Planned Parenthood South Atlantic and Dr. Beverly Gray, a Duke University OB-GYN, are asking a federal judge to block numerous provisions they argue are unclear and unconstitutional, or to place an injunction on the law to prevent it from being enforced.

Though the law may be commonly referred to as a 12-week abortion ban, the plaintiffs argue that it actually includes additional restrictions that many patients are not aware of — hurdles that will “impede health care professionals from providing quality care,” according to the lawsuit filed in U.S. District Court.

“Many of these provisions are going to constrain an already very constrained abortion ecosystem in this state,” Planned Parenthood South Atlantic CEO Jenny Black told The Associated Press on Friday. “And so we really thought it was important that we challenged the elements of the law that do that.”

North Carolina has been one of the few remaining Southern states with relatively easy access to abortions in the wake of last year’s U.S. Supreme Court decision to strip away constitutional protections for abortion. With the new restrictions set to take effect July 1, many out-of-state patients who had once viewed North Carolina as a refuge for care will soon have to travel even further up the coast to access abortions later in pregnancy.

The lawsuit comes one month after the Republican supermajority in the state’s General Assembly fast-tracked the measure through both chambers and overrode a veto from Democratic Gov. Roy Cooper, who called it “an egregious, unacceptable attack on the women of our state.”

He and other abortion-rights supporters have raised concerns about several provisions addressed in the complaint, including one that the plaintiffs argue could prevent providers from performing a medication abortion after 10 weeks of pregnancy, despite another provision stating it’s lawful through 12 weeks.

That is one example of the contradictory and confusing nature of the law, said lead attorney Brigitte Amiri, deputy director of the ACLU Reproductive Freedom Project. “The lack of clarity and vagueness run through,” she said.

Among the named defendants are North Carolina Attorney General Josh Stein, state Department of Health and Human Services Secretary Kody Kinsley and the district attorneys who represent every county in the state where Gray and Planned Parenthood provide abortions.

Kinsley’s office and Stein’s office said they are reviewing the lawsuit. Stein, a Democratic candidate for governor in 2024, is an outspoken abortion-rights supporter but is named in the lawsuit because it’s his job as attorney general to defend state laws in court.

Spokespeople for the Republican legislative leaders, Senate leader Phil Berger and House Speaker Tim Moore, did not immediately respond Friday to phone messages seeking comment.

In the lead-up to July 1, Black said Planned Parenthood staff members have been coming in early and working through lunch to treat as many patients as possible, while stressing to others that “time is of the essence.”

Republicans had pitched the 47-page measure as a middle-ground change to an existing state law banning nearly all abortions after 20 weeks of pregnancy, without exceptions for rape or incest. The new law adds exceptions, extending the limit through 20 weeks for rape and incest and through 24 weeks for “life-limiting” fetal anomalies, including certain physical or genetic disorders that can be diagnosed prenatally.

But abortion-rights advocates say limits on those exceptions, as well as new hurdles for patients and providers, make the law much more restrictive than the headline-grabbing 12-week limit conveys.

The lawsuit challenges a requirement that sexual assault survivors obtain abortions at a hospital after 12 weeks of pregnancy, rather than at one of the many clinics Planned Parenthood and other providers operate around the state.

Gray, an OB-GYN who provides care in a hospital setting, told the AP there is no procedural or medical difference between the unrestricted care she is able to provide miscarriage patients and the newly restricted care she provides abortion patients.

Similarly, Planned Parenthood clinics will be able to continue treating miscarriage patients after 12 weeks in cases where the fetus has already died but will be prohibited from providing identical care to rape and incest survivors in the context of an abortion.

“It’s the same care, and there’s zero regulations about caring for patients with miscarriages,” Gray said. “This is not about safety. This is about limiting access to abortion.”

Their complaint also seeks clarity on a provision that prohibits providers from advising how a person can access an abortion after 12 weeks, which Amiri said could violate the First Amendment if the court interprets it as preventing providers from helping patients access care in other states where it remains legal.

Amiri also raised concern about what she said was likely “a doozy of a drafting error” related to the state’s existing fetal homicide statute, which considers it homicide to willfully cause the death of an unborn child. That law contains exceptions for lawful abortions, but Amiri said when legislators replaced the abortion law, they removed the statutory reference for those exceptions.

“It leaves open the question of whether lawful abortion could be prosecuted under the fetal homicide statutes,” she said. “And that’s very concerning for everybody.”

___

Hannah Schoenbaum is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

The proposal restores a ban South Carolina had in place when the U.S. Supreme Court overturned Roe v. Wade last year — a ban that, once it took effect, was overturned by the state’s highest court because it violated the state Constitution’s right to privacy.

Republicans have been searching for an answer to that ruling because it left abortion legal through 22 weeks of pregnancy and sharply increased the number of abortions taking place in South Carolina as most other Southern states enacted stricter laws.

South Carolina is among the last bastions in the region for those seeking legal abortions, but that status likely will end soon.

Most abortions after 12 weeks of pregnancy will be banned in North Carolina beginning July 1 after the state’s Republican-controlled Legislature successfully overrode the Democratic governor’s veto last week. Abortion is banned or severely restricted in much of the South, including bans throughout pregnancy in Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, Tennessee, Texas and West Virginia. In Georgia, it’s allowed only in the first six weeks.

The South Carolina bill includes exceptions for fatal fetal anomalies, the patient’s life and health, and rape or incest up to 12 weeks. Doctors could face felony charges carrying two years imprisonment and a $10,000 fine.

Republican Gov. Henry McMaster has said he would quickly sign the bill into law.

Vicki Ringer, the director of public affairs for Planned Parenthood South Atlantic, said after Tuesday’s vote that her organization would file a request for a temporary restraining order once the governor signs the measure. Senate Majority Leader Shane Massey told reporters that he was confident that the law would be upheld.

The Republican-led Senate’s opportunity to pass the bill came after the South Carolina House backed off a proposal to ban abortion almost entirely at conception. Senators had not been able to get the votes for that proposal after three different tries.

The vote also came after the three Republican women in the Senate urged the other members of their party to adopt a 12-week abortion ban as they fought additional restrictions one month after helping filibuster a near-total ban. They joined all Democrats in voting against the bill.

The women of the Senate known as the “sister senators” — the three Republicans, one Democrat and one independent who are the only women in the 46-member chamber — entered the State House together Tuesday to rousing cheers from dozens of abortion rights supporters gathered on the main floor. All five donned buttons that read “elect more women.”

In blistering speeches, the three Republican women said the six-week proposal did not give women enough time to make a decision, and they criticized changes like one requiring child support beginning at conception as ridiculous. Republican Sen. Katrina Shealy endorsed a 12-week ban as a “real compromise.”

Shealy and Republican Sen. Penry Gustafson pushed back on assertions that they are not true Christians because of their positions.

“We in the South Carolina Legislature are not God. We do not know what’s going on in somebody else’s life. We do not have the right to make decisions for someone else,” Shealy said.

Massey outlined new regulations and definitions inserted by the Republican-dominated South Carolina House last week during proceedings slowed by hundreds of amendments from Democrats across two days. House Republicans had axed a section of the measure allowing minors to petition the court for an abortion up to 12 weeks of pregnancy.

Tuesday marked the fourth time that the chamber has taken up abortion since the U.S. Supreme Court overturned Roe v. Wade in June 2022.

The Senate’s 15 Democrats, unified against both abortion bans, have largely let the Republican majority debate the issue among themselves. Opponents argue that South Carolina’s high maternal mortality rates — with even poorer outcomes among Black patients — would grow worse under the new restrictions.

Abortion currently remains legal through 22 weeks in South Carolina, though other regulations largely block access after the first trimester at the state’s three clinics. But the law has gone unchanged amid a Republican disagreement over how far to restrict access that has only recently moved toward resolution.

Republican leaders have noted provisional state Health Department data that show rising numbers of abortions in South Carolina.

The South Carolina Supreme Court overturned a similar 2021 law as a violation of the state constitution’s right to privacy in a 3-2 decision this January. But many Republicans believe the latest version would stand after changes to both the proposal’s language and the court’s makeup.

The action comes one week after Republicans in the North Carolina General Assembly moved to enact a 12-week abortion ban by overriding the Democratic governor’s veto — pushing Virginia closer to being the last state in the region with relatively easy access.

—-

This story version substitutes the 12th paragraph to correct that the Republican women senators argued against a six-week ban as not giving women enough time to make a decision, not 12 weeks.

All of the women were told they could not end their pregnancies in Texas, a state that has enacted some of the nation’s most restrictive abortion laws.

Now, they’re asking a Texas court to put an emergency hold on some abortion restrictions, joining a lawsuit launched earlier this year by five other women who were denied abortions in the state, despite pregnancies they say endangered their health or lives.

More than a dozen Texas women in total have joined the Center for Reproductive Rights’ lawsuit against the state’s law, which prohibits abortions unless a mother’s life is at risk — an exception that is not clearly defined. Texas doctors who perform abortions risk life in prison and fines of up to $100,000, leaving many women with providers who are unwilling to even discuss terminating a pregnancy.

“Our hope is that it will allow physicians at least a little more comfort when it comes to patients in obstetrical emergencies who really need an abortion where it’s going to effect their health, fertility or life going forward,” Molly Duane, the lead attorney on the case, told The Associated Press. “Almost all of the plaintiffs in the lawsuit tell similar stories about their doctors saying, if not for this law, I’d give you an abortion right now.”

The Texas attorney general’s office, which is defending the state in the lawsuit, did not immediately return an email seeking comment Monday.

The lawsuit serves as a nationwide model for abortion rights advocates to challenge strict new abortion laws states that have rolled out since the Supreme Court overturned Roe v. Wade last year. Sixteen states, including Texas, do not allow abortions when a fatal fetal anomaly is detected while six do not allow exceptions for the mother’s health, according to an analysis by KFF, a health research organization.

Duane said the Center for Reproductive Rights is looking at filing similar lawsuits in other states, noting that they’ve heard from women across the country. Roughly 25 Texas women have contacted the organization about their own experiences since the initial lawsuit was filed in March.

The women who joined the lawsuit describe being elated about finding out they were pregnant before the experience turned catastrophic.

Jessica Bernardo and her husband spent years trying to conceive, even consulting fertility doctors, before finally become pregnant with a daughter, Emma, last July.

Almost immediately, Bernardo was coughing so hard and often she would sometimes throw up. Fourteen weeks into the pregnancy, test results revealed her baby likely had Down Syndrome, so she consulted a specialist who gave her devastating news: Emma’s heart was underdeveloped and she had a rare, deadly disorder called fetal anasarca, which causes fluid to build up in the body.

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“He handed me a tissue box,” recalled Bernardo, who lives in Frisco, Texas. “I thought maybe the worst thing he was going to tell us was that she’s going to have Down Syndrome. Instead, he said, ‘I can tell you right away…she wouldn’t make it.’”

The doctor warned her to watch out for high blood pressure and coughing, symptoms of Mirror syndrome, another rare condition where a mother “mirrors” the same problems the fetus is experiencing.

With Bernardo’s blood pressure numbers climbing, her OB-GYN conferred with the hospital’s ethics board to see if she could end the pregnancy but was advised Bernardo wasn’t sick enough. Bernardo spent $7,000 traveling to Seattle for an abortion a week later.

Even if Emma made it through the pregnancy, doctors would have immediately needed to drain excess fluids from her body, only for her to survive a few hours or days, Bernardo said.

“Reading about everything they would do sounded like complete torture to a newborn that would not survive,” she said. “Had I not received an abortion, my life would have very likely been on the line.”

Other women facing similar situations have not had the financial resources to travel outside of the state.

Samantha Casiano, a 29-year-old living in eastern Texas, found out halfway through her pregnancy last year that her daughter, Halo, had a rare diagnosis of anencephaly, where much of the skull and brain is missing. Her doctor told her she would have to continue with the pregnancy because of Texas law, even though her baby would not survive.

With five children, including a goddaughter, at home she quickly realized she could not afford an out-of-state trip for an abortion. The next next few months of her pregnancy were spent trying to raise money for her daughter’s impending funeral, soliciting donations through online websites and launching fundraisers to sell Mexican soup. Halo was born in April, living for only four hours.

“I was so full of heartbreak and sadness, all at the same time,” Casiano said.

Women in the lawsuit say they could not openly discuss abortion or labor induction with their doctors, instead asking their doctors discreetly if they should travel outside of the state.

Dr. Austin Dennard, an OB-GYN in Dallas, never talked about her own abortion with her doctors after they discovered anencephaly on the baby’s ultrasound during her third pregnancy last year. She worried her out-of-state trip to end the pregnancy could jeopardize her medical license or invite harassment against her and her husband, also an OB-GYN. Dennard was inspired to go public with her case when one of her own patients joined the original lawsuit filed in March after traveling to Colorado to abort a twin fetus diagnosed with a life-threatening genetic disorder.

“There was an enormous amount of fear that I experienced afterward,” Dennard said. “It’s an additional way of feeling silenced. You feel you have to do it in secret and not tell anyone about it.”

Dennard is expecting another child later this year.

___

Associated Press writer Paul Weber in Austin, Texas, contributed to this report.

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A three-judge panel of the 5th U.S. Circuit Court of Appeals heard arguments over whether the Food and Drug Administration approval of mifepristone should be revoked more than two decades after it was granted. The case is likely to wind up at the Supreme Court, which already intervened to keep the drug available while the legal fight winds through the courts. The high court’s decision came after a Texas-based judge revoked the drug’s approval.

Biden administration attorney Sarah Harrington opened by calling U.S. District Judge Matthew Kacsmaryk’s April 7 ruling an “unprecedented and unjustified attack on the FDA’s scientific expertise.”

“I hate to cut you off so early, but you said, `unprecendented’,” Judge James Ho said, referring to an unrelated case that was argued Tuesday. “We had a challenge to the FDA just yesterday.”

“Yes, but I don’t think there’s ever been a court that has vacated the FDA’s determination that a drug is safe to be on the market. … It’s not a court’s role to come in and second-guess that expertise,” Harrington told Ho, who was appointed to the court by former President Donald Trump.

There is no precedent for a U.S. court overturning the approval of a drug that the FDA has deemed safe and effective. While new drug safety issues often emerge after FDA approval, the agency is required to monitor medicines on the market, evaluate emerging issues and take action to protect U.S. patients. Congress delegated that responsibility to the FDA — not the courts— more than a century ago.

Arguments Wednesday went on for two hours, with Harrington and Jessica Ellsworth, an attorney for Danco Laboratories, telling the panel that the doctors and groups who brought the lawsuit did not have a right to sue because they failed to prove they have been or would be harmed by the approval of mifepristone. Their claims that they would be forced to treat people who suffer complications from mifepristone — perhaps even completing abortions when the drug fails — are “speculative,” Harrington said.

All three judges seemed skeptical of that argument.

“It just strikes me that what the FDA has done in making this more available … is you’ve made it much more likely that patients are going to go to emergency care or a medical clinic where one of these doctors is a member,” said Judge Cory Wilson, another Trump appointee.

Harrington disputed that, saying mifepristone is extremely safe, rarely results in complications, and that doctors could cite their conscience and refuse to participate in procedures.

But Erin Hawley, an attorney arguing for the anti-mifepristone plaintiffs, insisted that doctors opposed to abortion can be forced to violate their consciences if they are called upon to remove fetuses from the wombs of women who have had an incomplete medical abortion.

“They allege that they feel complicit in an elective abortion by being forced to complete that procedure,” she said in answer to questions from Judge Jennifer Walker Elrod, an appointee of President George W. Bush.

The case comes to the appeals court almost a year after the Supreme Court overturned the Roe v. Wade ruling that had established abortion rights. Fourteen states have since banned abortion at all stages of pregnancy and other states have adopted, or are debating, major restrictions.

Ho twice referred an “FDA can do no wrong” theme in the pro-mifepristone arguments.

“We are allowed to look at the FDA just like we’re allowed to look at any agency. That’s the role of the courts,” Ho told Ellsworth, who went on to say that the FDA has approved drugs later found to have safety problems.

The third judge hearing the case was Jennifer Walker Elrod, a George W. Bush nominee.

Abortion opponents sued in November in federal court in Amarillo, Texas, where Kacsmaryk, a Trump nominee, presides. An appellate panel voted 2-1 to narrow, but not completely block, Kacsmaryk’s ruling.

The panel’s April 13 decision said the abortion opponents appeared to be barred by time limits from challenging the initial 2000 approval. But the panel said adjustments made in later years — among them allowing the drug to be sent via mail and administered without a physician present — could still be revoked.

Wednesday’s hearing also dealt with the time limit issue, and whether the FDA’s later-year changes reset the clock and made full approval ripe for review.

“Is every time the FDA going to relax some prior restriction, requirement or safeguard based on a history of performance, does that mean we’re here on a reopening issue? I mean, how do you draw that line?” Wilson asked Hawley.

“Absolutely not, your honor,” she replied.

Other mifepristone rules that have changed since the drug’s initial approval include extending the time it can be used from seven to 10 weeks of pregnancy, and reducing the dosage needed to safely end a pregnancy.

Mifepristone is one of two pills used in medication abortions, along with misoprostol. Health care providers have said they could switch to misoprostol if mifepristone is no longer available or is too hard to obtain. Misoprostol is somewhat less effective in ending pregnancies.

The case involves a regulatory issue — whether the Food and Drug Administration’s approval of mifepristone, and subsequent actions making it easier to obtain, must be rolled back. The appellate hearing follows an April ruling by a federal judge in Texas, who ordered a hold on federal approval of mifepristone in a decision that overruled decades of scientific approval. His ruling was stayed pending appeal. The case was allotted to a panel made up of Jennifer Walker Elrod, James Ho and Cory Wilson.

The three judges of the New Orleans-based 5th U.S. Circuit Court of Appeals won’t rule immediately. Their decision, whatever it is, is also unlikely to have an immediate effect pending an expected appeal to the U.S. Supreme Court.

Here’s a look at who the judges are and their track records.

Jennifer Walker Elrod

Nominated to the court in 2007 by Republican President George W. Bush, Elrod was among several 5th Circuit judges allowing Texas to temporarily ban abortions as the coronavirus pandemic took hold in early 2020.

Elrod also was co-author of the opinion when the full 5th Circuit upheld in 2021 a Texas law outlawing an abortion method commonly used to end second-trimester pregnancies.

That same year, she wrote for a panel that refused to order Louisiana to issue a long-stalled license for a Planned Parenthood abortion clinic in New Orleans, saying “there is no free-standing federal right to receive an abortion-clinic license.”

In the Texas case involving pandemic restrictions, she was part of a panel allowing what amounted to a ban on abortions — including medication abortions — by classifying them as non-essential procedures legally postponed under an order by Gov. Greg Abbott. The 2020 order was in effect for about a month.

Elrod was in favor of decisions upholding Texas and Louisiana laws requiring doctors at abortion clinics to have admitting privileges at nearby hospitals — a move abortion rights advocates said would force some clinics to close.

When the full court narrowly refused to let Louisiana officials cut off Medicaid funding for Planned Parenthood facilities in the state, Elrod wrote the dissent.

Elrod also boasts a high profile in 5th Circuit decisions on regulatory issues. One, if upheld by the Supreme Court, could limit the authority of the Securities and Exchange Commission to impose hefty fees and fines. Another, eventually struck by the Supreme Court, held that the “individual mandate” in former President Barack Obama’s signature health care law had been rendered unconstitutional by congressional action.

James Ho

A former Texas solicitor general, Ho is the first Asian-American to serve on the 5th Circuit and is a former clerk for Supreme Court Justice Clarence Thomas. He was nominated to the 5th Circuit in 2017 by Republican President Donald Trump. His opposition to abortion and abortion rights was clear early in his tenure, including referring to abortion as a “moral tragedy” in one 2018 opinion.

In 2019, he wrote a 15-page grudging concurrence in a ruling that said a Mississippi abortion ban had to be struck down under then-existing court precedent. “Nothing in the text or original understanding of the Constitution establishes a right to an abortion,” he wrote.

He went on to cite “the racial history of abortion advocacy as a tool of the eugenics movement.” He harshly criticized a lower court for declining to consider arguments that a fetus can feel pain, and for displaying “an alarming disrespect for the millions of Americans who believe … that abortion is the immoral, tragic, and violent taking of innocent human life.”

That opinion was written in the case the Supreme Court ultimately used to overturn Roe v. Wade.

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Cory Wilson

Nominated to the federal appeals court in 2020 by Trump, Wilson is a former Mississippi appeals court judge who had a strong anti-abortion record when he served in the Mississippi House from January 2016 to February 2019 as a Republican. Abortion rights supporters opposed his confirmation to the federal appeals court. They noted he had expressed support for “complete and immediate reversal” of the Roe v. Wade decision in a questionnaire from Mississippi Right to Life’s political action committee.

Wilson voted for anti-abortion measures in 2016, including one to stop Medicaid funding to Planned Parenthood facilities in the state — a measure rejected in court. In 2018 he voted for the Mississippi law that ultimately led to the demise of Roe v. Wade in 2022. The law prohibited most abortions after 15 weeks.

At the 5th Circuit, Wilson joined Elrod, Ho and a majority of the full court in 2021 in upholding a Texas law outlawing an abortion method commonly used to end second-trimester pregnancies. He had voted for a similar law in the Mississippi Legislature.

___

Associated Press reporter Emily Wagster Pettus in Jackson, Mississippi, contributed to this report.

“The belief is they are delaying any move because of the abortion issue,” one U.S. official said, referring to the White House.

Another U.S. official said, “This is all about abortion politics.”

The White House directed the Air Force last December to conduct a review of the process that led to the Trump administration’s decision to move Space Command’s headquarters from Colorado to Huntsville, Alabama. The review was ordered up in the months after Alabama’s law banning nearly all abortions, including in cases of rape and incest, went into effect last summer. The law is considered among the most restrictive in the U.S.

It followed two previous, extensive reviews that took place after President Joe Biden took office that found there was no improper political influence on the process that awarded the headquarters to Alabama. Just days before leaving office, Donald Trump had announced Alabama would be home to Spacecom’s headquarters. He later said he was “single-handedly” responsible for the state’s selection over others that were under consideration, but the review did not support that claim.

Biden administration officials have signaled privately to Pentagon officials and lawmakers that they’re looking to reverse the Alabama decision over concerns about operational disruptions that moving Spacecom’s headquarters, which is currently located in Colorado Springs, Colorado, could bring.

The White House said Alabama’s abortion ban was not a factor in its ongoing review of the decision to build Spacecom’s permanent headquarters there. A White House official said that access to reproductive health care does not weigh in to making the decision about location.

For more on this story, go to NBC News.

The justices granted emergency requests from the Biden administration and New York-based Danco Laboratories, maker of the drug mifepristone. They are appealing a lower court ruling that would roll back Food and Drug Administration approval of mifepristone.

The drug has been approved for use in the U.S. since 2000 and more than 5 million people have used it. Mifepristone is used in combination with a second drug, misoprostol, in more than half of all abortions in the U.S.

The court’s action Friday almost certainly will leave access to mifepristone unchanged at least into next year, as appeals play out, including a potential appeal to the high court. The next stop for the case is at the New Orleans-based U.S. Court of Appeals for the 5th Circuit, which has set arguments in the case for May 17.

Two of the nine justices — Samuel Alito, the author of last year’s decision overturning Roe v. Wade, and Clarence Thomas — voted to allow restrictions to take effect, and Alito issued a four-page dissent. No other justices commented on the court’s one-paragraph order, and the court did not release a full vote breakdown.

President Joe Biden praised the high court for keeping mifepristone available while the court fight continues.

“The stakes could not be higher for women across America. I will continue to fight politically-driven attacks on women’s health. But let’s be clear — the American people must continue to use their vote as their voice, and elect a Congress who will pass a law restoring the protections of Roe v. Wade,” Biden said in a statement.

Alliance Defending Freedom, representing abortion opponents challenging the FDA’s approval of mifepristone, downplayed the court’s action.

“As is common practice, the Supreme Court has decided to maintain the status quo that existed prior to our lawsuit while our challenge to the FDA’s illegal approval of chemical abortion drugs and its removal of critical safeguards for those drugs moves forward,” ADF lawyer Erik Baptist said in a statement.

The justices weighed arguments that allowing restrictions contained in lower-court rulings to take effect would severely disrupt the availability of mifepristone.

The Supreme Court had initially said it would decide by Wednesday whether the restrictions could take effect while the case continues. A one-sentence order signed by Alito on Wednesday gave the justices two additional days, without explanation.

The challenge to mifepristone is the first abortion controversy to reach the nation’s highest court since its conservative majority overturned Roe v. Wade 10 months ago and allowed more than a dozen states to effectively ban abortion outright.

In his majority opinion last June, Alito said one reason for overturning Roe was to remove federal courts from the abortion fight. “It is time to heed the Constitution and return the issue of abortion to the people’s elected representatives,” he wrote.

But even with their court victory, abortion opponents returned to federal court with a new target: medication abortions, which make up more than half of all abortions in the United States.

Women seeking to end their pregnancies in the first 10 weeks without more invasive surgical abortion can take mifepristone, along with misoprostol. The FDA has eased the terms of mifepristone’s use over the years, including allowing it to be sent through the mail in states that allow access.

The abortion opponents filed suit in Texas in November, asserting that the FDA’s original approval of mifepristone 23 years ago and subsequent changes were flawed.

They won a ruling on April 7 by U.S. District Judge Matthew Kacsmaryk, an appointee of former President Donald Trump, revoking FDA approval of mifepristone. The judge gave the Biden administration and Danco Laboratories a week to appeal and seek to keep his ruling on hold.

Responding to a quick appeal, two more Trump appointees on the 5th U.S. Circuit Court of Appeals said the FDA’s original approval would stand for now. But Judges Andrew Oldham and Kurt Engelhardt said most of the rest of Kacsmaryk’s ruling could take effect while the case winds through federal courts.

Their ruling would have effectively nullified changes made by the FDA starting in 2016, including extending from seven to 10 weeks of pregnancy when mifepristone can be safely used. The court also would have halted sending the drug in the mail or dispensing it as a generic, and patients who seek it would have had to make three in-person visits with a doctor. Women also might have been required to take a higher dosage of the drug than the FDA says is necessary.

The administration and Danco have said that chaos would ensue if those restrictions were to take effect while the case proceeds. Potentially adding to the confusion, a federal judge in Washington has ordered the FDA to preserve access to mifepristone under the current rules in 17 Democratic-led states and the District of Columbia that filed a separate lawsuit.

The Biden administration has said the rulings conflict and create an untenable situation for the FDA.

Alito questioned the argument that chaos would result, saying the administration “has not dispelled doubts that it would even obey an unfavorable order in these cases.”

And a new legal wrinkle threatened even more complications. GenBioPro, which makes the generic version of mifepristone, filed a lawsuit Wednesday to preemptively block the FDA from removing its drug from the market, in the event that the Supreme Court doesn’t intervene.

The Supreme Court was only being asked to block the lower-court rulings through the end of the legal case.

The appeals court has sped up its review, but there is no timetable for a ruling.

Any appeal to the Supreme Court would follow within three months of a ruling, but with no deadline for the justices to decide whether to review the case.

The court is dealing with a new abortion controversy less than a year after its conservative majority overturned Roe v. Wade and allowed more than a dozen states to effectively ban abortion outright.

At stake now is whether to allow restrictions on mifepristone ordered by a lower court to take effect while a legal challenge to the medication’s Food and Drug Administration approval continues.

The justices had at first given themselves a Wednesday evening deadline in a fast-moving case from Texas in which abortion opponents are seeking to roll back FDA approval of mifepristone, which is used in the most common method of abortion in the United States.

But on Wednesday afternoon, Justice Samuel Alito issued a one-sentence order giving the court more time and indicating it expects to act by Friday night. Alito, the justice in charge of handling emergency appeals from Texas, provided no explanation.

The justices are scheduled to meet for a private conference Friday, where they could talk about the issue. The additional time could be part of an effort to craft an order that has broad support among the justices. Or one or more justices might be writing a separate opinion, and asked for a couple of extra days.

The drug first won FDA approval in 2000, and conditions on its use have been loosened in recent years, including making it available by mail in states that allow access.

The Biden administration and New York-based Danco Laboratories, the maker of the drug, want the nation’s highest court to reject limits on mifepristone’s use imposed by lower courts, at least as long as the legal case makes it way through the courts. They say women who want the drug and providers who dispense it will face chaos if limits on the drug take effect. Depending on what the justices decide, that could include requiring women to take a higher dosage of the drug than the FDA says is necessary.

Alliance Defending Freedom, representing anti-abortion doctors and medical groups in a challenge to the drug, is defending the rulings in calling on the Supreme Court to restrict access now.

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Complicating the situation, a federal judge in Washington has ordered the FDA to preserve access to mifepristone under the current rules in 17 Democratic-led states and the District of Columbia that filed a separate lawsuit.

The Biden administration has said the rulings conflict and create an untenable situation for the FDA.

Even as the abortion landscape changed dramatically in several states, abortion opponents set their sights on medication abortions, which make up more than half of all abortions in the United States.

The abortion opponents filed suit in November in Amarillo, Texas. The legal challenge quickly reached the Supreme Court after a federal judge issued a ruling on April 7 that would revoke FDA approval of mifepristone, one of two drugs used in medication abortions.

Less than a week later, a federal appeals court modified the ruling so that mifepristone would remain available while the case continues, but with limits. The appeals court said the drug should only be approved through seven weeks of pregnancy for now, even though the FDA since 2016 has endorsed its use through 10 weeks of pregnancy.

The court also said that the drug can’t be mailed or dispensed as a generic and that patients who seek it need to make three in-person visits with a doctor, among other things.

The generic version of mifepristone makes up two-thirds of the supply in the United States, its manufacturer, Las Vegas-based GenBioPro Inc., wrote in a court filing that underscored the perils of allowing the restrictions to be put into effect.

In the latest legal twist surrounding the case, GenBioPro filed a lawsuit Wednesday to preemptively block the FDA from removing its drug from the market, in the event that the Supreme Court doesn’t intervene.

The FDA approved the company’s generic pill in 2019, based on data and studies showing it is essentially identical to the original version of mifepristone. Both versions have been studied extensively and deemed safe for women.

If the justices aren’t inclined to block the ruling from taking effect for now, the Democratic administration and Danco have a fallback argument, asking the court to take up the challenge to mifepristone, hear arguments and decide the case by early summer.

The court only rarely takes such a step before at least one appeals court has thoroughly examined the legal issues involved.

The 5th U.S. Circuit Court of Appeals in New Orleans already has ordered an accelerated schedule for hearing the case, with arguments set for May 17.

Mifepristone has been available for use in medication abortions in the United States since the FDA granted approval in 2000. Since then, more than 5 million women have used it, along with another drug, misoprostol, to induce abortions.

A court case that began in Texas has sought to roll back Food and Drug Administration approval of the drug, mifepristone. Lower courts had said that women seeking the drug should face more restrictions on getting it while the case continues, but the Supreme Court disagreed.

The court’s action almost certainly will leave access to mifepristone unchanged at least into next year, as appeals play out, including a potential appeal to the high court.

The new abortion controversy comes less than a year after the Supreme Court’s conservative majority overturned Roe v. Wade and allowed more than a dozen states to effectively ban abortion outright.

The following is a look at the drug at issue in the new case, how the case got to the nation’s highest court and what’s next in the legal case.

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WHAT IS MIFEPRISTONE?

Mifepristone was approved for use by the Food and Drug Administration more than two decades ago. It has been used by more than 5 million women to safely end their pregnancies, and today more than half of women who end a pregnancy rely on the drug, the Justice Department said.

Over the years, the FDA has loosened restrictions on the drug’s use, extending from seven to 10 weeks of pregnancy when it can be used, reducing the dosage needed to safely end a pregnancy, eliminating the requirement to visit a doctor in person to get it and allowing pills to be obtained by mail. The FDA also approved a generic version of mifepristone that its manufacturer, Las Vegas-based GenBioPro, says makes up two-thirds of the domestic market.

Mifepristone is one of two pills used in medication abortions, along with misoprostol. Health care providers have said they could switch to misoprostol only if mifepristone is no longer available or is too hard to obtain. Misoprostol is somewhat less effective in ending pregnancies.

HOW DID THE CASE GET STARTED?

A lawsuit over mifepristone was filed in Amarillo, Texas, late last year. Alliance Defending Freedom, a conservative Christian legal group, represents the pill’s opponents, who say the FDA’s approval of mifepristone was flawed.

Why Amarillo? U.S. District Judge Matthew Kacsmaryk, who was nominated by then-President Donald Trump, is the sole district court judge there, ensuring that all cases filed in the west Texas city land in front of him. Since taking the bench, he has ruled against President Joe Biden’s administration on several other issues, including immigration and LGBTQ protections.

On April 7, Kacsmaryk issued a ruling that would completely revoke the FDA’s approval of mifepristone, but he put the decision on hold for a week to allow an appeal.

Complicating matters, however, on the same day Kacsmaryk issued his order, a court in Washington state issued a separate ruling in a lawsuit brought by liberal states seeking to preserve access to mifepristone. The Washington judge, Spokane-based Thomas O. Rice, whom then-President Barack Obama nominated, ordered the FDA not to do anything that might affect the availability of mifepristone in the suing states. The Biden administration had said it would be impossible to follow both judges’ directives at the same time.

HOW DID THE CASE GET TO THE SUPREME COURT?

HOW DID THE CASE GET TO THE SUPREME COURT?

The Biden administration responded to Kacsmaryk’s ruling by asking the New Orleans-based 5th U.S. Circuit Court of Appeals to prevent it from taking effect for now.

The appeals court didn’t do that, but it narrowed Kacsmaryk’s ruling so that the initial approval of mifepristone in 2000 wouldn’t be revoked. And it agreed with him that changes the FDA made to relax the rules for prescribing and dispensing the drug should be put on hold. It said those rules, including expanding when the drug could be taken and allowing for the drug’s delivery through the mail, should be on hold while the case continued.

The appeals court acted by a 2-1 vote. The judges in the majority, Kurt Engelhardt and Andrew Oldham, are both Trump picks.

The Biden administration and the maker of mifepristone, New York-based Danco Laboratories, appealed to the Supreme Court, saying that allowing the appeals court’s restrictions to take effect would cause chaos. At first, facing a tight deadline, the Supreme Court gave itself some breathing room and issued an order suggesting it would act by Wednesday evening. But no decision came Wednesday and the court instead just gave itself an extension until just before midnight Friday. It wasn’t clear why.

The court did make its second self-imposed deadline, issuing its brief decision around 6:30 p.m. in Washington. Two conservative justices, Clarence Thomas and Samuel Alito, said they disagreed with the court’s action but no other justice commented.

WHAT HAPPENS NEXT?

The case is on a fast track. Now that the high court has set out the rules that will govern access for now, the case can continue on its path through the courts.

The 5th U.S. Circuit Court of Appeals has already announced it will hear arguments in the case in less than a month, on May 17. Both sides as well as interest groups will submit written briefs ahead of those arguments. And a three-judge panel of the court will hear the case, though the court has not yet said who those three judges will be. The group won’t issue a decision from the bench but instead hear arguments and ask questions. That will give the public a sense of what they’re thinking. Their decision will be made privately after oral arguments, and at some point they’ll issue a written decision announcing it.

Both sides then have an opportunity to appeal, taking the case to all the judges of the appeals court or directly to the Supreme Court. The justices take a break for the summer, however, and don’t start hearing cases again until October.

“Today, we’re going to take action to make sure that our statutes and our laws reflect our values and our constitution,” Whitmer said at a bill signing outside of Detroit.

The 1931 abortion ban made it a four-year felony to assist in an abortion. Roe v. Wade had made the law null and void until the landmark decision was overturned in June by the U.S. Supreme Court.

Courts blocked the ban from taking effect while a citizen-led initiative to enshrine abortion rights in the state’s constitution received more signatures than any other ballot proposal in state history to put the question before voters. Voters overwhelmingly approved the proposal in last November’s midterms, making the 1931 law unconstitutional and unenforceable.

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Wisconsin Apr 4

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The 1931 ban could have been enforced in the future had voters collected enough signatures to once again amend the state constitution and repeal abortion rights. Whitmer’s signature Wednesday eliminated that possibility, erasing the law completely.

“We cannot allow archaic laws to remain on our books under the assumption that they’ll never be used again,” said Democratic state Rep. Laurie Pohutsky. “We don’t know what the future will hold and we don’t know what plans abortion opponents have.”

Last month, the Michigan House and Senate — each with a two-seat Democratic majority — voted to send a repeal of the abortion ban to the governor. A majority of Republicans opposed the bill, speaking out ahead of the vote on the legality of abortion as a whole.

Pohutsky, who sponsored the legislation repealing the law, said at the event Wednesday that “this is far from the end of the story,” and that the Democratic-controlled Statehouse will continue expanding access to reproductive health care.

Wednesday’s signing marked another victory for abortion rights supporters in Michigan, who joined California and Vermont last November in enshrining abortion rights in their state’s constitution. Kentucky, a reliably red state, rejected a ballot measure aimed at denying any state constitutional protections for abortion.

Voters in Wisconsin elected a Democratic-backed Milwaukee judge Tuesday to the state’s Supreme Court, ensuring liberals will take over majority control of the court with the fate of the state’s abortion ban on the line.

“Who would have thought two years ago, three years ago, five years ago, that we would be as Democrats looking to Michigan, Kansas, Wisconsin, Montana and Kentucky to be on the frontline of protecting reproductive freedom for women across this country,” said Laphonza Butler, the president of EMILYs List.

Whitmer joined other speakers at the event in Birmingham in calling out Republican-led states for restricting abortion rights, saying laws in Texas and South Carolina were “un-American, anti-free and, frankly, sickening.”

Florida Gov. Ron DeSantis, who has pushed for a six-week ban in his state, is scheduled to appear in Michigan on Thursday to speak at a Midland County GOP event before heading to southern Michigan to speak at Hillsdale College.

The justices refused to disturb an appeals court order that made it possible for the girl, Becky Pepper-Jackson, to continue playing on her school’s track and cross-country teams, where she regularly finishes near the back of the pack.

Justices Samuel Alito and Clarence Thomas would have allowed West Virginia to enforce its law against Pepper-Jackson.

Pepper-Jackson is in the middle of the outdoor track season. She had filed a lawsuit challenging the law, the Save Women’s Sports Act, which West Virginia lawmakers adopted in 2021. A federal appeals court had allowed her to compete while she appealed a lower court ruling that upheld the West Virginia law.

In an emailed statement issued by the ACLU’s West Virginia chapter to The Associated Press on Thursday night, Pepper-Jackson said: “I am so happy that the Supreme Court saw that this stay was not an emergency. I still get to play with my friends and teammates on the track team. That’s all I want to do, be with my friends and be the girl that I am.”

The high court announcement came the same day the Biden administration proposed a new rule that would prevent schools and colleges from enacting outright bans on transgender athletes, but would allow certain exceptions to promote fairness or reduce injuries.

Two weeks ago, track and field banned transgender athletes from international competitions. West Virginia is among 20 states that ban transgender athletes from participating in sports consistent with their gender identity, according to Movement Advancement Project, a pro-LGBTQ rights think tank.

West Virginia Gov. Jim Justice, a Republican, also recently signed legislation banning gender-affirming care for minors, part of an effort in Republican-led states across the country to curb LGBTQ+ rights this year.

West Virginia’s law on schools sports competition bars transgender athletes from female teams. Signed by Justice, the law defines male and female by looking to the student’s “reproductive biology and genetics at birth.” It applies to middle and high schools, as well as colleges.

Under the law, male athletes can play on male or co-ed teams and female athletes can play on all teams.

In a statement after the high court action, West Virginia Attorney General Patrick Morrisey said he “is deeply disappointed at the U.S. Supreme Court’s decision.”

Organizations that have backed Pepper-Jackson said they were “grateful.” “This was a baseless and cruel effort to keep Becky from where she belongs — playing alongside her peers as a teammate and as a friend,” the American Civil Liberties Union, the ACLU of West Virginia and Lambda Legal said in a joint statement.

Tennis great Martina Navratilova was among dozens of female athletes backing West Virginia at the Supreme Court, along with Republican attorneys general in 21 states.

U.S. District Court Judge Joseph Goodwin initially barred West Virginia from enforcing its law and allowed Pepper-Jackson to compete on the girls’ teams while the case continued.

But Goodwin ultimately found that the law does not violate the Constitution or Title IX, the landmark 1972 gender equity legislation. Goodwin, an appointee of former President Bill Clinton, ruled the law could remain in place as appeals continued.

Lawyers for the girl, known in the lawsuit by the initials B.P.J., appealed. A three-judge panel of the 4th U.S. Circuit Court of Appeals voted 2-1, without issuing any opinion, to put the law on hold while it considers the case.

The two appeals court judges who voted to put the law on hold were Pamela A. Harris, an appointee of former President Barack Obama’s, and Toby J. Heytens, an appointee of President Joe Biden’s. Judge G. Steven Agee, an appointee of former President George W. Bush, dissented.

The Supreme Court provided no justification for its action Thursday.

In dissent, Alito wrote: “I would grant the State’s application. Among other things, enforcement of the law at issue should not be forbidden by the federal courts without any explanation.” Thomas joined the dissent.

In asking the high court to allow the law to take effect while the case plays out, West Virginia told the justices: “This case implicates a question fraught with emotions and differing perspectives. That is all the more reason to defer to state lawmakers pending appeal. … The decision was the West Virginia Legislature’s to make. The end of this litigation will confirm that it made a valid one.”

Pepper-Jackson is identified in court documents by her initials because of federal rules that prohibit identifying minors. But Pepper-Jackson and her mother have spoken out repeatedly about the issue.

The U.S. attorney’s office in Madison announced that police arrested 29-year-old Hridindu Sankar Roychowdhury at Boston’s Logan International Airport on Tuesday. He was charged via the complaint with one count of attempting to cause damage by means of fire or an explosive.

He made an initial appearance in federal court in Boston on Tuesday. U.S. Magistrate Judge Donald L. Cabell set a detention hearing for Thursday. Roychowdhury’s attorney, Brendan O. Kelley, who is listed in online court records as a federal public defender, declined comment when reached by phone after Tuesday’s hearing.

Federal agents have been searching for almost a year for whoever tossed a pair of Molotov cocktails into the Wisconsin Family Action office in Madison on May 6. One of the firebombs failed to ignite; the other set a bookcase on fire. The message “If abortions aren’t safe then you aren’t either” was spray-painted on the building’s exterior. No one was in the office at the time.

The attack came about a week after a draft opinion suggesting the Supreme Court would overturn Roe v. Wade, the decision that legalized abortion, leaked. The release sparked abortion rights supporters to mount protests across the country. Two Catholic churches in Colorado were vandalized in the days leading up to the Madison firebombing. And someone threw Molotov cocktails into an anti-abortion organization’s office in a suburb of Salem, Oregon, several days later.

The court officially overturned Roe v. Wade in June, putting Wisconsin’s 1849 ban on abortion back into play.

According to the criminal complaint against Roychowdury, investigators pulled DNA samples from three individuals from evidence at the scene of the Wisconsin attack. But the samples didn’t match any profiles in the U.S. Department of Justice’s DNA database.

As time went on, Wisconsin Family Action President Julaine Appling offered a $5,000 reward for any information leading to an arrest. She accused Democratic Gov. Tony Evers and Madison Police Chief Shon Barnes of being more interested in empathizing with abortion rights activists than bringing any suspects to justice.

This past January, police assigned to protecting the state Capitol building in Madison reviewed surveillance video of a protest against police brutality. The footage showed several people spray-painting graffiti on Capitol grounds. The graffiti resembled the graffiti at the Wisconsin Family Action office.

The footage showed two people leaving the area in a white pickup truck, which investigators tracked to Roychowdhury’s residence in Madison, according to the complaint. Police began following him.

On March 1, he pulled into a Madison park-and-ride and threw away a bag of fast food. After he left, police retrieved the bag from the trash can. DNA on a burrito in the bag matched DNA taken from the Wisconsin Family Action office, according to the complaint.

The U.S. attorney’s office said in a statement that Roychowdhury traveled to Madison this month to Portland, Maine. He had a one-way ticket for a flight from Boston to Guatemala City, Guatemala, that was scheduled to depart Tuesday morning when he was arrested, the office said.

Investigators have been unable to match the other two DNA profiles from the scene to anyone, the complaint said.

Appling had no comment Tuesday on Roychowdhury’s arrest.

“I’m very proud of the tireless and determined efforts the combined federal, state and local team put in to identify and arrest this individual,” said William McCrary, the special agent in charge of the U.S. Bureau of Alcohol, Tobacco and Firearms and Explosives’ St. Paul Field Division, which handles crimes in Wisconsin. “It is very satisfying to me to see that this alleged perpetrator has been placed in custody.”

The U.S. attorney’s office in Madison announced that police arrested 29-year-old Hridindu Sankar Roychowdhury at Boston’s Logan International Airport on Tuesday. He was charged via the complaint with one count of attempting to cause damage by means of fire or an explosive.

He made an initial appearance in federal court in Boston on Tuesday. U.S. Magistrate Judge Donald L. Cabell set a detention hearing for Thursday. Roychowdhury’s attorney, Brendan O. Kelley, who is listed in online court records as a federal public defender, declined comment when reached by phone after Tuesday’s hearing.

Federal agents have been searching for almost a year for whoever tossed a pair of Molotov cocktails into the Wisconsin Family Action office in Madison on May 6. One of the firebombs failed to ignite; the other set a bookcase on fire. The message “If abortions aren’t safe then you aren’t either” was spray-painted on the building’s exterior. No one was in the office at the time.

The attack came about a week after a draft opinion suggesting the Supreme Court would overturn Roe v. Wade, the decision that legalized abortion, leaked. The release sparked abortion rights supporters to mount protests across the country. Two Catholic churches in Colorado were vandalized in the days leading up to the Madison firebombing. And someone threw Molotov cocktails into an anti-abortion organization’s office in a suburb of Salem, Oregon, several days later.

The court officially overturned Roe v. Wade in June, putting Wisconsin’s 1849 ban on abortion back into play.

According to the criminal complaint against Roychowdury, investigators pulled DNA samples from three individuals from evidence at the scene of the Wisconsin attack. But the samples didn’t match any profiles in the U.S. Department of Justice’s DNA database.

As time went on, Wisconsin Family Action President Julaine Appling offered a $5,000 reward for any information leading to an arrest. She accused Democratic Gov. Tony Evers and Madison Police Chief Shon Barnes of being more interested in empathizing with abortion rights activists than bringing any suspects to justice.

This past January, police assigned to protecting the state Capitol building in Madison reviewed surveillance video of a protest against police brutality. The footage showed several people spray-painting graffiti on Capitol grounds. The graffiti resembled the graffiti at the Wisconsin Family Action office.

The footage showed two people leaving the area in a white pickup truck, which investigators tracked to Roychowdhury’s residence in Madison, according to the complaint. Police began following him.

On March 1, he pulled into a Madison park-and-ride and threw away a bag of fast food. After he left, police retrieved the bag from the trash can. DNA on a burrito in the bag matched DNA taken from the Wisconsin Family Action office, according to the complaint.

The U.S. attorney’s office said in a statement that Roychowdhury traveled to Madison this month to Portland, Maine. He had a one-way ticket for a flight from Boston to Guatemala City, Guatemala, that was scheduled to depart Tuesday morning when he was arrested, the office said.

Investigators have been unable to match the other two DNA profiles from the scene to anyone, the complaint said.

Appling had no comment Tuesday on Roychowdhury’s arrest.

“I’m very proud of the tireless and determined efforts the combined federal, state and local team put in to identify and arrest this individual,” said William McCrary, the special agent in charge of the U.S. Bureau of Alcohol, Tobacco and Firearms and Explosives’ St. Paul Field Division, which handles crimes in Wisconsin. “It is very satisfying to me to see that this alleged perpetrator has been placed in custody.”