The hearing, which was kept secret until Monday to avoid possible excesses, began at 09:00 (14:00 GMT) in an Amarillo courthouse, and only a very small audience was allowed to attend.

Outside, a handful of protesters hold signs reading "Not your uterus, not your decision" or "Defend medical abortion." Among them, Lindsay London, a 41-year-old nurse, deplores a legal appeal "100% ideological, which has no scientific basis".

Judge Matthew Kacsmaryk, who was a lawyer for a Christian organization before being appointed to the post by former Republican President Donald Trump, will spend several hours questioning the parties.

Since then, fifteen states have banned all abortions on their soil, and therefore the abortion pill. But it remains widely used elsewhere. That is what is under threat today.

"Politics rather than science"

In November, a coalition of doctors and anti-abortion groups filed a lawsuit against the U.S. Food and Drug Administration (FDA) for authorizing mifepristone (RU 23), one of two pills used for medical termination, 486 years ago.

The plaintiffs accuse the FDA of choosing "politics over science" by approving a "dangerous" chemical, and of having "exceeded its prerogatives".

Pending consideration of the substantive arguments, they requested that the authorization of mifepristone be suspended throughout the country.

Strategically, they filed their appeal in Amarillo, a Texas city away from major urban centers, where Matthew Kacsmaryk is the only federal judge.

Her profile and her claimed opposition to abortion have raised concern among abortion rights defenders.

"It seems incredible that a simple judge in Texas could make a decision that would have an impact on a product approved by health authorities and marketed safely for more than twenty years," Elisa Wells, founder of the Plan C information network on abortion pills, told AFP.

Protesters for abortion rights outside the Amarillo courthouse, March 15, 2023 © Moisés ÁVILA / AFP

53% of abortions

Such a decision would be "devastating for women", had already denounced ten days ago the spokeswoman of the White House, Karine Jean-Pierre.

Since 2000, more than 5.6 million women have used the pill in the United States and a tiny proportion (less than 1,500) have subsequently experienced complications, without a link being established, according to the FDA.

Today, the majority (53%) of abortions are medical, a less intrusive and less expensive procedure than surgical abortions.

Judge Kacsmaryk's decision, whatever it may be, can be appealed by the federal appeals court in New Orleans, also known for its conservatism. The case could again end up before the Supreme Court of the United States which, since its reshuffle by Donald Trump, has six conservative justices out of nine.

Even if the court ultimately suspends the FDA's approval, it would likely take several months before its decision would take effect. According to health law experts, the drug regulator must follow a strict procedure before withdrawing the authorization of a product.

Women and doctors could also fall back on a second pill, misoprostol, whose use is now combined with mifepristone for greater effectiveness and less pain.

"In any case, I think it will be chaotic when the judge makes his decision," Wells said.

© 2023 AFP