In October, healthcare advocates and providers in Louisiana filed suit, with hopes of barring the enforcement of Act 246, the law that reclassified two medications commonly used with medical abortions.

Act 246, which made misoprostol and mifepristone controlled substances, was signed into law by Gov. Jeff Landry and went into effect on Oct. 1. It was passed despite strong opposition from many medical officials, who wrote an open letter to the bill’s sponsor as soon as the bill was proposed.

The new lawsuit, filed in Louisiana’s 19th Judicial District Court on Oct. 31, claims that Act 246 discriminates against people with certain physical conditions — pregnancy, for instance — based on Louisiana’s constitutional right to equal protection within the right to individual dignity. 

But data shows that the impact of drugs’ reclassification also goes far beyond pregnancy.

A KFF study published in 2022 found that six out of 10 women of reproductive age who were prescribed misoprostol were not pregnant. 

Half of the women were taking steps not to get pregnant: of the non-pregnant women, 52% used misoprostol for diagnosis for IUD usage — misoprostol helps soften the cervix to ease the insertion of IUDs, which can otherwise be painful — and 36% for conditions with abnormal bleeding, including postpartum hemorrhages, which The Lens has reported.

Now, in Louisiana, these medicines are stored in passcode-protected cabinets.

And many healthcare providers and advocates fear the precedent that Act 246 will set for reproductive-healthcare rights across the nation.

Last week, legislators in Texas filed a similar bill.

Right now, Texas is the only other state outside of Louisiana proposing laws that mirror Louisiana’s new re-labeling, said Alina Salganicoff, the lead expert in women’s health policy at KFF, a national health policy research and news organization.

But given that many states instituted abortion bans after the U.S. Supreme Court overturned Roe v. Wade a few years ago, more laws that further restrict those medications seem possible. And in the upcoming Trump administration, many fear that a national abortion ban may not be too far behind. 

No exceptions for birth defects or conditions where baby will not survive

Nancy Davis, a mother of four and healthcare advocate, became a plaintiff in the recent lawsuit after experiencing her own pregnancy-related complications. 

As Davis went in for a routine checkup at a hospital where she’d delivered a previous child, she learned that her pregnancy was complicated by a fatal fetal anomaly: the fetus did not have a skull. 

Abortion bans in some states contain some exceptions for birth defects or lethal fetal anomalies. Not Louisiana’s. “Because of Louisiana’s restrictive abortions laws I could not get the care that I needed,” Davis said.

To receive the medically necessary abortion, Davis at nearly 17 weeks traveled to New York for the required care.

It was a devastating, heartbreaking but eye-opening experience, Davis said. For her, it revealed how harmful the system is for women like her, which sparked her to become an advocate for reproductive justice and healthcare rights. 

Afterward, she launched the Nancy Davis Foundation to provide resources and support to other women and to educate about the other usages of mifepristone and misoprostol. 

“Women will be harmed by this type of policy. It’s particularly going to be challenging for women who live in rural communities with hospitals that don’t have a lot of resources,” Salganicoff said. “These laws are not necessarily cast with the intent to be discriminatory, but as in so many cases, low-income women and women of color are those who are disproportionately disadvantaged by policies that restrict access to medication and care.” 

Fear of using misoprostol at all — and reluctance to even see patients during early pregnancy 

Clinicians may be worried about how high the bar will be for distribution of misoprostol and the possible monitoring of data, such as who is prescribing and receiving the medications. That raises concerns about patient confidentiality, Salganicoff said.

In September, ProPublica obtained internal reports detailing the deaths of two pregnant women in Georgia as a result of the state’s restrictions on access to abortion care. Their deaths were deemed preventable and are the first known fatalities to result from strict state abortion policy. 

Certainly, one of the effects of the law has been to create anxiety among physicians about miscarriages, because misoprostol is an often-used, life-saving drug that can stop postpartum hemorrhaging — it is a crucial tool for women who are miscarrying. 

To avoid encountering miscarriages, at least one woman tells The Lens that her physicians declined to see her in her early pregnancy, when miscarriage is most common.

That fear of treating miscarriages has affected people like Kaitlyn Joshua, another lawsuit plaintiff who was turned away in Baton Rouge when seeking medical treatment for her miscarriage. 

Due to uncertainty about whether they heard a fetal heartbeat, medical officials refused to perform a medically assisted abortion, though Joshua was experiencing miscarriage symptoms and heavy bleeding. She was sent home with prescription Tylenol for pain that continued for two months.

Afterward, Joshua discovered she was pregnant again. Four weeks into her term, she called the trusted provider she’d used just a couple years earlier with her first pregnancy — who told her she couldn’t make an appointment until she was 12 weeks pregnant. 

“We know that women miscarry more often than not in those first 12 weeks, so as to mitigate the liability of dealing with patients who might experience miscarriages, they just decided to wait a whole trimester,” Joshua said.

For physicians like family doctor Emily Holt — who owns the family practice, Poppy Direct Care, and provides primary care including reproductive healthcare to young adults — there is concern about how Act 246 will affect her ability to practice and provide care to her patients.

For some of her patients, she provides IUDs for birth control. And in some cases, to insert the IUDs properly, she prescribes misoprostol. The new law changes how she accomplishes that.

Typically, she writes and fills all prescriptions at her practice. But no longer. “This law impacts my practice profoundly because I dispense medication on site. However, I do not have a license to dispense controlled substances,” said Holt. “I can prescribe controlled substances, meaning I can send them to a pharmacy, but I can’t keep them on-site at my practice. So this law makes it so that I can’t even have those medications at my business without jumping through significant administrative hurdles.” 

To combat this obstacle, Dr. Holt has begun her own type of drills which involve compiling a list of pharmacies that have controlled substances in stock. She also advocates on behalf of patients, who have her personal cell, to pharmacies or other physicians. 

These new tasks are the result of “politicians trying to practice medicine” by passing laws without consulting doctors, she said. “Legislators should listen to doctors and other medical professionals on the impacts of the laws they seek to pass. And that didn’t happen with Act 246.” 

Holt became a plaintiff in the lawsuit with hopes of taking the law off the books, because of its effects on her and her patients. 

‘Good must suffer for the bad’

As Louisiana lawmakers discussed the passage of Act 246, Joshua, who volunteers as a reproductive and healthcare equity advocate, shared her miscarriage experience in the Capitol with her young son strapped to her chest. 

To help tell stories like hers in states with abortion bans, Joshua co-founded Abortion in America, a digital story-telling project that tells the stories of what it’s like to live in an abortion-restrictive state.

Earlier this year she spoke to Sen. Thomas Pressly, who authored the bill that originally proposed to make coerced abortion a crime, then ended up reclassifying the two medicines. Pressly proposed the measures after his sister Catherine Herring was unknowingly given abortion medication by her then-husband in Texas. 

To her, Pressly — because of his sister’s unfortunate, but extremely unusual story — was creating a healthcare crisis that didn’t exist in Louisiana. 

“I told him something along the lines of while you’re trying to help one community of folks, you are going to disproportionately harm mine. And his response to that was, ‘Well, sometimes you can’t help everybody. Sometimes the good just have to suffer for the bad.’”