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A Crucial Option

Medication abortion is safe, legal, and capable of revolutionizing reproductive health care.

American women have been using legal medication abortion—an early abortion method that involves taking oral medication rather than having a surgical procedure—for a decade and a half.

In fact, one in four women opt for this method if it is available to her. It’s a safe, non-invasive way to end a pregnancy in a setting where a woman may feel most comfortable.

Yet in recent years, as part of a highly coordinated attack on abortion access, some states have been pushing sham laws to limit the use of medication abortion. Just in 2015, 11 states have introduced 20 bills related to medication abortion. Arkansas alone enacted four restrictions on medication abortion.

“It’s ridiculous,” says Kelly Baden, director of state advocacy at the Center for Reproductive Rights. “These are laws passed under false pretenses by politicians—not doctors—who are doing everything in their power to outlaw abortion altogether. Medication abortion is just one of their many targets, and the result is that it has become harder for a woman who has chosen to end her pregnancy to use this safe method. ”

The medication abortion drug mifepristone was approved by the FDA 15 years ago this month. It has been praised for its excellent safety record (over 99 percent) and for expanding the range of reproductive health options for women. Having options for how to end a pregnancy can be a crucial part of giving woman a better sense of control over her experience and for expanding abortion access.

“The potential for medication abortion to help women access early abortion care even in the face of clinic closures and extremely hostile political environments is part of what makes laws limiting its use so outrageous,” says Baden. “Women in rural areas or for whom getting to a clinic is difficult need to have this safe option kept available to them.

Further, we know that for some women, the opportunity to experience a more private, non-invasive procedure is important to the quality of their overall abortion experience.”

Since mifepristone’s U.S. approval, physicians’ real-world experience has determined a regimen preferable to what was initially approved by the FDA. The existing, outdated FDA label requires a higher dose of medication, which may cause more side effects, and a smaller time frame for use than the evidence shows; medication abortion is now considered safe at least up through nine weeks of pregnancy, rather than at seven weeks as initially indicated.

Opponents of legal abortion have set their sights on the promise of medication abortion and are trying to severely limit its use. Some states have passed laws that prohibit providers from using the most up-to-date, evidence-based regimen for medication abortion. Even more have declared that medication abortion must be administered only by a licensed physician, though there is no medical reason that other kinds of advanced-practice clinicians cannot also dispense mifepristone.

Many states have set out to explicitly exclude abortion access from the burgeoning field of telemedicine, cutting off access to medication abortion for rural women who face barriers to getting to a clinic. These attempts to treat medication abortion differently from other kinds of health care for political reasons have not gone unchallenged.

The Center has been active over the last several years fighting a number of these sham restrictions in the courts. This past year, we were successful in blocking Oklahoma and Arizona’s outdated protocol requirements. We are currently challenging an Arizona law that takes the already outrageous restrictions on medication abortion even further by forcing doctors to give misleading information to patients about the possibility of “reversing” medication abortion.

“Each victory obviously has a huge impact because it allows women to continue to have access to this crucial option for care,” notes Baden. “But the wins also have notable policy implications. A law has to do what it says it does, and the courts’ rulings affirm that we can’t just sit back and take the state’s dishonest word for it that they protecting women’s health.”

Medication abortion restrictions are not the only target of sham laws designed to restrict abortion rights. A number of states have seen the proliferation of unconstitutional pre-viability bans, as well as laws that impose impractical, prohibitive, and medically unwarranted requirements on abortion providers and their practices with the goal of shutting them down.

Not only are these measures deeply disingenuous, they jeopardize women’s health and rights, underscoring the need for federal protections such as Women’s Health Protection Act—proposed legislation that would permanently prohibit states from imposing unconstitutional restrictions on reproductive care providers and block access to safe, legal abortion services.

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