A study published by the Public Library of Science (PLOS) in August
of 2016, suggests that a strict medication abortion law has done more harm than
good. The 2011 Ohio law was passed based
on protocol that was adopted by the US Food and Drug Administration (FDA) in
2000. In order to induce a medication abortion, a woman’s physician will prescribe
her two pills. The first is mifepristone,
followed by misoprostol two days later.
The dosage recommended by the FDA was large enough that both pills had
to be taken at her doctor’s office, and both pills had to be taken before the
woman’s seventh week of pregnancy. The
Ohio law adopted both of these guidelines.
Although greater restrictions appear
to provide more protection for women seeking abortions, the PLOS study found the opposite. The
study evaluated abortion cases before the law passed and after to compare the
differences. The high dosage of
medication within the two pills created a need for women to receive additional medical
care and follow up visits that were not needed before the law passed. Due to the increased nausea and vomiting induced by the pills,
women were three times more likely to need a follow up visit. Additionally, medication abortions performed declined by 80% between 2010 and 2014.
With more office visits and pills
with large doses of medication comes higher costs. The price of medication abortions rose by approximately 16% after the
implementation of Ohio’s new law. Ohio
is not the only state to enact strict abortion laws under the pretext of
improving women’s health. Recently, Texas and North Dakota have both tried to pass stricter
abortion laws. These restrictions also include the requirement of hospital
admitting privileges for the doctor providing the abortion and requirements for
the building the abortions are to be performed in.
After the FDA initially approved
these methods, the research that followed began to show that the same effect
could be achieved with a small dose of both pills. With the lower dose, women would be able to
take the pills at home, which would ultimately lower the number of doctor’s visits,
decrease undesirable side effects and make the medication abortion option
available to women up to the tenth week of pregnancy.
A challenge identified by the PLOS study is the fact that the FDA
approval of best practices does not happen as fast as the development of new
best practice techniques. New techniques
are being discovered and tested all the time, and FDA approval simply cannot
keep up. The study highlights the problem with laws like Ohio’s. Ohio’s law simply states that providers must
follow what the FDA defines as the best practice for the medication abortion
procedure. This means that the way a
provider conducts these practices will depend on the current FDA definition of
best practice. However, this becomes problematic when new, safer advances are
created, yet they have not received FDA approval.
In March of 2016, the FDA updated its definition of best practice
for a medication abortion to reflect the fact that the same outcomes could be
achieved with lower doses of the same drugs.
With the continual updating of best practices, women in states with laws
that mimic Ohio’s will be forced to accept less than the most advanced practices when it
comes to the performance of medication abortions. While the increased restrictions for
medication abortions did not necessarily put these women at risk, they did create additional barriers to women wishing to
undergo this procedure and restricting their access to the health care they
desire.
Ohio’s abortion restriction laws
were enacted for the protection of women, but ended up doing more harm than good. The FDA already provides some level of
consumer protection by evaluating best practices for procedures and
medications, but one agency can only do so much. However, as the PLOS study
found, FDA approved best practices can become outdated and end up doing more
harm than good. Laws like Ohio’s that only indicate compliance with FDA
regulations are likely to be problematic as new research is conducted and new
best practices are developed.
Kathryn Green is currently
a second-year law student at DePaul University College of Law. Ms. Green
graduated from Texas State University with a degree in Healthcare
Administration. She is an active member in the Health Law Institute and will
complete her law degree and certificate in health law in 2018.