EXPLANATION: Medical abortion becomes the last target of the GOP

By IRIS SAMUELS Associated Press / Report for America

Medical abortion accounts for about 40% of all abortions in the United States. It is an option that has become important during the COVID-19 pandemic.

While Republican states strive to restrict access to abortion in general, many also limit access to medical abortions.

Providers say medical abortion is safe and essential, especially as access to clinics in Republican-controlled states becomes more difficult.

Medical abortion has been available in the United States since 2000, when the Food and Drug Administration approved the use of mifepristone.

A medical abortion involves taking mifepristone, waiting 24 to 48 hours, then taking misoprostol. Mifepristone blocks the hormone progesterone, which is essential for maintaining a pregnancy. Misoprostol empties the uterus causing cramping and bleeding.

The drugs are approved for use by the FDA up to 10 weeks gestation.
The method is considered by healthcare professionals to be very effective and safe, with terminations of pregnancy in over 95% of cases and serious complications in 0.4% of cases.

According to the FDA, 3.7 million women had medical abortion between 2000 and 2018. During this period, 24 women died after taking mifepristone.

The popularity of the method has continued to grow. The Guttmacher Institute, a research organization that supports the right to abortion, estimates that it accounts for about 40% of all abortions in the United States and 60% of those that take place up to 10 weeks gestation.

Abortion rights advocates say the pandemic has demonstrated the value of virtually provided medical care, including the privacy and convenience of abortion that takes place at a woman’s home, instead of a clinic .

Adding to its appeal: Clinics are rare in several states where Republicans have passed strict laws restricting access. Mississippi, Missouri, North Dakota, South Dakota, and West Virginia are states that only have one abortion clinic.

Abortion providers say that as access to clinics becomes more difficult, medical abortion can allow women to have an abortion without having to travel, which can be particularly difficult and costly for low-income women.

Opponents of abortion, fearing that medical abortion will become more prevalent, are pushing legislation in Republican-ruled states to limit access to drugs.

States have adopted several measures to limit its availability. These include banning the delivery of abortion pills by mail, shortening the 10-week window during which the method is allowed, and forcing women to take the pills at a clinic rather than at home.

Some states also require doctors to tell women who have medical abortions that the process can be reversed halfway, a claim according to critics that is unsupported by science.

In 33 states, only doctors are licensed to provide abortion pills. In 17 states and the District of Columbia, they can be delivered by advanced practice clinicians.

Clinicians providing the drug must be physically present when it is administered in 19 states, which means patients with abortions cannot take the drugs at home.

The Republican governors of Arkansas, Arizona, Montana, Oklahoma and Texas this year signed laws banning the delivery of abortion drugs by mail. These laws were widely seen as a response to the rise in popularity of telemedicine during the pandemic.

Laws face legal challenges in Montana and Oklahoma. In Ohio, a judge temporarily blocked a law that would have banned the use of telemedicine for abortion pills while a court challenge is pending.

Some Republican legislatures also impose limits on the time of pregnancy when medical abortion can be performed. In Indiana and Montana, laws passed this year ban the drug after 10 weeks gestation, and in Texas, a newly signed law bans the drug after seven weeks.

Texas law is expected to come into effect in December. It happened just as Texas began to ban almost all abortions under a more ambitious law, known as Senate Bill 8, which became the biggest curb on abortion in the world. country in half a century.

Eight states require counseling to promote the idea that medical abortion can be reversed with a high dose of progesterone after taking mifepristone.

The American College of Obstetricians and Gynecologists does not support the prescription of progesterone for this use and states that the reversal claim is not based on scientific evidence.

Such laws are in effect in Arkansas, Idaho, Kentucky, Louisiana, Nebraska, South Dakota, Utah, and West Virginia. Court cases in Indiana, North Dakota, Oklahoma and Tennessee have blocked enforcement of these counseling requirements. In Montana, the law is due to go into effect Oct. 1 but is being challenged in court.

At the onset of the coronavirus pandemic, the Food and Drug Administration – under a federal court order – relaxed restrictions on abortion pills so they could be mailed.

But the FDA and its parent health agency, under the Trump administration, then argued that the rules were necessary to ensure the pills were used safely. The rule requires patients to take the only mifepristone tablet in a hospital, clinic, or doctor’s office and sign a form with information about the drug’s potential risks.

The association of obstetricians and gynecologists has filed a lawsuit to overturn the rule, triggering a series of conflicting court rulings.

Last April, the FDA again asserted that women seeking an abortion pill would not be required to visit a doctor during the COVID-19 pandemic. The policy change only applies in states where there are no laws prohibiting the use of telemedicine or requiring the presence of a physician when medications are taken.

FDA policy also only applies for as long as the COVID-19 health emergency lasts. Several medical organizations are pushing for medical abortion to be permanently available through online prescription and mail order pharmacies.

Aid Access is one of several online initiatives that offer to mail abortion pills to women. It is headed by Dr Rebecca Gomperts, a Dutch doctor.

The FDA, then under the Trump administration, sent a letter to Aid Access over two years ago asking it to cease operations, but the online drug supplier continued to send abortion pills to female patients in the United States. United.

The legality of the practice is ambiguous, but groups such as Plan C, which aims to raise awareness about self-administered abortions, provide information on where and how the drugs can be obtained online.

These groups say such access is especially important for women in places where abortion clinics are constantly attacked by abortion advocates and where lawmakers and governors are making it progressively more difficult to maintain clinics.

If / When / How, a reproductive rights legal aid group, has followed 24 cases since 2000 when women were prosecuted for self-administered abortions.

“It is possible that someone will be targeted for investigation, arrest or prosecution, even in the absence of a law that makes it truly illegal,” said Sara Ainsworth, group policy director.

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