News Abortion

Missouri Bill Banning ‘Telemed’ Abortions Could Limit Access to Medication Abortions Altogether

Robin Marty

A new ban on "telemed" abortions could make accessing all medication abortions much more difficult for patients in Missouri.

The anti-choice mission to eliminate access to medication abortion continues as Missouri takes an additional step to put restrictions on how RU-486 can be administered in the state. Spearheaded by Missouri Right to Life with the intention of eliminating medication abortion—a more private, less invasive alternative to a surgical procedure—the bill has passed the senate judiciary on a party-line vote.

Missouri is the latest state to propose a law allegedly meant to restrict so-called telemed abortions, or “web-cam abortions,” but which would severely curb the ability to offer medication abortions in general. HB 400 mandates that a doctor be present when the patient takes the first dose of the medication, as well when she takes the second done 24 to 48 hours later. It also requires that the “physician inducing the abortion, or a person acting on such physician’s behalf, shall make all reasonable efforts to ensure that the patient returns twelve to eighteen days after the administration or use of RU-486.” The repeated office visits would make it much more difficult for women to obtain a medication abortion, and may cause many women to choose a surgical procedure just to save the additional trips to the clinic.

That’s exactly what the bill intends. “We have cases of women on a computer ‘Skyping’ with a doctor in a different city while they are taking this pill,” the bill’s sponsor, state Rep. Jeanie Riddle (R-Fulton), told the Missouri Times, evoking Rep. Steve King’s (R-IA) “Robo-skype” abortion comments. “That’s just not safe. It’s dangerous for the woman and allows her to be exploited, and it puts her at great risk.”

Missouri Right to Life appears to have reached out expressly to Riddle to find the right sponsor for the bill. The fact that “telemed” bans and additional doctor trips are in bills being created by anti-abortion action groups and championed by anti-choice lawmakers should make it clear that patient safety has no role in the laws, and these anti-choice players are trying to create barriers to access.

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“Non-surgical abortion, whether in-person or through telemedicine is safe and effective,” Michelle Trupiano, public policy manager for Planned Parenthood of Kansas and Mid-Missouri, said during public testimony. “The bill’s proponents do not have women’s safety in mind. Their goal is to ultimately eliminate women’s access to safe, legal abortion care altogether.”

HB 400 has now passed out of senate committee and will head to the full senate for a vote. There are three weeks left in the session.

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.

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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.

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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.

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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.

Analysis Abortion

From Webbed Feet to Breast Cancer, Anti-Choice ‘Experts’ Renew False Claims

Ally Boguhn & Amy Littlefield

In a series of workshops over a three-day conference in Herndon, Virginia, self-proclaimed medical and scientific experts renewed their debunked efforts to promote the purported links between abortion and a host of negative outcomes, including breast cancer and mental health problems.

Less than two weeks after the Supreme Court rejected the anti-choice movement’s unscientific claims about how abortion restrictions make patients safer, the National Right to Life Convention hosted a slate of anti-choice “experts,” who promoted even more dubious claims that fly in the face of accepted medical science.

In a series of workshops over the three-day conference in Herndon, Virginia, self-proclaimed medical and scientific experts, including several whose false claims have been exposed by Rewire, renewed their efforts to promote the purported links between abortion and a host of negative outcomes, including breast cancer and mental health problems.

Some of those who spoke at the convention were stalwarts featured in the Rewire series “False Witnesses,” which exposed the anti-choice movement’s attempts to mislead lawmakers, courts, and the public about abortion care.

One frequent claim, that abortion increases the risk of breast cancer, has been refuted by the National Cancer Institute, the American Cancer Society, and the American Congress of Obstetricians and Gynecologists. But that hasn’t stopped “experts” like Dr. Angela Lanfranchi, a breast cancer surgeon and anti-choice activist, from giving court testimonies and traveling around the world spreading that brand of misinformation.

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During a Thursday session titled “The Abortion-Breast Cancer Link: The Biological Basis, The Studies, and the Fraud,” Lanfranchi, one of Rewire’s “False Witnesses,” pushed her debunked talking points.

Throughout the presentation, which was attended by Rewire, Lanfranchi argued that there is “widespread fraudulent behavior among scientists and medical organizations to obfuscate the link” between abortion and breast cancer.

In a statement, the irony of which may have been lost on many in the room, Lanfranchi told attendees that sometimes “scientists in the pursuit of truth can be frauds.” Lanfranchi went on to point to numerous studies and texts she claimed supported her theories and lamented that over time, textbooks that had previously suggested a link between abortion and breast cancer in the ’90s were later updated to exclude the claim.

Lanfranchi later pivoted to note her inclusion in Rewire’s “False Witnesses” project, which she deemed an “attack.” 

“We were one of 14 people that were on this site … as liars,” said Lanfranchi as she showed a slide of the webpage. “Now when people Google my name, instead of my practice coming up,” Rewire’s story appears.

Priscilla Coleman, another “False Witness” best known for erroneously claiming that abortion causes mental health problems and drug abuse, similarly bemoaned her inclusion in Rewire’s project during her brief participation in a Thursday session, “The Conspiracy of Silence: Roadblocks to Getting Abortion Facts to the Public.”

After claiming that there is ample evidence that abortion is associated with suicide and eating disorders, Coleman suggested that many media outlets were blocking the truth by not reporting on her findings. When it came to Rewire, Coleman wrote the outlet off as a part of the “extreme left,” telling the room that “if you look deeply into their analysis of each of our backgrounds, a lot of it is lies … it’s bogus information.”

An extensive review conducted by the American Psychological Association in 2008, however, found “no evidence sufficient to support” claims such as Coleman’s that “an observed association between abortion history and mental health was caused by the abortion.”

Rounding out the medical misinformation pushed in that session was Eve Sanchez Silver, the director and founder of the International Coalition of Color for Life. According to the biography listed on her organization’s website, Silver bills herself as a “bioethicist” who focuses on “the Abortion-Breast cancer link.”

Silver, who previously worked at the Susan G. Komen Foundation but left, she said, after finding out the organization gave money to Planned Parenthood, spent much of her presentation arguing that abortion increases the risk of breast cancer. She also detailed what she referred to as the “Pink Money Cycle,” a process in which, as she explained, money is given to Komen, which in turn donates to Planned Parenthood. As Silver told it, Planned Parenthood then gives people abortions, leading to more cases of breast cancer. 

The seemingly conspiracy-driven theory has popped up in several of Silver’s presentations over the years.

Though Komen does in fact provide some funding to Planned Parenthood through grants, a July 2015 press release from the the breast cancer organization explains that it does “not and never [has] funded abortion or reproductive services at Planned Parenthood or any grantee.” Instead, the money Planned Parenthood receives from Komen “pays for breast health outreach and breast screenings for low-income, uninsured or under-insured individuals.”

On Saturday, another subject of Rewire’s “False Witnesses” series, endocrinologist Joel Brind, doubled down on his claims about the link between abortion and breast cancer in a workshop titled “New American Export to Asia: The Cover-Up of the Abortion-Breast Cancer Link.” 

Brind described the Indian subcontinent as the ideal place to study the purported link between abortion and breast cancer. According to Brind, “The typical woman [there] has gotten married as a teenager, started having kids right away, breastfeeds all of them, has lots of them, never smokes, never drinks, what else is she going to get breast cancer from? Nothing.”

When it came to research from Asia that didn’t necessarily support his conclusions about abortion and breast cancerBrind chalked it up to an international cover-up effort, “spearheaded, obviously, by our own National Cancer Institute.”

Although five states require counseling for abortion patients that includes the supposed link between abortion and breast cancer, Brind told Rewire that the link has become “the kind of thing that legislators don’t want to touch” because they would be going “against what all of these medical authorities say.” 

Brind also dedicated a portion of his presentation to promoting the purported cancer-preventing benefits of glycine, which he sells in supplement form through his company, Natural Food Science LLC. 

“If I sprain my ankle it doesn’t swell up, the injury will just heal,” Brind claimed, citing the supposed effects of glycine on inflammation. 

In a Thursday session on “the rise of the DIY abortion”, panelist Randall O’Bannon questioned the U.S. Food and Drug Administration’s (FDA) March update to regulations on mifepristone, a drug also known as RU-486 that is used in medical abortions. Noting that the drug is “cheap,” O’Bannon appeared to fret that the new regulations might make abortion more accessible, going on to claim that there could be “a push to make [the drug] available over the counter.”

O’Bannon claimed there are “documented safety issues” associated with the drug, but the FDA says mifepristone is “safe and effective.” A 2011 post-market study by the agency of those who have used the drug since its approval found that more than 1.5 million women had used it to end a pregnancy in the U.S. Of those women, just roughly 2,200 experienced an “adverse event.” According to the Association of Reproductive Health Professionals, mifepristone “is safer than acetaminophen,” aspirin, and Viagra.

Speculating that misoprostol, another drug used in medication abortions, was less effective than medical experts say, O’Bannon later suggested that more embryos would “survive” abortions, leading to an “increased numbers of births with children with club feet, webbed toes, and fingers [and] full and partial facial paralysis.”

According to the World Health Organization, “Available data regarding a potential risk of fetal abnormality after an unsuccessful medical abortion are limited and inconclusive.”