South Dakota imposes new restrictions on medical abortions


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Current state law allows the medical abortion process to begin 72 hours “after the doctor has met the pregnant mother physically and personally”, except in a medical emergency, and usually only required an additional visit. in an approved establishment to receive the drugs necessary to treat it.

The rule means South Dakota will be the first state to require a visit to obtain misoprostol, according to Elizabeth Nash, state policy analyst at the Guttmacher Institute.

A medical abortion, also called a medical abortion, is a nonsurgical procedure that is effective until around 10 weeks of pregnancy. This involves taking mifepristone and misoprostol one or two days apart.

Usually, women are given both drugs at the same visit to their doctor or clinic. They take the mifepristone pill at the clinic and have to take the misoprostol pill at home a day or two later.

Under the new regulations, women in South Dakota will now have to go to an approved abortion center four times for a medical abortion.

The rule comes after the Biden administration temporarily relaxed federal medical abortion regulations in April, removing the requirement that mifepristone be dispensed in person during the Covid-19 pandemic.

The move prompted South Dakota and other conservative states to take action against the federal government.

South Dakota Gov. Kristi Noem, a Republican, signed an executive order in September ordering the state’s Department of Health to write rules to ensure that drugs distributed in the state cannot be mailed , among other restrictions.
In December, the FDA permanently lifted the requirement that the first drug be dispensed in person, allowing the pills to be mailed instead. The agency has also started requiring pharmacies that dispense the drug to be certified.

After a public hearing last month and a committee hearing that resumed Thursday, the Republican-majority Interim Rules Review Committee of the South Dakota Legislature voted to pass the rule requiring the in-person distribution of both drugs.

Current South Dakota law requires physicians to obtain “voluntary and informed written consent” from a pregnant woman for an abortion, except for medical emergencies.

Under the new rule, three days after a pregnant woman has given informed consent for a medical abortion, the woman can return to the clinic to receive the first drug, mifepristone. She is not allowed to take the drugs until nine weeks after conception.

But before dispensing the drug, according to the new regulations, a doctor must inform the woman that if she changes her mind and decides to carry the baby to term, it is possible to reverse the effects of mifepristone.

If she is taking this medication, she must wait 24 to 72 hours later and return to the clinic for a third time to have the second medication, misoprostol, delivered in person.

The abortion center staff should then schedule a follow-up appointment with the woman for 14 days after taking the drug.

The abortion facility should also monitor the patient and report to the Ministry of Health any complications requiring medical follow-up, what follow-up care was required, the facility where the follow-up appointment took place and whether the woman pregnant was sexually trafficked.

Ali Tornow, an attorney for the Department of Health, argued during Thursday’s hearing that “the purpose of this rule is to protect the health and safety of women in South Dakota by requiring the in-person delivery of both medications”.

Other supporters of the rule, including several doctors in South Dakota, have testified that cutting in-person visits could lead to life-threatening health complications for pregnant women.

North Central States of Planned Parenthood and the American Civil Liberties Union of South Dakota have criticized the new regulations, saying it mandates another “unnecessary” visit to the clinic.

Dr Sarah Traxler, chief medical officer of Planned Parenthood North Central States, said in Thursday’s hearing that the rule was “not medically necessary” and could instead prevent women “from taking the second drug, exposing them to thus at an increased risk “.

Traxler argued that for patients who spend hours driving to the clinic, additional travel is an “insurmountable barrier to care” and for some women, “the unpredictability of daily life can ultimately prevent patients to return to the clinic to receive the misoprostol. . “

Jett Jonelis, the South Dakota ACLU’s advocacy officer, said in a statement provided to CNN that warrants like South Dakota’s “represent dangerous political interference and compromise patient care and safety.”

“These restrictions violate patients’ rights to liberty, privacy and equal protection as guaranteed by the US Constitution by imposing significant burdens on access to abortion without proof of a valid medical justification.” , said Jonelis.

The American College of Obstetricians and Gynecologists (ACOG) and several other medical associations have advocated for the removal of federal restrictions on how drugs are administered.

The restrictions “do not make care safer, are not based on medical evidence or need, and create barriers to clinicians and patients’ access to medical abortion,” ACOG says on its website Web.

But “the limited available evidence suggests that using mifepristone alone without subsequent administration of misoprostol may be associated with an increased risk of bleeding,” the group said.

According to data collected by the FDA since the drug’s approval in 2000, of the 4.9 million women who took mifepristone for a medical abortion, 26 have died, a death rate of less than 0.0001%. .

The governor decides to make the new rule permanent

Noem “plans to work with the South Dakota legislature to make these and other protocols permanent,” his office said in a press release. The next session starts on Tuesday.

“I look forward to the day when the life of every unborn child is protected in South Dakota,” the governor said in a statement.

South Dakota has a number of restrictions on access to abortion, including a ban on abortion after 22 weeks of pregnancy, with a few exceptions.

It is also one of 19 states that require a doctor performing a medical abortion to be physically present during it, effectively prohibiting telemedicine from prescribing abortion medications, according to the Guttmacher Institute.

CNN’s Jen Christensen and Tierney Sneed contributed to this report.

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