News Abortion

How the Ohio Court Decision on RU-486 Set Back the Clock on Fifteen Years of Medicine

Jodi Jacobson

A recent federal district court decision upholding a 2004 Ohio limiting the use and availability of RU-486 for early termination of pregnancy exacerbates the increasing intrusion of ideology into medical practice, and creates a different standard for off-label use of abortion drugs than for other commonly-used drugs. 

This article was amended at 5:50 pm Thursday, June 2, 2011 to correct an error stating that early surgical abortions were riskier than early medication abortions.  That is incorrect: the two procedures have roughly the same safey profile.

In 2004, the Ohio legislature passed a law barring use of RU-486, the combination drug used for early termination of pregnancy, unless it was prescribed strictly in accordance with official labeling by the Food and Drug Administration. The law never went into effect because of an injunction immediately sought and won by Planned Parenthood of Ohio and partner organizations in a suit claiming the law was unconstitutionally vague, lacked an exception to protect patients’ lives and health, and created undue burdens on a woman’s right to access abortion care by limiting their options and forcing many to undergo surgical abortion rather than early medication abortion.

After remaining under injunction as it wended its way through court for the past seven years, the case came before Ohio Federal District Court Judge Susan Dlott, who vacated the injunction and set the stage for enforcement of the law.

Both the law and the court’s decision ignore the medical and scientific evidence regarding safety of RU-486 and create a different standard for clinical delivery of an abortion drug than for other drugs approved by the FDA.  As a result, fewer women in the state seeking to end an unwanted and untenable pregnancy will be able to access RU-486 for early termination and will instead be forced to undergo surgical abortion instead. Moreover, those whose doctors can and do prescribe RU-486 will have to pay more, in some cases three times as much, for the drug: “Strict adherence” to the FDA labeling standards ironically requires administration of much higher doses of mifepristone than data collected since the original FDA approval show to be necessary and effective for inducing abortion.

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RU-486, or mifepristone, was approved for use in the United States by the FDA in September 2000.  The drug blocks the action of the hormone progesterone, which is needed to sustain a pregnancy.  Mifepristone has been used, in combination with other medications called prostaglandins, for medical abortion since 1988 in France and China, and since the early 1990’s in the United Kingdom and Sweden. It has been licensed for use in 37 countries, including the United States.

The FDA approval of mifepristone in the United States was based on data derived from clinical trials involving less than 3000 women in the mid-nineties, all of which followed a certain regimen.  The data from these trials were submitted for review to the FDA, and the regimen used in the trials was the one specifically approved by the FDA for use in medication abortion up to 49 days of pregnancy.

Since the original trials were conducted, however, data have been collected on use of RU-486 by more than 1.5 million women in the United States alone and millions more women around the world. These data show that mifepristone administered in lower doses and in combination with the drug misoprostol can safely and effectively terminate a pregnancy up to 63 days.  The combination–again using lower doses of mifepristone–is more than 90 percent effective in terminating a pregnancy.  Moreover, data show that the off-label regimens have fewer side effects and allow a woman to take part of the combination of drugs at home, thereby lowering both clinical as well as personal economic costs (money, time, travel and the like).

Unhappy with women’s rapidly expanding access to early medication abortion, in no large part because it reduces the ability to harass and stigmatize women for terminating a pregnancy, anti-choice advocates have repeatedly attacked medication abortion in much the same way they have surgical abortion: spreading lies and distortion about the medical safety of abortion procedures, stigmatizing abortion (and contraception) and seeking to pass one law after another creating spurious barriers to access to abortion, all under the guise of “protecting women.”

The 2004 Ohio law is one such example: A law forbidding off-label use of mifepristone means doctors can not prescribe medication based on new evidence (evidence-based prescribing). In other words, they can not use their skills or their medical judgment to prescribe an already-approved drug in accordance with the most recent medical and clinical data available.

Administration of Mifepristone Under Evidence-based Practices Not Allowed Under Ohio Law

Clinical studies have shown that several variations in mifepristone/misoprostol treatment regimens are safe and effective. Generally, however, once a woman has decided to have a medical abortion, there are three steps in the process of a medical abortion:

Step One (at the medical office or clinic)

  • A medical history is taken and a clinical exam and lab tests are performed.
  • Counseling is completed and informed consent is obtained.
  • If eligible for medical abortion, the woman swallows the mifepristone pill(s).

Step Two (at the office/clinic or at home depending on the treatment regimen)

  • This step takes place within about 2 days of step one.
  • Unless abortion has occurred and has been confirmed by the clinician, the woman uses misoprostol. Misoprostol tablets may be swallowed, placed between cheek and gum, or inserted into the vagina, depending on the treatment regimen.

Step Three (at the office or clinic)

  • This step takes place within about 2 weeks of step two.
  • The clinician evaluates the woman to confirm a complete abortion. It is essential for women to return to the office/clinic to confirm that the abortion is complete.
  • If there is an ongoing pregnancy, a suction abortion should be provided.
  • If there is an incomplete abortion, the clinician will discuss possible treatment options with the woman. These may include waiting and re-evaluating for complete abortion in a number of days or performing a suction procedure.

Among other points, the Planned Parenthood case argued that the law posed an undue burden on women’s right to access safe abortion, in part because Ohio now requires 4 trips to a clinic for medication abortion instead of the two above, and therefore creates undue burdens on women.  In addition, according to Planned Parenthood, the act “violates a woman’s right to bodily integrity because it compels surgical abortion in circumstances where medical abortion would otherwise be desired or appropriate treatment.”

The suit also argued that the law was unconstitutionally vague because it required physicians to comply with FDA labeling, despite confusion on just what interpretation of the labeling applied.

According to Courthouse News:

Planned Parenthood attributed the law’s vagueness to “language requiring physicians to comply with ‘all provisions of the federal law’ [that] did not make clear what specific standards physicians must follow in order to prescribe or administer mifepristone without risking prosecution.”

The abortion providers maintained that the law requires doctors to follow the FDA’s printed labeling for the drug, though that labeling is contradictory and consists of four separate documents.

In this regard, and others, mifepristone is being treated differently under Ohio law than many other commonly-used drugs which are prescribed off-label using evidence-based criteria. It has been estimated, for example, that up to one-fifth of drug prescriptions in the United States are off-label; this percentage rises to approximately one-third among psychiatric drug prescriptions and to nearly one-half among cardiac medication prescriptions.  A 2009 study found that 62 percent of pediatric office visits included off-label prescription practices. A 1997 study of cancer doctors by the American Enterprise Institute and the American Cancer Society found that 60 percent of the doctors prescribed drugs off-label, and a 1991 study by the United States General Accounting Office found that more than half of cancer patients were prescribed at least one drug off-label.

Certain types of birth control pills are prescribed to treat endometriosis although the FDA has only approved them as contraceptives.  Avastin, a drug approved to treat certain types of cancer, is used off-label to treat late-stage, age-related macular degeneration. Doxepin, an antidepressant and insomnia medication, is recommended off-label to treat severe allergies. In fact, most common drugs administered to children constitute off-label use because they have been tested in adults, not children, and physicians go “off-label” to adjust dosages.

And some anti-depressants, such as Prozac, Zoloft, and Paxil, are recommended for the treatment of premature ejaculation.  No laws against that one

These are but a few examples of the evidence-based prescribing in which doctors engage every day to most effectively treat their patients.

Under Ohio law, however, mifepristone is singled out and its use off-label prohibited.  This despite the fact that the on-label dosage is higher, requiring 3 doses, instead of one.  At $90.00 a pill, the cost of the drug for early medication abortion triples to $270.00, a clear barrier for many poor women seeking to terminate an untenable pregnancy. The law also results in more visits to the doctor, less autonomy on the part of the woman, and, because the off-label cut-off of 63 days is now against Ohio law, an increased number of surgical abortions.  First trimester surgical abortions are among the safest medical procedures carried out in the United States and medication abortion also is very safe.  But the earlier the abortion procedure, the safer it is for the woman. So from a medical and ethical standpoint, forbidding doctors from using evidence-based prescribing to provide medication abortions means higher costs and later terminations for many women, all against the prevailing evidence and against the expressed wishes of the woman in question.

Still, Judge Susan Dlott handed a victory in the form of a summary judgment to the Ohio Attorney General and to the anti-choice movement, without hearing any evidence in the case.  In regard to the issue of vagueness, Dlott wrote that “[t]he Court is confident that physicians have fair notice of what conduct is prohibited,” she wrote.

Dlott also denied Planned Parenthood’s claim that restricting action to medication abortion is an infringement on women’s rights to access, stating “the Act does not force women to undergo any procedure, surgical or otherwise.”

“When broken down, Plaintiffs’ argument appears to be this: by prohibiting off-label use of mifepristone, the Act leaves women with gestational durations exceeding 49-days with no other option but a surgical abortion to terminate their pregnancies,” according to the 30-page ruling. “While this may be true, it does not change the fact that the Act itself does not compel women to undergo surgery to terminate a pregnancy.”

According to Courthouse News, Dlott declined, however, to dismiss the claim that says the law is unconstitutional because it lacks an exception to protect the health or life of the mother.

“Defendants argue that medical disagreement exists over the need for a health or life exception, and yet Defendants also concede that surgical abortions pose greater risks for women with medical complications,” Dlott wrote. “These contentions are, at a minimum, laden with contested factual issues that cannot be resolved in Defendants’ favor on summary judgment.” “The current record indicates, and Defendants concede, that surgical abortions pose greater risks for women with medical complications,” she added. “Additionally, both parties are able to articulate the discrete instances in which an off-label mifepristone abortion may be medically necessary.”

“We are very disappointed in the federal district court ruling,” said Planned Parenthood Ohio in a statement the day of the ruling. “[It] denies women in Ohio access to the same safe abortion care that is available in every other state in the country. We continue to believe that this law which prohibits Ohio women from having full access to medication abortion violates their constitutional rights.”

This ruling upholds a bad law passed by Ohio politicians who think they know better than doctors how to practice medicine.  Evidence-based prescribing is common practice in all aspects of medicine, but the judgment of Ohio doctors is being trumped by right-wing, ideological legislators when it comes to this one, safe medication.

Planned Parenthood and other advocates are considering their next steps.

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

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Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”

Analysis Abortion

Legislators Have Introduced 445 Provisions to Restrict Abortion So Far This Year

Elizabeth Nash & Rachel Benson Gold

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

So far this year, legislators have introduced 1,256 provisions relating to sexual and reproductive health and rights. Of these, 35 percent (445 provisions) sought to restrict access to abortion services. By midyear, 17 states had passed 46 new abortion restrictions.

Including these new restrictions, states have adopted 334 abortion restrictions since 2010, constituting 30 percent of all abortion restrictions enacted by states since the U.S. Supreme Court decision in Roe v. Wade in 1973. However, states have also enacted 22 measures this year designed to expand access to reproductive health services or protect reproductive rights.

Mid year state restrictions

 

Signs of Progress

The first half of the year ended on a high note, with the U.S. Supreme Court handing down the most significant abortion decision in a generation. The Court’s ruling in Whole Woman’s Health v. Hellerstedt struck down abortion restrictions in Texas requiring abortion facilities in the state to convert to the equivalent of ambulatory surgical centers and mandating that abortion providers have admitting privileges at a local hospital; these two restrictions had greatly diminished access to services throughout the state (see Lessons from Texas: Widespread Consequences of Assaults on Abortion Access). Five other states (Michigan, Missouri, Pennsylvania, Tennessee, and Virginia) have similar facility requirements, and the Texas decision makes it less likely that these laws would be able to withstand judicial scrutiny (see Targeted Regulation of Abortion Providers). Nineteen other states have abortion facility requirements that are less onerous than the ones in Texas; the fate of these laws in the wake of the Court’s decision remains unclear. 

Ten states in addition to Texas had adopted hospital admitting privileges requirements. The day after handing down the Texas decision, the Court declined to review lower court decisions that have kept such requirements in Mississippi and Wisconsin from going into effect, and Alabama Gov. Robert Bentley (R) announced that he would not enforce the state’s law. As a result of separate litigation, enforcement of admitting privileges requirements in Kansas, Louisiana, and Oklahoma is currently blocked. That leaves admitting privileges in effect in Missouri, North Dakota, Tennessee and Utah; as with facility requirements, the Texas decision will clearly make it harder for these laws to survive if challenged.

More broadly, the Court’s decision clarified the legal standard for evaluating abortion restrictions. In its 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, the Court had said that abortion restrictions could not impose an undue burden on a woman seeking to terminate her pregnancy. In Whole Woman’s Health, the Court stressed the importance of using evidence to evaluate the extent to which an abortion restriction imposes a burden on women, and made clear that a restriction’s burdens cannot outweigh its benefits, an analysis that will give the Texas decision a reach well beyond the specific restrictions at issue in the case.

As important as the Whole Woman’s Health decision is and will be going forward, it is far from the only good news so far this year. Legislators in 19 states introduced a bevy of measures aimed at expanding insurance coverage for contraceptive services. In 13 of these states, the proposed measures seek to bolster the existing federal contraceptive coverage requirement by, for example, requiring coverage of all U.S. Food and Drug Administration approved methods and banning the use of techniques such as medical management and prior authorization, through which insurers may limit coverage. But some proposals go further and plow new ground by mandating coverage of sterilization (generally for both men and women), allowing a woman to obtain an extended supply of her contraceptive method (generally up to 12 months), and/or requiring that insurance cover over-the-counter contraceptive methods. By July 1, both Maryland and Vermont had enacted comprehensive measures, and similar legislation was pending before Illinois Gov. Bruce Rauner (R). And, in early July, Hawaii Gov. David Ige (D) signed a measure into law allowing women to obtain a year’s supply of their contraceptive method.

071midyearstatecoveragetable

But the Assault Continues

Even as these positive developments unfolded, the long-standing assault on sexual and reproductive health and rights continued apace. Much of this attention focused on the release a year ago of a string of deceptively edited videos designed to discredit Planned Parenthood. The campaign these videos spawned initially focused on defunding Planned Parenthood and has grown into an effort to defund family planning providers more broadly, especially those who have any connection to abortion services. Since last July, 24 states have moved to restrict eligibility for funding in several ways:

  • Seventeen states have moved to limit family planning providers’ eligibility for reimbursement under Medicaid, the program that accounts for about three-fourths of all public dollars spent on family planning. In some cases, states have tried to exclude Planned Parenthood entirely from such funding. These attacks have come via both administrative and legislative means. For instance, the Florida legislature included a defunding provision in an omnibus abortion bill passed in March. As the controversy grew, the Centers for Medicare and Medicaid Services, the federal agency that administers Medicaid, sent a letter to state officials reiterating that federal law prohibits them from discriminating against family planning providers because they either offer abortion services or are affiliated with an abortion provider (see CMS Provides New Clarity For Family Planning Under Medicaid). Most of these state attempts have been blocked through legal challenges. However, a funding ban went into effect in Mississippi on July 1, and similar measures are awaiting implementation in three other states.
  • Fourteen states have moved to restrict family planning funds controlled by the state, with laws enacted in four states. The law in Kansas limits funding to publicly run programs, while the law in Louisiana bars funding to providers who are associated with abortion services. A law enacted in Wisconsin directs the state to apply for federal Title X funding and specifies that if this funding is obtained, it may not be distributed to family planning providers affiliated with abortion services. (In 2015, New Hampshire moved to deny Title X funds to Planned Parenthood affiliates; the state reversed the decision in 2016.) Finally, the budget adopted in Michigan reenacts a provision that bars the allocation of family planning funds to organizations associated with abortion. Notably, however, Virginia Gov. Terry McAuliffe (D) vetoed a similar measure.
  • Ten states have attempted to bar family planning providers’ eligibility for related funding, including monies for sexually transmitted infection testing and treatment, prevention of interpersonal violence, and prevention of breast and cervical cancer. In three of these states, the bans are the result of legislative action; in Utah, the ban resulted from action by the governor. Such a ban is in effect in North Carolina; the Louisiana measure is set to go into effect in August. Implementation of bans in Ohio and Utah has been blocked as a result of legal action.

071midyearstateeligibilitytable

The first half of 2016 was also noteworthy for a raft of attempts to ban some or all abortions. These measures fell into four distinct categories:

  • By the end of June, four states enacted legislation to ban the most common method used to perform abortions during the second trimester. The Mississippi and West Virginia laws are in effect; the other two have been challenged in court. (Similar provisions enacted last year in Kansas and Oklahoma are also blocked pending legal action.)
  • South Carolina and North Dakota both enacted measures banning abortion at or beyond 20 weeks post-fertilization, which is equivalent to 22 weeks after the woman’s last menstrual period. This brings to 16 the number of states with these laws in effect (see State Policies on Later Abortions).
  • Indiana and Louisiana adopted provisions banning abortions under specific circumstances. The Louisiana law banned abortions at or after 20 weeks post-fertilization in cases of diagnosed genetic anomaly; the law is slated to go into effect on August 1. Indiana adopted a groundbreaking measure to ban abortion for purposes of race or sex selection, in cases of a genetic anomaly, or because of the fetus’ “color, national origin, or ancestry”; enforcement of the measure is blocked pending the outcome of a legal challenge.
  • Oklahoma Gov. Mary Fallin (R) vetoed a sweeping measure that would have banned all abortions except those necessary to protect the woman’s life.

071midyearstateabortionstable

In addition, 14 states (Alaska, Arizona, Florida, Georgia, Idaho, Indiana, Iowa, Kentucky, Louisiana, Maryland, South Carolina, South Dakota, Tennessee and Utah) enacted other types of abortion restrictions during the first half of the year, including measures to impose or extend waiting periods, restrict access to medication abortion, and establish regulations on abortion clinics.

Zohra Ansari-Thomas, Olivia Cappello, and Lizamarie Mohammed all contributed to this analysis.