After the 2022 Dobbs decision ripped away abortion access for millions of women and patients nationwide, Michigan voters passed Proposal 3, enshrining reproductive freedom into our state constitution. We made it clear that reproductive freedom belongs to the people, not politicians.
Although this was a great step, the measure itself did not guarantee that care would remain accessible for patients. It cannot prevent extremist politicians from weaponizing our democratic institutions, or from restricting medication abortion via telehealth or mail delivery.
Just last week, Michigan watched even more Planned Parenthood health centers close due to Medicaid cuts and reimbursement blocks. Medicaid is a lifeline for pregnant patients, working families,
and rural communities across the country who need comprehensive health care ‒ including reproductive care.
These closures are only a small piece of what is happening in the greater landscape.
It is unlikely that a national abortion ban will arrive under a giant headline. Instead, access to care will be dismantled piece by piece.
This week, President Donald Trump nominated Dr. Heidi Overton to lead the Food and Drug Administration. She is an anti-abortion extremist, and the latest addition to Trump’s assembly of loyalists positioned across the federal government to restrict abortion nationwide.
Her nomination should concern every Michigander who believes Proposal 3 settled this issue. But it should concern us even beyond abortion access. It should concern anyone who believes the FDA must follow evidence, not the ideology of the person appointed to lead it.
subhed
Overton has criticized the National Institutes of Health, FDA and Centers for Disease Control and Prevention for failing to fund research that confirms conservative viewpoints. She has said that “all of those agencies need to be reformed.”
Now she is being asked to lead one of them.
Medication abortion allows a patient to end an early pregnancy using FDA approved medications instead of having a procedure in a clinic. The most common regimen uses mifepristone followed by misoprostol. Mifepristone is also used in miscarriage management.
Medication abortion now accounts for two thirds of abortions nationwide. As states banned or severely restricted abortion after the Supreme Court overturned Roe v. Wade, telehealth and mailed medication helped fill gaps in care.
For someone in Michigan’s Upper Peninsula or another rural community, the closest abortion provider may be hours away. Receiving medication through the mail can mean avoiding a long drive, an overnight stay, missed work and additional child care. It can be the difference between having access and having a right that exists only on paper.
The FDA determines how mifepristone may be prescribed and dispensed. Its commissioner therefore has influence over whether patients can receive the medication through telehealth and certified pharmacies or must appear in person.
Until now, the FDA’s decisions about mifepristone have consistently followed the evidence, even under immense political pressure.
subhed
A recent JAMA study examined more than 5,000 pages of internal FDA memoranda, emails and other records covering 12 years. Researchers found that the agency repeatedly evaluated new evidence about mifepristone and repeatedly based its decisions on the science.
Again and again, the evidence supported its safety.
The American Medical Association has been unequivocal: serious adverse events occur in fewer than one-third of one percent of patients, and continuing a pregnancy carries roughly 14 times the risk of death. In February, the American College of Obstetricians and Gynecologistsled a coalition of 15 medical organizations defending mifepristone’s safety record in court.
That evidence has not stopped anti-abortion extremists from pressuring the FDA to restrict mifepristone. Commissioner Dr. Marty Makary resigned after months of public demandsfor his removal from organizations that accused him of failing to act quickly enough against the medication.
Overton would enter the agency amid that pressure ‒ and with a record that aligns with it.
She celebrated the fall of Roe v. Wade meanwhile dismissed federal legislation protecting reproductive rights as “radicalism.” Before joining the White House, she served as chief policy officer at the America First Policy Institute, which called for the FDA to reinstate in-person dispensing requirements for mifepristone, prohibit telehealth prescribing and mandate in-person ultrasounds—burdens that are not medically necessary for every patient.
The Trump administration has already directed the FDA to review mifepristone’s safety againdespite the extensive evidence available. If confirmed, Overton would oversee that review ‒ and have the power to turn political pressure into sweeping restrictions.
These changes would be especially devastating in states where abortion is already banned and care is scarce.
And Michigan is not immune.
subhed
Mifepristone is safe and effective, yet it remains more tightly regulated than the medical evidence warrants—not because of medical necessity, but because of political interference. If the FDA restores an in-person dispensing requirement, patients who can safely receive care through telehealth would be forced to find a clinic and appear in person. Distance will once again become a barrier for Michiganders who depend on mail delivery.
Those burdens would fall hardest on rural and Upper Peninsula patients, people with low incomes, patients with disabilities, parents arranging child care and anyone who cannot afford to miss work or travel hours for an appointment.
When clinics are already closing, every additional barrier matters.
A legal right means far less if we cannot exercise it. Michigan can protect abortion in its constitution, but federal officials can still dismantle everything meaningful access depends on. That is what this playbook looks like. It is not one sweeping act of Congress. It is the weaponization of government, using federal agencies to advance a dangerous political agenda piece by piece.
Medicine should not be partisan. Most of the time, it is not. But reproductive health care has been singled out and politicized in ways we would never accept in other areas of medicine.
subhed
Overton will have a choice: follow the evidence or allow partisan ideology to dictate her decisions.
That scrutiny matters especially at the FDA, the agency responsible for deciding which medications doctors may prescribe and how patients can access them. Overton’s stated political goals create a clear conflict with the agency’s responsibility to make independent, evidence-based decisions. That conflict is not in the public’s best interest.
Our senators should demand clear answers about which path Overton will choose, and if she cannot commit to putting science above ideology, they must reject her nomination. It is really that simple.
Michigan voters protected reproductive freedom at the ballot box. We did not do that work only to have an unelected political appointee quietly regulate it out of reach.
Nikki Sapiro Vinckier, PA-C, is an OB/GYN Physician Assistant, author of the upcoming book We Deserve More, a reproductive health content creator, and a plaintiff in Koskenoja v. Whitmer. She is the founder of Take Back Trust, a digital platform helping people navigate reproductive healthcare in this changing landscape. You can find her on social media @nikkivinck. Write a letter to the editor at freep.com/letters and we may publish it in print or online.
This article originally appeared on Detroit Free Press: Michigan protected abortion rights. The FDA could still limit access. | Opinion
