. States with high use of medication abortions were almost all rural, including Wyoming, Alaska and Vermont. These abortions are generally approved until the 10th week of a pregnancy.

Under the most popular method, mifepristone is taken first. It dilates the cervix and blocks a hormone needed to maintain pregnancy. After that, the drug misoprostol is taken to expel the embryo. The FDA has found the method is safe and effective with low risk of complications.

While mifepristone is the target of the Texas case, medication abortions would not stop if the judge blocks its sale. A misoprostol-only abortion method is used in many parts of the world and is also deemed safe and effective but less so than the other one.

It also comes with a higher rate of side effects, including fever and diarrhea, according to the Kaiser Family Foundation.

Between 60 percent and 70 percent of abortions done at Maine Family Planning use medication. Surgical ones are offered at its Augusta location only, Hill said. The ratio is about the same at Planned Parenthood of Northern New England, spokesperson Nicole Clegg said.

The Texas case has led Hill’s group to begin working on offering surgical abortions in other places. Both providers would also switch to misoprostol-only abortions if a judge forces the federal Food and Drug Administration to take mifepristone off the market.

Opponents say such an order would be unprecedented. The anti-abortion coalition behind the lawsuit argues the FDA overstepped its authority by quickly approving the drug, that it ignored evidence of risk at the time and that Biden’s rules on pills are illegally circumventing conservative states’ bans on abortion.

U.S. District Court Judge Matthew Kacsmaryk, who has the case, is an appointee of President Donald Trump who opposes abortion rights. The FDA is all but certain to appeal a decision against it, so the legal process could drag out for months longer.

Medication abortions are being targeted by a Maine bill submitted by Rep. Reagan Paul, R-Winterport, that is on a short list of conservative abortion restrictions being floated by conservatives this year. A leader at one anti-abortion group here said medication abortion runs the risk of leaving women “alone” if there are complications.

“It seems way too open,” said Mike McClellan, the policy director for the evangelical Christian Civic League of Maine.

But women increasingly choose medication abortions because it is easier to have supportive people at home, said Clegg of Planned Parenthood, who called it “sort of crazy” that a judge could take away the most effective method.

“People who are opposed to legal abortion, they’re going through the courts to try and take away as much as they possibly can, and it’s not in states where they banned abortion,” she said. “It’s in states like Maine.”

Michael Shepherd

Michael Shepherd joined the Bangor Daily News in 2015 after three years as a reporter at the Kennebec Journal. A Hallowell native who now lives in Augusta, he graduated from the University of Maine in...