“Fetal Age” Filing to Begin In Nebraska

Robin Marty

Medical professionals performing abortions in Nebraska will begin filing new information in preparation for the institution of the "fetal pain" law in October.

Nebraska’s “fetal pain” law, a new abortion restriction based on the erroneous assertion that fetuses may feel pain at 20 weeks gestation is still scheduled to go into effect in October.  In preparation for the law, doctors are being reminded that they will now need to file “fetal age” information to the state, in order to ensure they are not in fact breaking the new rule.

Via CNBC:

The fetal-pain measure (LB1103) passed by state lawmakers last year takes effect Oct. 15.

“The reporting requirements in LB1103 should lead to more accurate and reliable data for the benefit of Nebraska lawmakers and all who are interested in these issues,” said Speaker of the Legislature Mike Flood of Norfolk, who introduced the bill.

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Current Nebraska law requires doctors to file reports with the state Department of Health and Human Services on each abortion performed. Those reports must include where and when the abortion was performed, the woman’s age and state of residence, the number of previous births and abortions, the length and weight of the aborted fetus, the reason for the abortion, the type of procedure used and whether there were complications.

The reporting of gestational age is optional, and Nebraska’s 2009 abortion statistics show it was included on just one of 2,551 reports. Additionally, the length and weight of the aborted fetuses — which could offer a clue as to age — were listed as immeasurable on all but one report.

As Vicki Saporta, of the National Abortion Federation, points out in the article, once a woman is in the second trimester, ultrasound equipment cannot pinpoint age as accurately, making the “20 week” rule increasingly at a doctor’s discretion.

Vicki Saporta, president of the National Abortion Federation, a professional society for North American abortion providers, said ultrasound equipment can pinpoint gestational age within three days during the first trimester and within two weeks in the second. That could mean that, because of the current ultrasound technology, a doctor could date a woman’s pregnancy at 21 weeks when she’s really at 19 and deny her an abortion under the Nebraska legislation, which Saporta said “is yet another flaw in this law.”

There is no indication yet as to whether this law will be challenged, as was a previous regulation requiring women to undergo mental health screenings and listen to erroneous abortion information before undergoing the procedure. That law was struck down in August as unconstitutional, and the state decided not to try to overturn the ruling.

News Abortion

FDA’s Update to Medication Abortion Regulations a Boon for Access

Teddy Wilson

There have been dozens of bills introduced in the past few years to restrict medication abortion access. This year lawmakers have introduced similar bills in Iowa and New Hampshire.

The U.S. Food and Drug Administration (FDA) approved a label change Wednesday for mifepristone, a drug known as RU-486 used during medication abortions. The change brings federal regulations in line with scientific research and evidence-based medicine.

Anti-choice legislators have for years restricted access to medication abortion by charging that off-label use of abortion-inducing medication posed a danger to pregnant people.

When the FDA approved medication abortion for use in the United States in 2000, the agency adopted the regimen that had been developed by French researchers in 1988. However, medical consensus is that this protocol is outdated.

The FDA updated the agency’s supplemental application for Mifeprex, the brand name of the drug distributed by Danco Laboratories, based on data and information submitted by the drug manufacturer. After reviewing the supplemental application, the agency determined that Mifeprex is safe and effective when used to terminate a pregnancy in accordance with the revised labeling.

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The FDA label change announced Wednesday will increase the time a pregnant person has to receive a medication abortion, from 49 days to 70 days of gestation.

Vicki Saporta, president and CEO of the National Abortion Federation (NAF), said in a statement that since mifepristone was initially approved by the FDA in 2000, NAF members have used an evidence-based regimen that has allowed for a lower dose of mifepristone.

“Because providers in the United States have already been providing evidence-based care, which the new label now recognizes, actual practice will not change,” Saporta said. “What will change is that politicians can no longer deny women access to this safe and effective method of early abortion care by insisting on an out-dated regimen.”

A medication abortion is a non-surgical procedure by which pregnancy is terminated through the use of two drugs. The first drug, mifepristone, works by blocking the hormone progesterone, which causes the lining of the uterus to break down so that the pregnancy cannot continue. The second drug, misoprostol, which causes cramps and heavy bleeding that usually lasts for a few hours, induces contractions and ends the pregnancy.

Anti-choice lawmakers in recent years have targeted medication abortion with legislation designed to restrict access to abortion care. Republican state lawmakers have been aided by anti-choice organizations such as Americans United for Life, which has drafted copycat bills designed to make medication abortion inaccessible.

These anti-choice bills force doctors to administer medication abortion in a manner that contravenes research-driven guidelines published by the most trusted public health organizations, including the World Health Organization, the American College of Obstetricians and Gynecologists, and the American Medical Association.

A five-year study of 13,000 women published last year in the journal Contraception found that evidence-based alternatives to the FDA-approved regimen for medication abortion are safe and effective. The study found that the evidence-based protocols were more than 98 percent effective for pregnancies of up to 42 days’ gestation, and more than 95 percent effective up to 63 days.

There have been dozens of bills introduced in the past few years to restrict medication abortion. This year lawmakers have introduced similar bills in Iowa and New Hampshire.

Lawmakers in Ohio and Texas passed laws that required mifepristone be provided in accordance with the outdated FDA protocol. North Dakota and Oklahoma have enacted laws requiring the use of the FDA protocol, but those GOP-backed laws have been blocked by courts and are not in effect.

An Arizona state court judge last year permanently blocked a state law that mandated physicians to follow the outdated protocol established by the FDA when administering “any medication, drug, or substance” to induce an abortion.

Last week Arizona’s Republican-majority house once again approved a bill requiring doctors to follow the same outdated standards on medication abortion.

“We hope the new label changes will soon allow women to access medical abortion care in states where anti-choice restrictions have made this evidence-based care unavailable,” Saporta said.

Dr. Nancy Stanwood, board chair of Physicians for Reproductive Health, praised the FDA for approval of the label change.

“We applaud the FDA for recognizing the safety of medication abortion and the voluminous research that shows evidence-based regimens are beneficial to patients,” Stanwood said in a statement. “As physicians, we work every day to provide the highest quality care to our patients. An updated label means that providers in states that require adherence to the FDA-approved Mifeprex label will not have to practice outdated medicine.”

News Abortion

New Mexico Abortion Providers See Spike in Texas Patients

Nicole Knight

Democratic lawmakers in New Mexico have successfully beaten back anti-choice measures. But across its eastern border is a state with some of the nation's most onerous abortion access laws: Texas.

In a busy week, Brittany Defeo fields as many as a dozen calls from people traveling to New Mexico seeking abortion care.

Defeo, a program manager with the aid group New Mexico Religious Coalition for Reproductive Choice, said in an interview with Rewire that the callers ask for many types of assistance during their brief stays in the state. Sometimes it’s a ride from the bus stop, or a lift from the airport, or a place to stay the night.

The number of patients from other states seeking abortion care in New Mexico has doubled in recent years. About 20 percent of the roughly 4,500 abortions performed there in 2014 involved out-of-state patients, according to state health department data reported by the Albuquerque Journal.

Democratic lawmakers in New Mexico have successfully beaten back anti-choice measures. But across its eastern border is a state with some of the nation’s most restrictive abortion access laws: Texas.

When Defeo picks up the phone, there’s a good chance that the pregnant person on the other end is a Texan.

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“So far this year, one-third are from Texas,” Defeo said of the callers who ask for the coalition’s assistance.

Defeo said the out-of-state patients arrive after flying, boarding a Greyhound bus, or driving solo. They travel hundreds—or thousands—of miles, coming from as far away as Maine and Oregon.

“They’re ages 18 to 40. It’s all walks of life,” Defeo told Rewire.

The coalition has a couple dozen volunteers who ferry the patients to appointments. Some volunteers offer up the hospitality of their own homes, and hotel discounts are available. Patients are greeted with unconditional support, said Joan Lamunyon Sanford, the coalition’s executive director.

New Mexico has four abortion clinics. Three are in Albuquerque, which is where most of the coalition’s volunteers are located. One is in Las Cruces, about a 45-minute drive from El Paso.

Abortion services are available in New Mexico in all trimesters of pregnancy. Republican legislators in Texas, on the other hand, have outlawed abortion care beyond 20 weeks.

The unconstitutional 20-week ban is one of many policies that have kneecapped abortion access throughout Texas. The state’s onerous clinic shutdown law, HB 2, requires Texas doctors who perform abortions to maintain admitting privileges at a nearby hospitals, and mandates that abortion facilities must be outfitted like mini-hospitals. In 2014, the first full year after HB 2 was enacted, the state’s rate of legal abortions fell 14 percent, as the Dallas Morning News recently reported.

Since July 2013, when then-Gov. Rick Perry (R) signed HB 2 into law, 22 of the state’s 41 abortion clinics have stopped offering the procedure, according to Reuters.

Texas women now must drive four times farther for abortion services and often wait three times longer for appointments, researchers at the Texas Policy Evaluation Project found in a series of recent studies. Abortion care in the sprawling state is now concentrated in cities, with the Houston-Beaumont area accounting for more than one-third of abortions performed between November 2013 and April 2014.

The number of Texas patients seeking abortion services in New Mexico has skyrocketed. In the first 11 months of 2015, the National Abortion Federation (NAF) hotline referred 209 Texas patients to New Mexico, up from a mere 21 in all of 2013, said Vicki Saporta, president and CEO of NAF.

The U.S. Supreme Court is poised to decide in the coming months whether HB 2 imposes an undue burden on the state’s pregnant people. During oral arguments this month, Justice Ruth Bader Ginsburg pointed out that Texas, which has argued that its harsh restrictions safeguard pregnant people’s health, seemed to have no problem with pregnant people seeking the procedure in New Mexico, where abortion care is easier to come by.

“It’s not just Texas and New Mexico where women travel out of state,” Saporta told Rewire.

In fact, Kansas is the leader nationwide in out-of-state abortions among those states from which the Kaiser Family Foundation could procure data. Fifty-one percent of abortions in Kansas were obtained by patients coming from other states in 2012. The data, however, predates a flood of Republican-led state-level restrictions enacted in recent years.

As the number of state-level restrictions grows,  Saporta said, “it may be easier and quicker for [pregnant people] to go out of state.”

Saporta offered the example of a Missouri patient who lives far from the St. Louis area, where abortion services are available. That individual, she said, may find it easier to cross into neighboring Iowa or Kansas.

But geography isn’t always the reason. Saporta said that barriers to care play a growing role for pregnant people.

“Maybe they want to have a medication abortion and the state they’re in requires multiple visits,” Saporta said. “Where is it most feasible to obtain care? It’s not always the state they live in due to onerous restrictions that have nothing to do with safety.”

Restrictions force patients to wait longer, travel farther, spend more, or resort to at-home attempts to end pregnancy. Facilities also must cope.

Saporta said one Albuquerque provider has seen its number of Texas patients more than triple, going from 19 Texas patients in the first quarter of 2012 to 67 patients in the first quarter of 2015.

Defeo recalled a Texas woman who called the aid group asking for help. Already a mother of two, the woman was carrying a fetus that had been diagnosed with anomalies. She was just days past the 20-week mark, meaning the procedure was illegal in Texas.

Defeo said the woman first made the more than 1,000-mile drive to a Georgia facility, discovering upon arrival that a new abortion restriction had gone into effect the day of her appointment.

“The day she got there, the new law went in place and they had to turn her away,” Defeo said.

The woman was finally able to receive abortion care in New Mexico.

That might not always be the case, advocates said. An offshoot of the radical anti-choice group Operation Rescue is targeting New Mexico providers. The anti-choice organization Americans United For Life rated the state the tenth-worst on its 2015 “Life List.” And state Democrats managed to narrowly defeat a series of abortion restrictions this legislative session, but more are likely to come.

Saporta said Texas is shifting its constitutional responsibilities to other states, while ignoring the damaging effects on those who are most vulnerable.

The U.S. Supreme Court will soon decide whether this restrictive landscape is an enduring reality.

“The consequences for women are huge,” Saporta said.

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