A federal court ruling from a Texas judge known for his anti-abortion views soon could outlaw the most common method of ending an unwanted pregnancy in Maine, forcing local providers to resort to a less-effective form of medication abortion.

The case, Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration, could lead to the nationwide ban of one of the two drugs used in the prescription used in more than half of all U.S. abortions, according to Guttmacher Institute, a national abortion research group.

The preference for medication abortions is even higher in Maine, accounting for two-thirds of all abortions at two of Maine’s three abortion clinics, Maine Family Planning in Augusta and Planned Parenthood in Portland, and half of the abortions at Mabel Wadsworth Center in Bangor.

Mareisa Weil, Maine Family Planning’s vice president of development and community engagement, called the Texas case outrageous.

“What we are seeing play out across the United States is the result of a decades-long strategic plan to stack the courts with conservative judges and justices in order to successfully advance an ideological agenda that does not have popular support,” Weil said Thursday.

Maine’s three abortion providers say they will change their medication regimen if the Texas judge rules against the FDA – possibly as early as Friday – and they are barred from prescribing Mifepristone, which blocks the production of progesterone and stops a pregnancy from continuing.

Instead, Maine clinicians will prescribe only Misoprostol, the second drug used in current medication abortion protocol, which causes the uterus to empty. This regimen is standard practice in many parts of the world, where Mifepristone is too costly or unavailable.

Nicole Clegg, senior vice president of public affairs at Planned Parenthood of Northern New England, speaks to the press in May 2022. Derek Davis/Staff Photographer

But Nicole Clegg, chief strategy and impact officer for Planned Parenthood of Northern New England, cautioned that the Misoprostol-only medication abortion is slightly less effective, with a success rate of 84% to 89% compared to 95% to 99% for the two-drug regimen.

Misoprostol-only abortions can cause a patient more discomfort, such as increased cramping and pain, and require repeated doses and a higher rate of follow-up care to ensure a patient is no longer pregnant, she said. That makes the process more complicated for patients traveling from afar.

“Both options are safe and effective, however, Mifepristone and Misoprostol (together) is the best medication abortion regimen,” Clegg said. “The miso-only regimen has been used in other parts of the world where Mifepristone is unavailable for decades.”

According to an analysis from the Guttmacher Institute, the Texas decision would have especially harsh impacts on people in 10 states, like Maine, that rely heavily on medication abortion – even though half of these states, like Maine, are considered to be protective of abortion rights and access.

The use of medication abortion has steadily increased across the United States over the last 20 years. In 2020, 492,210 of the country’s 930,160 abortions were done this way, Guttmacher data shows. Since its approval, medication abortion has been used over four million times.

The Texas case was brought by Alliance Defending Freedom, the same conservative medical group that was behind the Mississippi state abortion law that led the U.S. Supreme Court to overturn Roe v. Wade. Advocates claim ADF decided to file in Texas because it has a medication abortion ban.

The ADF lawsuit alleges the FDA erred when it approved Mifepristone for abortion in 2000 through an expedited process that is intended to get medical treatments to ill patients faster. The plaintiffs say this was an improper use of the fast-track approval process because pregnancy is not an illness.

In its defense of the FDA, the Justice Department notes ADF has shown no proof Mifepristone is unsafe.

Texas is one of 18 states that have banned medication abortions. Other states allow it, but forbid it to be prescribed through telehealth, which creates a hardship for patients who don’t live near a clinic or can’t afford to travel or take time off from work to get the medication in a clinical setting.

The Amarillo judge hearing the case, Matthew Kacsmaryk, was appointed by former President Donald Trump. Before that appointment, Kacsmaryk had worked for the First Liberty Institute, a conservative legal group that filed legal challenges intended to restrict abortion access.

“This is an unprecedented attack on a safe medication already used by millions of people,” said Abbie Strout, education and community engagement director at the Mabel Wadsworth Center in Bangor. “The regimen is the most effective way of terminating a pregnancy by pills.”

Local providers say patients prefer medication abortions for a variety of reasons, especially the speed at which an abortion appointment can be obtained and the flexibility of being able to take their pills where and when they want so they can decide how best to manage any cramping or bleeding.

Medication abortion can be used up to 11 weeks after a patient’s first day of their last menstrual period. About 70 percent of Planned Parenthood of Northern New England patients who end their pregnancies in the first 11 weeks opt for a medication abortion.

Although Maine’s clinics charge the same for a typical medication abortion as a surgical one – $500 to $550 – the soft costs are often lower. Some providers approve medication abortions through telehealth appointments and mail the pills so patients do not have to miss work, hire babysitters or pay for travel.

The use of medication abortion has been growing steadily since the FDA approved it in 2000, but local providers say the pandemic-related changes to the healthcare setting and patients’ desire for no-touch medical care led to a dramatic surge in medication abortions in Maine.

The preference for medication abortion has only continued to grow, even as the pandemic’s impacts on healthcare delivery are easing, providers say. That is probably why ADF has targeted the method in this legal challenge despite evidence showing it is the safest way to end a pregnancy, providers say.