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‘No Surprise’: Congressional Republicans Go After Medication Abortion

Casey Quinlan

Reproductive health experts say that a recent federal bill is part of a strategy of heightened attacks on medication abortion.

U.S. House Rep. Robert Latta (R-OH) recently introduced a bill that falsely characterizes medication abortion as dangerous and in need of more regulation.

Reproductive health experts say the bill is yet another example of pushback to a method of abortion that is threatening the anti-choice movement. Latta’s push to stigmatize and create more regulations for medication abortion care comes as lawmakers in four states have enacted counseling requirements that spread misinformation about medication abortion, which constituted nearly 40 percent of abortions in the United States in 2017.

Last month, Latta introduced HR 4399, the Support and Value Expectant Moms and Babies Act of 2019, with 37 Republican co-sponsors. The legislation would prevent the use of telemedicine or mail for medication abortion, prevent the Food and Drug Administration (FDA) from approving new medication abortion drugs, and prevent labeling changes for already approved drugs.

Latta in a statement criticized those advocating for over-the-counter use of medication abortion pills, citing “the safety and health of women across this country” as the reason for his anti-choice legislation—a common refrain from lawmakers who oppose abortion rights.

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Medication abortion, which consists of taking two pills, mifepristone and misoprostol, is commonly used for abortion at or under ten weeks after the first day of a person’s last period. It has been available in the United States since 2000. Serious complications from medication abortion are rare and “safety and quality are enhanced when the abortion is performed as early in pregnancy as possible,” according to a 2018 report from the National Academies of Sciences, Engineering, and Medicine. The report found that medically unnecessary regulations to abortion care create barriers to safe and effective care.

Despite its 19-year safety record, abortion opponents have continued to push misinformation about medication abortion being unsafe and about an unproven abortion reversal method for medication abortion. Experts on reproductive health say that this federal bill is part of a strategy of heightened attacks on this method of abortion.

“It has transformed the landscape of abortion care and is increasingly on the rise,” said Megan Donovan, senior policy manager at the Guttmacher Institute, a reproductive and health research and advocacy group. “It almost comes as no surprise that anti-abortion policymakers are seizing upon and focusing on medication abortion as one kind of abortion that they want to continue restricting. It’s all part of a strategy to limit those access points for people who don’t want to be pregnant.”

Medication abortion accounted for 39 percent of all U.S. abortions in 2017 and that same year, the number of early medication abortions provided in clinical settings increased 25 percent from 2014.

The ability to expand access to abortion through this method due its convenience is another reason abortion opponents have focused on restricting medication abortion, Donovan said.

“Medication abortion is a simple safe and effective method that can be completed in a location of one’s choosing—at home for example. Despite onerous restrictions, it is provided via telemedicine in a number of states, and that allows abortion providers to expand access to otherwise underserved areas,” she said. “So even in midst of years of restrictions that end up shutting down clinics and exacerbating gaps in services around the country, medication abortion is one method that allows providers to serve a wider area.”

Restrictions on medication abortion fall hardest on people with low incomes, people of color, young people, and people who live in rural areas, Donovan added.

Around half of U.S. counties didn’t have an obstetrician-gynecologist in 2010, according to a 2017 report from the American Congress of Obstetricians and Gynecologists. Under typical telemedicine methods for medication abortion, a patient who wants medication abortion speaks to a clinician through a video conference and they consider the patient’s health records, answer the patient’s questions and then authorize the medication remotely.

Republican-majority legislatures in Kentucky, Nebraska, Oklahoma, and North Dakota have enacted a counseling requirement this year to require, as part of pre-abortion counseling, health-care providers to falsely tell patients that it’s possible to reverse a medication abortion. Arkansas Republicans passed a law in March that required abortion providers to notify patients in writing of abortion reversal in addition to the state’s counseling requirement passed in 2015. This so-called reversal, according to the University of California, San Francisco’s research group Advancing New Standards in Reproductive Health (ANHSR), is an experimental treatment that involves doses of progesterone. But according to ANHSR, “there is no evidence that progesterone treatment increases the chance of the pregnancy continuing.”

Anti-choice groups and activists continue to push misinformation about so-called abortion reversal as they encourage flooding the FDA with adverse effects claims. The website abortiondrugfacts.com has a section devoted to abortion reversal as well as a section called “Tell Your Story” asking people to share their stories about medication abortion with the FDA. The Charlotte Lozier Institute, which collects and discloses the information, is the “research” branch of the anti-choice group Susan B. Anthony List, which seeks to end legal abortion in the United States.

Thirty-four states require that clinicians who perform medication abortion be physicians and 18 states require that clinicians providing this abortion method be physically present as the procedure happens, eliminating the use of telemedicine that would help many underserved communities, according to the Guttmacher Institute.

“Someone like a nurse practitioner or other advanced clinician are equipped to do that in their professional capacities,” Ashley Gray, state advocacy adviser at the Center for Reproductive Rights, said. “Restricting medication abortion is just another way to essentially ban it or push it out of reach entirely for people who can’t access it … So as more and more states are passing these restrictions prohibiting telemedicine in these ways, they are essentially banning abortion for those people living in those rural regions.”

Gray added that despite the FDA updating its protocols on medication abortion in 2016, North Dakota, Ohio, and Texas still require the provision to be in accordance with outdated FDA protocol. Arkansas and Oklahoma enacted laws that required the outdated protocol. One of those changes involved a change in eligibility for medication abortion from 49 days’ to 70 days’ gestation, which dramatically increased the proportion of all abortions eligible for medication abortion.

Gray said that Latta, the sponsor of the congressional bill introduced last month, is using the legislation to spread misinformation about the safety of medication abortion.

“The real reason for introducing laws like this federal one is to further stigmatize and spread misinformation about abortion generally and it’s very telling that anti-abortion groups would rather pass bills that prevent further research on critical health care people need to access instead of making that health care more available, affordable, and easier to obtain,” she said.

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