TO: Interested Parties
FROM: Ianthe Metzger, Planned Parenthood Federation of America & Planned Parenthood Action Fund
CC: Abby Ledoux, Planned Parenthood Federation of America & Planned Parenthood Action Fund
DATE: March 22, 2022
RE: Legislatures ramp up efforts to restrict medication abortion this session
Medication abortion has been aggressively attacked during this state legislative session. From total bans on medication abortion to bills forcing health care providers to tell their patients medically inaccurate information that could be harmful to their health, 24 states have introduced more than 40 bills against access to medication abortion.
Medication abortion — also known as the “abortion pill” — is the process of taking two medications, mifepristone and misoprostol, to safely and effectively end a pregnancy. It has been used by more than 4 million people in the United States since the U.S. Food & Drug Administration (FDA) approved the brand name Mifeprex more than 20 years ago. Medication abortion, under commonly accepted medical standards, can be used up to 77 days, or 11 weeks, after the first day of someone's last menstrual period. Mifepristone is incredibly safe with a more than 99% safety record. Multiple studies have confirmed that far less than 1% of patients experience serious complications from medication abortion — a number that is significantly lower than those experienced by patients who go through childbirth.
The increased restrictions on medication abortion in states that have long been hostile to sexual and reproductive health and rights comes as no surprise for two main reasons:
- In December 2021, the FDA moved to bring federal law in line with years of scientific evidence and permanently repeal the unnecessary and onerous in-person dispensing requirement for mifepristone. Previously, patients were required to obtain the medication directly from a doctor’s office, hospital, or health center, rather than from a pharmacy or by mail, as is allowed for other equally safe medications. These unnecessary in-person visits are especially burdensome for people living in remote or rural areas.
- According to recent preliminary data from the Guttmacher Institute, as of 2020, medication abortion accounts for the majority (54%) of all abortions in the United States. That number was 39% just three years prior in 2017. While its prevalence has steadily increased, the COVID-19 pandemic likely contributed to this acceleration, because a temporary repeal of the in-person requirement allowed people to access needed abortion services without risking increased exposure to the virus.
Medication abortion has expanded access to reproductive health services and helped ensure that patients are able to make their own private medical decisions. Patients increasingly are seeking this safe and private option that still offers support and information from a health care provider. For many, access to medication abortion is not just a preference, it is critical to their safety and well-being.
Medical experts such as the American College of Obstetricians and Gynecologists and the American Medical Association have enthusiastically supported expanding access to this important option for abortion care. These organizations have acknowledged that there is no medical justification for limiting access to telehealth abortion through unnecessary in-person lab tests or visitation requirements. Also, for the first time ever, the World Health Organization issued updated abortion guidelines this month including recommendations for abortion pills prescribed via telehealth, which the WHO notes has played a large role in maintaining access to care during the COVID-19 pandemic. Members of the House Oversight and Reform Committee also penned a letter to Health and Human Services Secretary Xavier Becerra last week calling for him to protect and expand access to medication abortion.
Despite this overwhelming support from the medical community, some state legislatures have continued to try to ban or otherwise restrict access to medication abortion. These attacks are particularly cruel given the number of abortion restrictions that already exist in many states. For many abortion providers today, it is the only method of abortion they can offer because layers of targeted restrictions have — by design — made it impossible for health centers to comply with the costly and burdensome regulations required for procedural abortion methods in their state. In some states, any move to restrict medication abortion effectively decimates access to safe and legal abortion, which has always been the goal of anti-abortion extremists.
Lawmakers are targeting medication abortion in a number of ways, including:
- Complete bans that outlaw medication abortion entirely, despite mifepristone’s 99% safety record;
- Gestational age bans that fly in the face of science by limiting how far into a pregnancy a patient can use medication abortion;
- Bans on telehealth for medication abortion or at-home delivery via mail that force patients to unnecessarily travel to a health center — and have to navigate child care, transportation, time off work, and other logistics — just to obtain this medication;
- Laws requiring providers to go against their professional oath and lie to their patients by peddling the myth of so-called “abortion reversal,” a dangerous, unethical, and scientifically unproven claim created by anti-abortion rights activists that is not supported by medical evidence and is potentially dangerous for patients;
- Bans on medication abortion in schools or state property, including universities, meant to further stigmatize abortion and limit access to health care;
- Government-mandated waiting periods and ultrasounds and in-person follow-up appointment requirements that offer no health benefit, shame patients, and have a negative effect on patients’ health. Abortion is essential, time-sensitive care. A delay of only a few weeks can make it completely inaccessible. Delays can also increase the cost, which then further delay an abortion as patients struggle to secure the funds;
- Informed consent bills that interfere with the doctor-patient relationship by requiring providers to present medically inaccurate and biased information to their patients;
- State registration and oversight programs requiring all manufacturers, distributors, and providers of medication abortion to register and remained certified by redundant and onerous FDA-like certification programs under the state’s Boards of Pharmacy. These efforts represent unprecedented oversight of a drug regimen with a proven safety record.
- Targeted Restrictions on Abortion Providers (TRAP) laws that require burdensome and medically unnecessary reporting requirements that exist solely to make abortion more difficult to provide.
Medication abortion can be a key tool in making health care more equitable, by increasing abortion access for those who need it most — particularly Black, Latino, and Indigenous communities, people living in rural and medically underserved areas, and people with low incomes. Like other abortion restrictions, burdensome restrictions on medication abortion most harm, and deepen the health inequities experienced by, those who already face the most extensive barriers to accessing fundamental health care. Here are egregious medication abortion bans and restrictions we’ve seen this session:
- South Dakota: South Dakota became the first state this session to pass restrictions on medication abortion. The bill is awaiting Gov. Noem’s signature and would eliminate access to medication abortion in the state. It is modeled after a now-blocked rule from the South Dakota Department of Health, created at the direction of Noem, that would have mandated three unnecessary in-person visits for patients seeking a medication abortion.
- Kentucky: Kentucky lawmakers are working to limit access to medication abortion as part of an anti-abortion omnibus package that includes a myriad of restrictions. The bill would require that the names of all physicians that provide medication abortion be published online; create a state-run “complaint portal” that would allow any member of the public to submit anonymous complaints about abortion providers, opening them up to increased harassment from anti-abortion extremists; create a redundant and onerous FDA-like certification program under the state Board of Pharmacy targeting medication abortion drugs that would require drug manufacturers, distributors, and pharmacies to register and certify with the state; and require that the state promote the fraudulent idea that medication abortion can be reversed. This extensive and harmful piece of legislation, which has already passed the Kentucky House, also targets parental consent requirements and defunding for abortion providers.
- Ohio: A recently introduced bill in Ohio would ban telehealth for medication abortion and require that patients have an in-person visit 24 hours before receiving their medication. It also seeks to place extensive limitations on manufacturers, distributors, and providers of medication abortion pills under a new state-run program operated by the board of pharmacy, similar to the program proposed in the Kentucky omnibus bill.
- South Carolina: Lawmakers are considering bills that direct providers to participate in state-sanctioned deception by sharing medication “abortion reversal” misinformation upon dispensing mifepristone.
- Iowa: There were several bills to restrict medication abortion proposed in the Iowa legislature this session, some of which could still become law. They include restrictions requiring that medication abortion only be dispensed in a health setting or in-person; banning the manufacture, distribution, prescription of abortion pills entirely, labeling it a Class C felony; and requiring a licensed mental health counselor or licensed marital and family therapist to provide information on alternatives to abortion. One of the bills takes informed consent and “abortion reversal” legislation a step further by requiring that facilities that provide medication abortion post a sign in each patient waiting room and patient consultation room with misleading information. Providers must obtain written certification from each patient that they have been informed of “abortion reversal,” share information about the risk of medication abortion, and provide written discharge instructions that include a false statement on so-called “abortion reversal.”
- Tennessee: Tennessee’s proposed legislation would require that medication abortion only be provided in person and would ban provision by mail. The law would also require a 24-hour waiting period before the abortion and an in-person follow-up appointment to be scheduled 14 days afterward; ban the provision of medication abortion at schools; and mandate provision of false information about so-called “abortion reversal” and the overall risks of abortion. Additional reporting requirements would also be imposed on providers.
- Wyoming: Politicians in Wyoming are working to pass a total ban on medication abortion that would ban the manufacture, distribution, prescription, selling, and transfer of mifepristone and misoprostol. If passed, it would go into effect on July 1. Wyoming has already passed a trigger ban for all abortions this session.
- Nebraska: Nebraska legislators proposed a law that would ban the provision of medication abortion via mail and after 49 days, well before the 77 day industry standard or the 70 day FDA label. It would also require the physician providing the abortion to file a report and force all patients to have an in-person examination and a follow-up visit scheduled within 14 days of the abortion. It died last week.
- Georgia: The Georgia state legislature is advancing an omnibus bill full of medication abortion restrictions, including banning provision via mail, requiring that it only be provided by a qualified physician who must perform an in-person exam and be credentialed to handle complication management, banning medication abortion in schools, and including harmful and inaccurate “abortion reversal” language. The bill has passed the state Senate.
Politicians' ongoing attempts to ban or restrict medication abortion are irresponsible, fly in the face of science, and are just another way to push their own political agenda and control people’s lives. People should be able to receive an abortion in the way that works best for their circumstances — whether that is obtaining medication at a health center, picking it up at their local pharmacy, or having it delivered to their home. Planned Parenthood will never stop fighting to ensure that everyone has access to the health care they need and deserve — no matter what.
If you plan to cover medication abortion, would like to connect with a local spokesperson or abortion provider, or have general questions on anti-abortion rights bills moving this legislative session, please reach out to [email protected] or [email protected].