For years now, the anti-abortion movement has been passing restrictions on abortion in the name of protecting women. Last week we have yet more evidence that this is a feint. But first, we need some background. This past March, the FDA revised its guidelines for using mifepristone, the medical abortion pill. The Los Angeles Times editorial board explained as follows:
The Food and Drug Administration was absolutely right to re-label mifepristone, a drug used to induce abortions, to reflect a regimen already adopted by doctors. The FDA — which hadn’t changed its guidelines on the drug since it was approved for medication-induced abortions in 2000 — now calls for a substantially lower dose of the drug to be administered, and extends the time into pregnancy when it can be used. The agency also now suggests that misoprostol — a second drug used along with mifepristone to complete the abortion process — be taken a day or two later by the woman at home rather than in a doctor’s office. The new guidelines also recommend that qualified healthcare providers, not just doctors, be allowed to dispense the drugs.
That’s the way doctors have been using the drugs for years, saying that the process was safe and efficient and had fewer adverse effects than what the FDA had recommended on the old label. And it is easier for women. The advocacy arm of the American College of Obstetricians and Gynecologists praised the FDA’s change, noting that it aligned with “current available scientific evidence and best practices.”
In other words, the FDA made its recommendations for mifepristone dosage and usage in 2000, but later evidence led doctors to administer the drug slightly differently. Abortion opponents knew that the way the doctors were administering mifepristone made it easier to obtain (extending the period during which it could be used and requiring fewer doctor visits). They urged states to pass laws requiring doctors to follow the FDA recommendations, and a number of states, including Ohio, did just that. Abortion opponents argued that this was about safety, but in practice it was about making abortions harder to obtain.
Well guess what? A study out of Ohio, where a law requiring doctors to follow the FDA recommendations when administering mifepristone went into effect in 2011, found that the statute made abortion less safe.
Ohio law required use of a medication abortion protocol that is associated with a greater need for additional intervention, more visits, more side effects, and higher costs for women relative to the evidence-based protocol. There is no evidence that the change in law led to improved abortion outcomes. Indeed, our findings suggest the opposite.
Here are some of the details:
…the law change was associated with a 9.4% absolute increase in the rate of requiring an additional intervention. … The percentage of women requiring two or more follow-up visits increased from 4.2% in the prelaw period to 6.2% in the postlaw period. … Overall, 12.6% of women reported at least one side effect during their medication abortion: 8.4% in the prelaw period and 15.6% in the postlaw period. …
It turns out that the way doctors were administering the drug was indeed safer than the regimen the FDA recommended. Surprise, surprise. The upside is that now that the FDA has changed its recommendations to reflect the way doctors have been administering the drug for years, Ohio doctors no longer have to follow the out-of-date FDA recommendations. The study itself makes this point as follows:
In March 2016, the FDA-protocol was updated, so Ohio providers may now legally provide current evidence-based protocols. However, this law is still in place and bans physicians from using mifepristone based on any new developments in clinical research as best practices continue to be updated.
Because it’s not about best practices or women’s safety. It’s about taking any steps necessary to prevent women from accessing reproductive healthcare.