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A combative three-judge panel at one of the most conservative courts in the country grilled attorneys for the federal government and a drug manufacturer as anti-abortion activists continue a legal battle to overturn the government’s approval of a widely used abortion drug. On 17 May, the case against mifepristone returned to the Fifth Circuit Court of Appeals in New Orleans, where attorneys for the US Department of Justice and drug manufacturer Danco Laboratories faced skeptical Republican-appointed judges hearing oral arguments in a case that could upend abortion care for millions of Americans. Within seconds of her opening argument, Justice Department attorney Sarah Harrington was interrupted by Judge James Ho, a Donald Trump appointee, who challenged her description of the legal challenge against the drug’s approval by the US Food and Drug Administration. “I don’t think there’s ever been any court that has vacated an FDA determination that a drug is safe to be on the market,” she replied. “FDA can make that determination based on exercising its own scientific expertise, but it’s not a court’s role to come in and second-guess that expertise.” “Why not focus on the facts,” Judge Ho said, “rather than this ‘FDA can do no wrong’ theme.” The judges repeatedly interrupted Ms Harrington and appeared sympathetic to the plaintiffs: an anti-abortion group represented by influential right-wing legal group Alliance Defending Freedom, whose senior counsel Erin Morrow Halley – the wife of Republican senator Josh Hawley – baselessly asserted that medication abortion is “particularly dangerous”. Judge Jennifer Walker Elrod, who was appointed by George W Bush, also took a moment to chastise lawyers for their “unusual remarks” in filings objecting to the widely derided lower-court decision from a former right-wing activist attorney who was appointed to the federal bench by Mr Trump. Judge Elrod suggested their criticisms amounted to personal attacks and suggested that the attorney retract the statements and apologise. “Those statements reflect our view that the district court was very outside the bounds,” said Jessica Ellsworth, an attorney for Danco. “I don’t think those remarks, any of them, were intended as any personal attack.” The judges are not expected to rule immediately. But a decision from the panel judges – each with a history of support for abortion restrictions – is likely to return the case to the US Supreme Court, which has paused any action on mifepristone until the legal challenge plays out. In her arguments, Ms Hawley conflated the risk of serious complications from mifepristone – which is less than 1 per cent – with the risk that a medication abortion failed and would then require medical attention. Her arguments suggested that doctors are enduring a moral harm by providing abortion care, without evidence that doctors have been forced to do so, while also claiming that the FDA illegally approved the drug when it was approved more than 20 years ago. The judges repeatedly questioned the FDA’s approval process for mifepristone, which plaintiffs argued was done too hastily through an expedited process that is typically reserved for treating serious or life-threatening illnesses. But the FDA did not do that with mifepristone; it took years of study before the FDA’s approval. The part of that process that the agency invoked for mifepristone’s approval allowed the FDA to add safety restrictions, such as a requirement that physicians be able to diagnose ectopic pregnancies. But judges appeared to argue that because pregnancy is not an illness, mifepristone should not have been approved through that process at all, repeating plaintiffs’ false claim that the FDA called pregnancy a “life-threatening illness.” “When we celebrated Mothers’ Day, were we celebrating illness?” Judge Ho said at one point. “The arguments today demonstrated in detail that the case has no legal or scientific merit and should have been laughed out of court from the very start,” Jennifer Dalven, director of the ACLU Reproductive Freedom Project, said in a statement. “Unfortunately, the deck is stacked as the judges hearing this case are well known for their extraordinary hostility to abortion,” she added. “The whole point of the case is to prevent anyone in America, no matter where they live, from using a medication that has been safely used in this country for decades and is used in most abortions today.” Major medical groups and research from hundreds of studies over the last two decades have confirmed the overwhelming safety and efficacy of the drug, one of two drugs used in a two-drug protocol for a medication abortion, the most common form of abortion care in the US. Studies show it is as safe to use as common over-the-counter pain relievers like ibuprofen and acetaminophen, and the protocol for medication abortion is used in more than 60 other countries. The drug was first approved by the FDA in 2000 and is approved for use up to 10 weeks of pregnancy. A vast majority of abortions occur within the first nine weeks of pregnancy. From 2019 through 2020, nearly 93 per cent of all abortions were performed before the 13th week, according to the US Centers for Disease Control and Prevention. Mifepristone is also used to treat miscarriages. Roughly 10 per cent of clinically recognised pregnancies end in miscarriages, according to the American College of Obstetricians and Gynecologists. The American College of Obstetricians and Gynecologists and the American Medical Association also joined a brief in the challenge opposing arguments from anti-abortion groups. Last year, Alliance Defending Freedom filed a lawsuit in US District Court in Amarillo, Texas on behalf of a group of anti-abortion activists incorporated as the Alliance for Hippocratic Medicine, which was organised that same month with an address in Amarillo. The Alliance Defending Freedom also led the challenge at the Supreme Court that ultimately struck down Roe v Wade. In April, US District Judge Matthew Kacsmaryk – a former right-wing activist lawyer who was appointed to the federal judiciary by then-President Trump – issued a ruling to suspend the FDA’s approval of mifepristone, which was immediately challenged by abortion rights advocates, providers, major medical groups, drug manufacturers and the Biden administration. An appeal landed at the Fifth Circuit court, which has jurisdiction over the Amarillo court. A three-judge panel blocked a part of the judge’s ruling, and a subsequent ruling at the Supreme Court paused the lower-court ruling as the legal challenge continues. Read More North Carolina Republicans approve 12-week abortion ban as sweeping restrictions spread across US South Nebraska Republicans approve combined gender-affirming care ban and anti-abortion bill after epic filibuster Anti-abortion laws harm patients facing dangerous and life-threatening complications, report finds A Texas man sued his ex-wife’s friends for allegedly helping her with an abortion. Now they’re suing him Louisiana Republicans refuse rape and incest exceptions to state’s sweeping anti-abortion law What is mifepristone? The widely used pill in the abortion rights battle at the Supreme Court

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There remains a space above England’s crest, where that star could have been. It was what Lucy Bronze had dreamt of, ever since the moment where she first played for her country and realised England’s men’s and women’s teams don’t share the same badge. The Lionesses had the chance to change that, the opportunity to add their first star, the moment to capture their 1966. But the wait will now go on. After a historic tournament where the Lionesses again made their mark back home and demonstrated the immense power of what they have created, Sarina Wiegman’s side were left with a devastatingly simple conclusion. As a first Women’s World Cup slipped out of reach, the deflating reality was that, on the day, Spain were just better. And as England’s World Cup came to a close, there was no disgrace in that – certainly not against a side as talented as Spain’s, even with their issues. At full time, as the Spanish players celebrated at one end of the pitch, head coach Jorge Vilda and his staff at the other, Wiegman and her team were a picture of unity in the centre. Even in that moment, they realised they had already managed to achieve something far greater. Wiegman told them they could still be proud, that they had given everything not just in the final but on their journey to reach it. The England manager reminded them of the challenges they had been forced to overcome and the togetherness they had shown to grow through the tournament, right until that final moment. There was pride, too, that the team had given its nation reason to love them even more. “We’re the Lionesses,” Georgia Stanway said afterwards, and that term of itself has become synonymous with their ability to inspire and transcend, to bring a country to a halt and take millions along with them. “We’re not done yet,” Stanway continued. “We’ll continue to break barriers, we’ll continue to push on." This isn’t a team who stands still. The Lionesses have created an identity and image that represents the immense change and progress, and whose performances at the World Cup will result in more. If the impact of last summer’s Euros win is anything to go by, then when the WSL returns there will be bigger attendances, more investment, more growth. Eventually, Mary Earps will get her shirt and when she does it will be another moment to symbolise the power of what the Lionesses have done. And, of course, winning the World Cup would have galvanised that further, but when a team and a manager have a purpose like the Lionesses do then it only becomes a step on the journey. “This group of players are so eager to be successful. We want to grab every moment to be better,” Wiegman said. The World Cup turned out to be the ultimate test of just that, an examination of England’s strength, not that it was ever in doubt. England won fans in a different way to last summer. From the dizzying buzz of the Euros, the Lionesses had to grind it out far away from home in Australia. Wiegman said she had “never faced so many problems” during the World Cup, an admission she made after the Lionesses scraped past Nigeria on penalties in the last-16. From the clarity and continuity of last summer’s Euros, England had anything but at the World Cup and at times were vulnerable to an early exit. Amid the shocks and unpredictability of the group stages, enough teams were succumbing to that particular theme of the World Cup to suggest that England could have quite easily become its latest victim. England’s players had set the bare minimum of the semi-finals yet the way the Lionesses played in their first two matches against Haiti and Denmark suggested even that was a stretch. Yet England managed to overturn it – they didn’t accept their fate and instead found something new, creating a new formation that breathed new life into their campaign. In the knockout stages, they showed resilience and mentality, and in the semi-finals against Australia they produced the performance of their campaign, a gutsy win in the back garden of a traditional sporting enemy, and the sort of performance that the nation back home could be proud of. The regret was they were unable to replicate it in the final, even though Wiegman insisted she had none from a final where Spain ultimately showed their class. It spared the grand inquest into England’s World Cup that would have inevitably followed a defeat to Nigeria in the last-16 or Colombia in the quarter-finals. Even without Beth Mead, Leah Williamson and Fran Kirby, England showed where they stand in the power rankings to reach the final. Defeat there is not the end of anything, rather a continuation of a journey. As for what is next, the answer is invariably more football, yet more opportunities. England will need to perform well in the inaugural Women’s Nations League and reach the final in order to guarantee qualification to next summer’s Olympics in Paris, a competition Wiegman is determined to be at after a miserable experience with the Netherlands at the ‘Covid Games’ in Tokyo in 2021. Then it’s 2025, and the defence of the Euros. As England pick themselves to go again, it will be a priority for the FA that Wiegman is there for the next World Cup. Wiegman’s contract is until 2025 and while she has made it clear that she is happy with England and the support of the team, the Dutch coach will undoubtedly attract interest from elsewhere. The FA would be wise to act swiftly. Certainly, when Wiegman is paid an annual salary of £400,000 to Gareth Southgate’s £5m, it is clear where the FA could make a statement of how much they value Wiegman and the job she has done for English football and the exponential growth of the Lionesses. In the aftermath of another World Cup final defeat, after also losing at that point with the Netherlands in 2019, Wiegman admitted that thinking four years ahead was too far away. But the reality is some players may have already had their last opportunity, particularly Bronze. The right-back had reached the semi-finals in 2015 and 2019, then had the historic high of breaking the barrier and reaching England’s first World Cup final, only for it to be followed by the crushing low of losing the ball in the build-up to Olga Carmona’s goal. It’s the cold reality of World Cup finals, where the opportunity to be champions only comes along every four years. It is exactly why it is the game’s greatest stage and why defeat on it, of being so close but remaining so far away, is the most heartbreaking of all. For Bronze and England the chance to claim the World Cup was right there, and, while the Lionesses may bask in the seismic impact of their achievements back home, it is the thought of that missing star that will remain with them for at least another four years. Read More England suffer World Cup heartache as brilliant Spain show Lionesses what’s missing A change too far? England’s last roll of the dice comes up short How not to win a World Cup: Spain, Jorge Vilda and the story of a complicated victory How not to win a World Cup: Spain, Jorge Vilda and the story of a complicated victory The vital lesson England must take to ‘continue breaking barriers’ England players ‘heartbroken’ after World Cup final defeat to Spain