A large new study in the journal Contraception effectively debunks the rationale for passing restrictions on abortion-inducing pills, a legislative trend that often slips under the radar but that threatens to make it all the way up to the Supreme Court. In light of the findings, the lead researchers conclude that “politics should never trump science.”
The new research, which tracked more than 13,000 women’s medication abortions at Planned Parenthood health centers in Los Angeles over a five-year period, confirms that an off-label regimen for providing medication abortion is very safe. That finding stands in direct contrast to an increasing number of state laws that specifically prevent doctors from prescribing this effective regimen — legislation that is misleadingly framed in terms of women’s “health and safety.”
“It’s very unsettling that politicians are trying to dictate medical practice,” Deborah L. Nucatola, one of the lead researchers who worked on the new study, told ThinkProgress. “In some states, the laws basically prevent health care providers from doing the best for their patients around medication abortion.”
Right now, there are two different ways to have a legal abortion in the United States. Women can have a surgical procedure that’s performed in a clinic by an abortion provider. Or, during the first trimester of pregnancy, women can opt for a less invasive procedure that involves taking two rounds of medication to induce an abortion.
As states pass a mounting number of abortion restrictions intended to curtail women’s access to the procedure, they’ve attacked it from both angles. Driven by the right-wing group Americans United for Life (AUL), which writes draft legislation for anti-choice laws and shops it around to conservative lawmakers, 16 states have adopted some type of restrictions on the way doctors may administer the abortion pill.
Some of those states require a doctor to be physically present for both rounds of medication, forcing women to make additional and unnecessary trips to the clinic. Others have specifically attempted to ban doctors from using the regimen that’s the subject of the new Contraception study. Instead, those states have mandated that doctors must follow the current FDA protocol for administering medication abortion.
Upon first glance, that seems logical enough — you might assume that the FDA guidelines are in place for a reason, and doctors should be paying attention to the agency’s recommendations in order to keep their patients safe, for instance. But, as the new study demonstrates, it’s not exactly that straightforward.
The guidelines for administering abortion-inducing medications — known as mifepristone and misoprostol — were released back in 2000, and doctors say they’re now extremely outdated. Over the past 15 years, the best practices have evolved past the FDA’s old protocol, and doctors now know that pregnant women can safely take a lower dosage of medication to achieve the same outcome. A lower dosage ensures the pills are cheaper and women can take the second round of medication from the comfort of their own homes. As far back as 2001, more than 80 percent of providers were no longer using the FDA-approved protocol for medication abortion.
This isn’t unusual in the medical field. The way a medication is administered often evolves to what’s called “evidence-based protocol,” which means that doctors prescribe drugs based on the best practices in the field rather than following what’s technically written on the label. That’s partly because drug manufacturers don’t usually go through the costly and time-consuming process of updating the official FDA protocol for their products.
“It’s very rare for a pharmaceutical company to go back to the FDA to ask for a new label when they know that health care providers are going to use the best evidence,” Nucatola said. “This is one reason that evidence-based protocols are so common and accepted in medicine.” She added that there’s now been “more than 10 years of time and research” resulting in better medication abortion care.
But it’s not hard to see why this is an incredibly effective framework for abortion opponents. The facts regarding the abortion pill, the FDA’s protocol, and the evolving medical practice in this area are complicated. It’s much easier to make the case that women need common sense regulations to keep them safe.
Particularly as the number of patients who opt for the abortion pill has been on the rise — in 2008, an estimated 25 percent of abortions were performed with medication, and evidence from around the country suggests those numbers have only increased since then — some experts see this conflict as one of the next big battlegrounds over abortion access.
“I think governors and legislatures know they can’t outlaw medication abortions in their state, but they know they can restrict them,” Kelly Cleland, a researcher at Princeton University who has conducted similar studies into the abortion pill, explained to the Wisconsin Center for Investigative Journalism in 2013, after that state passed harsh regulations on the abortion pill. “Sometimes they state it overtly and sometimes it’s masked behind arguments that they’re trying to make it safer for women.”
Legal challenges against these restrictions have been inching their way toward the nation’s highest courts. Just last month, the U.S. Supreme Court declined to review a case involving a medication abortion restriction in Arizona. Similar lawsuits have come before the Oklahoma and North Dakota Supreme Courts, and depending on the ultimate resolutions of those cases, it’s possible that this question over FDA protocol could land in front of the country’s top justices.
Although the new study provides important evidence confirming that there’s no good reason for state lawmakers to target medication abortion, its findings are not necessarily revolutionary. Based on the existing evidence in the field, major medical groups like the American College of Obstetricians and Gynecologists already oppose the outdated FDA protocol for abortion-inducing pills.
Nonetheless, scientific evidence doesn’t necessarily do much to persuade abortion opponents. Several large studies, for instance, have confirmed that abortion is extremely safe — but state lawmakers continue to pass restrictions based on the assumption that abortion doctors are somehow putting their patients at risk.