Walling off access: medication abortion restrictions
September 27th, 2013
For Abortion Access Month, the National Women's Health Network shines a spotlight on medication abortion, which can be taken very early in pregnancy and is available in some states via long-distance consultation with medical providers, potentially reducing travel time and expense for people who live far from an abortion clinic. However, politicians are taking dramatic steps to prevent the availability of this alternative.
Excerpted from "Stop State Attacks on Medication Abortion!" by Kate Ryan, Senor Program Coordinator, National Women's Health Network, and Chris Olah, Senior Associate, Reproductive Health Technologies Project.
This month marks the 13th anniversary of U.S. approval of Mifeprex, the “early abortion pill,” which provides women with greater access to abortion care across the country.
When personal healthcare decisions need to be made, people appreciate having options available, and abortion care is no different. Access to medication abortion means that women in the U.S. can terminate a pregnancy without a surgical procedure, at lower cost, and can carry out some or all of the process in their own home. Unfortunately, attacks on abortion access by ultra-conservatives are restricting women's access to this safe and effective option for early abortions. These state legislative attacks run the gamut from restricting who can administer the abortion pill to limiting where or how it can be given to women.
In 39 states, Mifeprex can only be provided by a physician, eliminating entire categories of health practitioners from being able to offer this medication to their patients. And in 12 states, anti-choice politicians have passed laws requiring that the early abortion pill be provided in the physical presence of a physician. This restriction implies that speaking with a clinician via teleconference is inherently less safe than speaking in person prior to using Mifeprex. However, studies show that medication abortion with a doctor connected by teleconference is safe and that outcomes for telemedicine patients are identical to those with conventional office visits. These restrictions are not applied to other healthcare services that use telemedicine – they have nothing to do with the quality or safety of health care and everything to do with preventing a woman from getting abortion services.
In Ohio and soon in Texas, Mifeprex must be provided in strict compliance with the FDA protocol specified on the label. This prohibition on what is known as “off-label use” is unnecessary and also potentially less safe for women seeking a medication abortion. The dose prescribed back in 2000 when the drug was first approved was three times the amount of Mifeprex now commonly administered under the evidence-based practice followed by physicians today. Also under the original protocol, women are not allowed to self-administer the follow-up dose, requiring them to complete the abortion at a clinic rather than in the comfort and privacy of their own home.
The insidious harm done by opponents of abortion in attacking off-label use of Mifeprex is that it sounds like a reasonable safety precaution and makes people think abortion providers are acting differently than other clinicians. However, doctors in almost all areas of medicine prescribe medications off-label – in fact, 20% of all prescription drugs in the U.S. are used by physicians for purposes or doses that are not covered on the original label. For example, many cancer drugs are used off-label and most drugs prescribed to children (because children are not generally included in clinical trials to test medications).