Off the Kuff Rotating Header Image

mifepristone

Another story about the chaos that has been unleashed by banning abortion

There will be more to come for as long as this situation remains.

A sexual assault survivor chooses sterilization so that if she is ever attacked again, she won’t be forced to give birth to a rapist’s baby. An obstetrician delays inducing a miscarriage until a woman with severe pregnancy complications seems “sick enough.” A lupus patient must stop taking medication that controls her illness because it can also cause miscarriages.

Abortion restrictions in a number of states and the Supreme Court’s decision to overturn Roe vs. Wade are having profound repercussions in reproductive medicine as well as in other areas of medical care.

“For physicians and patients alike, this is a frightening and fraught time, with new, unprecedented concerns about data privacy, access to contraception, and even when to begin lifesaving care,” said Dr. Jack Resneck, president of the American Medical Association.

In the past week, an Ohio abortion clinic received calls from two women with ectopic pregnancies — when an embryo grows outside the uterus and can’t be saved — who said their doctors wouldn’t treat them. Ectopic pregnancies often become life-threatening emergencies and abortion clinics aren’t set up to treat them.

It’s just one example of “the horrible downstream effects of criminalizing abortion care,’’ said Dr. Catherine Romanos, who works at the Dayton clinic.

Dr. Jessian Munoz, an OB-GYN in San Antonio, Texas, who treats high-risk pregnancies, said medical decisions used to be clear cut.

“It was like, the mom’s life is in danger, we must evacuate the uterus by whatever means that may be,” he said. “Whether it’s surgical or medical — that’s the treatment.”

Now, he said, doctors whose patients develop pregnancy complications are struggling to determine whether a woman is “sick enough” to justify an abortion.

With the fall of Roe vs. Wade, “the art of medicine is lost and actually has been replaced by fear,” Munoz said.

Munoz said he faced an awful predicament with a recent patient who had started to miscarry and developed a dangerous womb infection. The fetus still had signs of a heartbeat, so an immediate abortion — the usual standard of care — would have been illegal under Texas law.

“We physically watched her get sicker and sicker and sicker” until the fetal heartbeat stopped the next day, “and then we could intervene,” he said. The patient developed complications, required surgery, lost multiple liters of blood and had to be put on a breathing machine “all because we were essentially 24 hours behind.”

In a study published this month in the American Journal of Obstetrics and Gynecology, doctors at two Texas hospitals cited the cases of 28 women less than 23 weeks pregnant who were treated for dangerous pregnancies.

The doctors noted that all of the women had recommended abortions delayed by nine days because fetal heart activity was detected. Of those, nearly 60% developed severe complications — nearly double the number of complications experienced by patients in other states who had immediate therapeutic abortions. Of eight live births among the Texas cases, seven died within hours. The eighth, born at 24 weeks, had severe complications including brain bleeding, a heart defect, lung disease and intestinal and liver problems.

[…]

Becky Schwarz, of Tysons Corner, Virginia, found herself unexpectedly thrust into the abortion controversy even though she has no plans to become pregnant.

The 27-year-old has lupus, an autoimmune disease that can cause the body to attack tissue surrounding joints and organs, leading to inflammation and often debilitating symptoms. For Schwarz, these include bone and joint pain, and difficulty standing for long periods of time.

She recently received a notice from her doctor saying she’d have to stop taking a medication that relieves her symptoms — at least while the office reviewed its policies for methotrexate in light of the Supreme Court ruling. That’s because the drug can cause miscarriages and theoretically could be used in an attempt to induce an abortion.

“For me to have to be essentially babysat by some policy, rather than being trusted about how I handle my own body … has made me angry,” she said.

The Arthritis Foundation and American College of Rheumatology have both issued statements of concern about patients’ access to the drug. Steven Schultz of the Arthritis Foundation said the group is working to determine how widespread the problem is. Patients having trouble getting the medication can contact the group’s helpline, he said.

I mean, what is there to say? This is all a feature and not a bug. The collateral damage to literally everyone else is of no concern to the forced birth fanatics. It’s time for doctors and other medical professionals who don’t want the state meddling in their ability to treat patients to vote and organize like it. Passing some federal laws if the next election allows for a continued Democratic majority in the House and enough anti-filibuster Senators to actually do something will help, but the chaos will continue until there’s also some action taken to mitigate the damage of 20 years’ worth of Federalist Society judges legislating from the bench. We’ve got a lot of work to do, and it’s going to be bad until we can get it done.

The coming fight over medical abortion

Sure is a good thing SCOTUS will leave this up to the states, isn’t it?

Republican-led states are moving swiftly to restrict access to medication abortion.

The efforts so far have focused on regulations around the pills, such as banning them from being shipped or prescribed. But can states ban the actual abortion pill itself, even though the Food and Drug Administration has approved it? That question could be the next frontier in the abortion wars.

The short answer comes down to this: The issue isn’t settled law and will likely be litigated in the courts. Some argue states may be hard-pressed to ban the federally approved medication, though antiabortion advocates disagree.

[…]

Some states have introduced bills focused on banning abortion pills, but they haven’t gotten a lot of traction, per Elizabeth Nash, an interim associate director at Guttmacher Institute, a research group that supports abortion rights. (A recent exception is Oklahoma, whose Republican governor is poised to sign legislation banning abortions – including medication abortions – from the moment of “fertilization.”)

Rather, states are banning the practice of medicine around the pills. For instance: At least 19 states ban the use of telehealth for medication abortion, and some states have additional restrictions, like prohibiting pills from being mailed.

Yet, if Roe v. Wade is overturned, some states may try to ban the actual medication. And states already have gestational limits and other abortion bans on the books that could kick in quickly if Roe is overturned — and those likely encompass limitations on the pills, experts said.

Can states ban a medication the FDA has signed off on?

There’s no clear precedent here.

Some states may argue they can ban medication abortion because states have the authority to regulate the practice of medicine. The FDA, on the other hand, is the acknowledged authority on medical products, such as the abortion pill. But the line between medical practice and medical products is not always clear.

And if a state squared off against the federal government over an FDA-approved drug … “We don’t know how the court would rule. It’s an open question,” Patti Zettler, an associate professor of law at Ohio State University and former associate chief counsel in the FDA’s Office of the Chief Counsel.

See here for some background. Reminder #1: The state of Texas has made it a felony to provide abortion medication after seven weeks, after having already banned anyone but doctors from dispensing such medication, and only via an in-person office visit – no telemedicine. You can be sure that Texas will take this to the next level in the next legislative session if it is in position to do so.

Reminder #2: The same medicine that is used for abortion is also used to treat miscarriages. Needless to say, women who are suffering through a miscarriage will face – and as that story notes, are already facing – barriers to medical care that could threaten their health, their future ability to get pregnant and carry a child to term, and even their lives. That’s our future, and if you think I’m being alarmist, go back and read all those soothing articles about how this Supreme Court was never ever going to overturn Roe v Wade because it would cause too much upheaval.

More people are choosing the medical abortion option

It’s not like there are good alternatives right now in Texas.

The demand for abortion-inducing medication spiked in the month after Texas significantly limited abortion access and has remained high since, according to new data from a researcher at the University of Texas at Austin.

The study reviewed requests for abortion-inducing medication made to Aid Access, an international nonprofit that provides the medication via the internet to people who cannot otherwise legally access the procedure. Prior to September 2021, the organization typically received an average of 10.8 requests a day from Texans.

Then, the Texas Legislature passed Senate Bill 8, which prohibits abortions after about six weeks of pregnancy, a point at which many people do not know they are pregnant. In the first week after the law went into effect on Sept. 1, Aid Access received an average of 137.7 daily requests from Texas, an increase of over 1000%.

“That big of a spike in requests shows us the uncertainty and chaos created by Senate Bill 8 going into effect,” said Abigail Aiken, the lead researcher on the study. “If it’s not certain that you can go to a clinic and get the care that you need, people will be looking around for what other options they have.”

The demand for the medication has remained higher than normal in the months since, Aiken found.

Medical abortion is typically a two-drug regimen of mifepristone and misoprostol that has been shown to be effective at terminating a pregnancy through the first 10 weeks of pregnancy. In December, the federal government lifted a requirement that the medication be dispensed in person, allowing it to be prescribed by telemedicine and sent through the mail.

But Texas law does not allow the medication to be prescribed through telemedicine or mailed and has limited its use to the first seven weeks of pregnancy.

[…]

Aiken, the researcher behind the study, said it’s impossible to know how and when patients use the medication they access through Aid Access — or how many patients are terminating pregnancies through other means.

But as the U.S. Supreme Court considers whether to overturn the constitutional protection for abortion, Aiken said this Texas data serves as a snapshot of what whole swaths of the country may be facing.

“It’s clear from this research and many studies that just because you make abortion harder to get, it doesn’t mean the need for abortion goes away,” she said. “And many people, they will look for other ways of doing that.”

See here and here for some background. The forced-birth contingent is of course not happy with this and murmuring about ways to pursue “legal action” against international and out of state groups like Aid Access. Not sure how they could do that without being extremely invasive, but I have no doubt that such a thought does not bother them at all. On the assumption that SCOTUS is going to gut Roe v Wade in some significant way, the main question is whether people will mostly still be able to get abortion pills freely, or whether they will have to rely on more evasive options. Both seem very much in play. The Chron has more.

FDA lifts restrictions on medical abortion

Long overdue

The Biden administration on Thursday ended a long-standing restriction on a medication used to terminate early stage pregnancies, even as politicians across the United States intensified efforts that represent the most serious challenge to abortion rights in decades.

The elimination of the rule by the Food and Drug Administration means abortion pills can be prescribed through telehealth consultations with providers and mailed to patients in states where permitted by law. Previously, the pills could not be mailed, though that regulation had been temporarily suspended by the FDA.

In large swaths of the nation, however, strict state rules will dampen the impact. Several states ban sending abortion pills by mail and impose other restrictions.

The medication, mifepristone, was approved by the FDA in 2000 for what’s known as medication abortion. It is used with a second drug, misoprostol. The FDA required patients to pick up mifepristone in person at a hospital, clinic or medical office. There is no FDA requirement that the medication, also known as RU-486, be taken in a clinical setting, and most patients take it at home.

In April, the FDA waived the in-person dispensing requirement during the pandemic, saying research showed the action did not raise “serious safety concerns.” It then launched a scientific review to see whether restrictions on mifepristone should be lifted permanently, with Thursday as the deadline.

The agency, writing to a medical group that had sued the FDA over the rule, said it was dropping the in-person dispensing requirement “to minimize the burden on the health care delivery system” and “to ensure that the benefits of the drug outweigh the risks.” The FDA did not give an effective date for the change.

[…]

Loosening the federal restrictions will not change abortion access in many states with stricter regulations on the pills. Nineteen states have banned receiving the drugs through telehealth appointments, making the relaxed FDA rules irrelevant in places including Alabama, Arizona and Missouri. Some states impose other limitations on medication abortion, including allowing only physicians to prescribe the drug and mandating that patients take the pills under a doctor’s supervision rather than at home.

As federal officials have moved to ease restrictions on the drug, many states have tightened access. At least 16 states have proposed new restrictions on medication abortions this year, said Elizabeth Nash, state policy analyst for the Guttmacher Institute.

“State legislatures have been watching very carefully what happens at the federal level,” Nash said.

The highest-profile limitations were enacted in Texas, where lawmakers made it a felony to provide abortion pills after seven weeks of pregnancy and outlawed sending the drugs through the mail. Texas also banned nearly all abortion within the state by making any form of abortion illegal after about six weeks of pregnancy, though that law is being challenged in the courts.

The differing rules have the potential to widen disparities in abortion access, Nash said.

“Access looks very different depending on where you live,” Nash said. “Abortion access will continue to be very limited in states in the South, in the Plains and in the Midwest, and more accessible in states along the West Coast and the Northeast. … That’s problematic in and of itself, and could become an even bigger divide.”

Yeah, it sure is an issue here in Texas. The main question I have is how effectively will Texas be able to enforce its restrictions. It seems to me that there will be a lot of effort put into avoidance, and as such the only way to really make that law work as intended is to be pretty darned invasive. I don’t know how that will work.

Restrictive state laws are spurring an increase in some areas of what’s known as “self-managed abortions” in which patients buy illegal medication on the Internet and terminate pregnancies without interacting with the health-care system.

While some see this as a dangerous trend, others say the situation is sharply improved from decades earlier — because of the abortion pills.

Abigail Aiken, assistant professor of public affairs at the University of Texas at Austin, said she is often asked whether the country is headed to “back-alley abortions and infections” if Roe v. Wade is struck down.

“One of the things we have that we didn’t have in the ’60s and ’70s is access to abortion pills that are very safe, very effective if you have the right instructions,” Aiken said. “Self management is a safety net. And it’s also an ability to take your health care into your own hands when the state legislature is trying to block access.”

That sounds logical to me. And it should be known, this way around the law has been in use for some time. Again, the question to me is how vigorously Texas will try to crack down on that, and how heavy-handed such enforcement will be. I feel very confident saying that the zealots who pushed the bounty hunter law will not be satisfied by anything other than an all-out crackdown, whatever the consequences. If you think I’m being alarmist, look at where we are now and tell me honestly it’s not far worse than you thought it would be. The 19th and Mother Jones have more.

By the way, medical abortion is now more tightly restricted in Texas, too

Another piece of crap from the special session.

Misoprostol

A new law limiting the use of abortion-inducing medication in Texas goes into effect Thursday.

The law makes it a felony to provide the medication after seven weeks of pregnancy, putting Texas at odds with federal regulations. It also makes it a crime to send the medication through the mail.

Medical abortion is the most common way women in Texas terminate their pregnancies, according to state data.

These new restrictions reflect a growing concern among abortion opponents about the rise of “self-managed” abortions, in which pregnant people obtain the medications from out-of-state or international providers, with or without a prescription.

There’s evidence that more women turn to self-managed abortions when legal abortion is restricted. Texans have been unable to access abortions after about six weeks of pregnancy since Sept. 1, when a controversial new ban went into effect.

“Texas is looking at the ways that people are navigating around restrictions and trying to essentially make that as unsafe and as frightening for people as possible in order to deter them,” said Farah Diaz-Tello, senior legal counsel for If/When/How, a reproductive justice legal group.

Diaz-Tello and other advocates worry that the new criminal penalties may make pregnant Texans fearful of seeking medical care after a self-managed abortion.

[…]

Texas’ new law also specifies that no one may provide abortion medication “by courier, delivery or mail service.”

Texas already required the medication to be provided by a physician in person. But this specific clause addresses a growing concern among abortion opponents that patients are trying to circumvent the required doctor visit by getting the drugs by mail, especially with the state’s new restrictions that bans abortions after around six weeks.

Called a “self-managed abortion,” this usually entails ordering abortion-inducing drugs online, with or without a prescription, from doctors, pharmacies and other providers out of state or overseas.

The FDA has attempted to crack down on some providers, including AidAccess, a group founded in 2018 by Dr. Rebecca Gomperts, a European doctor. AidAccess provides abortion-inducing medications to women in areas that have restricted access to the procedure.

Gomperts has said she will continue prescribing to patients in Texas. She told CBS News in September that she believes she is on solid legal ground since it is legal to prescribe this medication where she is based.

See here for the backgroun; I didn’t blog it at the time for whatever the reason. A bit more than half of all abortions in Texas are medical abortions, which the FDA says are safe up to ten weeks. I suspect Dr. Gomperts and others like her if they exist will get more business now, despite the prohibition on sending the medication via mail. It’s really a matter of enforcement, and it’s not clear to me how Texas will be able to do that. That FDA action against her was from 2019, by the way. It would be nice for the current FDA to maybe revisit that now. I don’t have anything positive to end with. This is where we are right now.

Once again with the religious objection to a Texas anti-abortion law

Stepping up again.

The Satanic Temple has joined the legal wrangling to block or overturn Texas’ severe new abortion law. That law, which the U.S. Supreme Court refused to block this week, bans the medical procedure after six weeks, including in cases of rape and incest.

The Salem, Massachusetts-based Temple filed a letter with the U.S. Food and Drug Administration arguing that its Texas members should have legal access to abortion pills. The group’s attorneys contend that its status as a non-theistic religious organization should ensure access to abortion as a faith-based right.

In the letter, the Temple argues that abortion pills Misoprostol and Mifepristone should be available for its use through the the Religious Freedom Restoration Act, which protects Native Americans’ use of peyote in religious rituals. The Temple says those the same rights should apply to the drugs it uses for its own rituals.

“I am sure Texas Attorney General Ken Paxton — who famously spends a good deal of his time composing press releases about Religious Liberty issues in other states — will be proud to see that Texas’s robust Religious Liberty laws, which he so vociferously champions, will prevent future Abortion Rituals from being interrupted by superfluous government restrictions meant only to shame and harass those seeking an abortion,” said Lucien Greaves, the Temple’s spokesman and co-founder, in an emailed statement.

“The battle for abortion rights is largely a battle of competing religious viewpoints, and our viewpoint that the nonviable fetus is part of the impregnated host is fortunately protected under Religous Liberty laws,” Greaves added.

The U.S. Supreme Court last year declined to hear a case brought by the the Temple to overturn Missouri abortion laws.

I can’t find a copy of the letter, so it’s not clear to me if this is an attempt to challenge SB8, the so-called “heartbeat” bill, or the bill restricting access to medical abortion that was passed during the second special session. The Temple’s own website has some general language about its actions, but not much more than that. They had previously objected to the “fetal remains” law, though I don’t know if they took any legal action about it, and earlier this year they filed a lawsuit over the sonogram law; you can see their statement about that here. I think it’s an overbid to call this the last hope to stop SB8, and I don’t know of any past successes by the Temple in stopping anti-abortion laws, but I applaud their efforts.

More on the Texas telemedicine lawsuit

Texas Monthly has a nice overview.

Imagine you’re sick, or you think you might be sick, and you want to talk to a doctor. Instead of waiting a week or two to see your primary care physician, you just open an app on your phone or computer and within minutes you’re video-chatting with a doctor or nurse. Maybe you even have a medical device, like a blood pressure monitor, that connects your computer and transmits images and data to your doctor in real time while you’re talking.

That’s not science fiction. It’s called telemedicine, an $18 billion worldwide industry and one of the fastest-growing sectors in health care. In many ways, telemedicine represents the future of health care, promising to do for medicine what Uber and Lyft have done for transportation. Across the country, the use of telemedicine is expanding as consumers realize how much more convenient it is to talk to a doctor when and where they choose. It’s also a lot cheaper. The average telemedicine visit costs between $40 and $50, compared to the average in-person doctor’s visit, which is about $100 more—not counting the cost of the time and effort it takes to travel to and from a brick-and-mortar doctor’s office.

But here in Texas, where we have an infamous shortage of doctors and nurses, telemedicine has hit a snag. New rules promulgated by the Texas Medical Board last year prompted Dallas-based Teladoc, the largest telemedicine firm in the country, to file a federal antitrust lawsuit against the board. Specifically, the medical board’s new rules (PDF), approved in April 2015 but blocked by a federal judge’s preliminary injunction just days before they were set to take effect, stipulate how physicians in Texas can establish a “doctor-patient relationship” with new patients before engaging in telemedicine. A patient must either visit the doctor in person or meet “face-to-face” over video conference. But the video conference must be at an approved medical site like a hospital, clinic, or a fire station, and there must be a “patient site presenter” on hand, like a nurse or a physician’s assistant. In other words, you can’t just turn on your computer at home, login to a telemedicine app and be connected with a doctor. Put another way, in Texas you have to go to a medical clinic to be seen by a doctor, even if the doctor isn’t there.

This presents a substantial obstacle for Texans who are interested in using telemedicine. Many people, especially younger folks, simply won’t go to a doctor’s office, either because they don’t have what doctors and policymakers call “a medical home,” or because they don’t have health insurance.

So in Texas, which has the highest uninsured rate in the nation, on-demand telemedicine could be a game-changer. It holds the promise that, instead of forgoing medical care, more people might actually seek out a doctor when they’re sick.

All of this is why the antitrust lawsuit Teledoc filed has sparked so much debate—and confusion. Teladoc, which says Texas was already among the most restrictive states in the country for telemedicine, claims the new rules will hamstring telemedicine firms and limit patients’ access to healthcare. The medical board claims just the opposite. It views its new regulations as an expansion of telemedicine, not a restriction of it. Meanwhile, as the case wends its way through federal courts, a consortium of health care and tech groups is calling on the Texas Legislature to step in and settle the matter when lawmakers convene in Austin early next year.

[…]

The Legislature seems at least somewhat aware that it needs to step in. Last session, both the Senate and House issued interim charges to study telemedicine and give recommendations about how to improve it. To date, most of these hearings have steered clear of the lawsuit and spent considerable time hearing testimony about how great telemedicine is in Texas. To be fair, Texas was one of the first states to invest in telemedicine technology in the 1990s, and since then has tried to encourage its use in rural areas where medical specialists are scarce. One pilot program, supported by state funds and run by the Texas Tech University Health Sciences Center in Lubbock, will equip ambulances in rural West Texas with technology that allows first responders to communicate with physicians at regional trauma centers on a secure internet connection and transmit patient data in real-time while en route to a trauma center or an emergency room.

Those are real advances, and will likely save some lives in rural communities. But the big gains from telemedicine will come from hundreds of thousands of consumers using the services for routine care—and doing so on their own initiative from their homes and offices. To make that possible in Texas, lawmakers might need to act. During the 2015 session, Representative Jodie Laubenberg filed several telemedicine bills, including one that would have prevented the medical board from issuing the rule requiring a face-to-face consultation if the physician had never seen the patient. The bill was introduced and referred to the House Public Health Committee, but after the board published its new rules in April and Teladoc sued, Laubenberg, pulled it. “If something’s going to court, we stand back,” she said—a line that’s since been repeated in interim hearings on telemedicine.

But Laubenberg, along with Teladoc and many other Texas-based healthcare firms, thinks the legislature should step in once the court case is settled. They think this is about something much larger than a single antitrust suit. “Over the last five to ten years, telemedicine changed from a promise to a reality,” says Gorevic. “Now we’re starting to see the benefits. Today it’s becoming part of the fabric of the healthcare delivery system.” Just how much a part of the fabric it becomes in Texas depends not only on the Fifth Circuit Court, but how well lawmakers can work with regulators once the dust settles. Right now, the tide seems to be turning in telemedicine’s favor. In September, Robinson, the medical board’s executive director since 2001, announced she’s leaving the board to direct the telemedicine program at University of Texas Medical Branch in Galveston.

For lawmakers like Laubenberg, the issue is about something yet greater than healthcare: the degree to which regulatory boards should make up rules for their industries. “I’ve never been a big fan of agency rulemaking. They tend to go rogue,” she said. “I think the medical board thought they could get ahead of it, but the issue’s too big, and they couldn’t do it.”

See here for the background, and be sure to read the whole thing. It seems likely that Teladoc will prevail in court, though one never knows for sure, and it won’t surprise me if the Lege decides to step in and attempt to settle the matter themselves. There is of course an irony in Jodie Laubenberg being so involved with this, since the omnibus anti-abortion HB2 from 2013 prohibits dispensing abortion-inducing drugs (mifepristone-misoprostol regimen) by anyone other than a physician and requires that the physician dispensing the drug first examine the pregnant woman, which is interpreted to mean “in person”, thus making HB2 itself a telemedicine ban. That provision wasn’t part of the lawsuit that led to much (but not all!) of HB2 being struck down, though it may well come later. Point being, Laubenberg considers regulating doctors to be her job, not the Medical Board’s. We’ll see who gets to make the next move, the Fifth Circuit or the Lege. Texas Association of Business President Bill Hammond, opining in the Chron, has more.

State finally releases abortion data

It’s exactly what you’d expect.

Right there with them

Right there with them

The Texas Department of State Health Services has released the state’s 2014 abortion data after weeks of allegationsthat the agency had been intentionally withholding the numbers.

The 2014 data is significant because it is the first year to reflect the impact of Texas’ anti-abortion law, House Bill 2, on abortion providers and patients across the state.

The U.S. Supreme Court struck downparts of HB 2 as unconstitutional this week, in part because the court could not find evidence for Texas’ justification for the law — that mandatory hospital admitting privileges for abortion providers and hospital-like renovations for abortion clinics would increase patient safety. In their challenge to the law, Texas abortion providers argued that HB 2 would instead reduce access to abortion and would have a disproportionately negative impact on Texas Latinas.

According to the newly released numbers, the providers were right.

One of the most striking revelations is the change in number of medical abortions — a two-pill regimen that, under HB 2, was heavily restricted and required many more clinical visits than a surgical abortion procedure. In 2013, 16,189 Texans got medical abortions; in 2014, that number dropped to almost 5,000. (Medication abortions became easier to access earlier this year, when an FDA label change enabled more providers to issue the drugs under the law.)

The 2014 DSHS data also suggest the law had a disproportionate impact on Texans of color. In 2013, over 24,000 of Texans who got abortions were Hispanic; in 2014, that number decreased by 18 percent to under 20,000. The numbers also show a 7.7 percent decrease among black Texans who got abortions.

Overall, the number of abortions in Texas decreased by 14 percent from almost 64,000 in 2013 to almost 55,000 in 2014. The data also show that the number of abortions performed in clinics dropped by 21 percent from 2013, and the number performed at ambulatory surgical centers increased by 12 percent, reflecting the closure of half the state’s non-surgical center clinics after parts of HB 2 took effect in 2013.

The new numbers also don’t show abortion was any safer post-HB 2. For both 2014 and 2013, complication rates were negligible; the complication rates were 0.04 percent and 0.05 percent, respectively.

See here for the background. On the matter of medical abortions, the Austin Chronicle explains:

While more than 16,000 women took medication to terminate their pregnancies in 2013, less than 5,000 did so in 2014 – a stunning 75% decrease. The number of women going in for surgical abortion, on the other hand, rose about 3,000. The likely reason? HB 2 included a provision that forced women to ingest abortion pills following outdated, more expensive, and potentially more harmful FDA protocol. Some providers responded by discontinuing the service and it was reported that women were less eager to opt for medication abortion, which had forced them to take the pill in the doctor’s office rather than their homes. The FDA has since updated its guidelines. Planned Parenthood Central Texas centers, including the Austin location, saw its medication abortion rates drop to less than 1% from 40% before HB 2.

See here for more on that. Since the FDA updated its guidelines, use of the abortion pill has risen sharply, which is exactly what you’d expect since taking a pill is safer, cheaper, and more convenient than going to a medical facility for an invasive procedure. Of course, women were still seeking medical abortions after HB2’s passage, they just were doing it on their own, without any assistance from a medical professional. Because HB2 was all about their safety, don’t ya know.

More women traveled out of state to obtain abortions as well.

The statistics also show a slight increase in the number of pregnant persons who traveled out of state to obtain abortion care. The number of abortions that took place “out of state” was 754 in 2014, compared to 681 in 2013.

However, data from other states suggest a much larger increase during that time period. As Rewire previously reported, statistics from Arkansas, Kansas, Oklahoma, and Louisiana appear to indicate at least 1,086 patients traveled to those states from Texas to obtain an abortion in 2014.

Basically, everything is as abortion rights activists said it would be under HB2, and whatever the reasons for the delayed release of this data, there’s no question that the timing was convenient for the state. Thanks for not buying the BS, Supreme Court. The Trib and the Chron have more.

Use of abortion pill rises

Until the Lege reconvenes, anyway.

Misoprostol

There’s been a sharp increase in the number of Texas women who are using the abortion pill to end their pregnancies now that federal officials have eased restrictions on the drug, according to officials at Planned Parenthood of Greater Texas.

Until recently, the number of women seeking medically induced abortions at Texas’ Planned Parenthood facilities had dipped to about 1 percent because of stringent guidelines put in place by state lawmakers, officials say.

That changed in late March, when the U.S. Food and Drug Administration relaxed guidelinesfor women taking mifepristone, a pill geared to induce abortion early in a pregnancy.

“We have seen a fourfold increase in the number of our patients choosing medication abortion since the FDA updated its protocol,” said Sarah J. Wheat, chief external affairs officer at Planned Parenthood. “From our perspective, it’s restoring options for women.

“It’s putting decisions back in the hands of women instead of politicians at the Capitol.”

No firm numbers are available yet, but Texas researchers and abortion providers say they see the increase and hope to have better estimates in the coming months.

[…]

Planned Parenthood continues to run clinics statewide, including the Southwest Fort Worth Health Center, a privately funded $6.5 million licensed ambulatory surgical center that opened in 2013.

A medical abortion has remained an option for patients at these facilities, but fewer women have used it because Texas law required them to visit the clinic four times for it, said Daniel Grossman, an investigator with the Texas Policy Evaluation Project and a professor at the University of California, San Francisco.

“In the six months after HB 2 went into effect, there was a 70 percent decline in medication abortions performed statewide,” said Grossman, who is working with researchers at the University of Texas at Austin to determine the impact of legislation on abortions. “Interviews with women … [showed they were] incredibly frustrated when they had a preference for medication abortion” and couldn’t get it.

Wheat said some women have had to travel 100 miles or more to reach a Planned Parenthood clinic, which put a hardship on them for multiple visits.

“That requirement alone created huge barriers for our patients,” she said.

Now that the FDA change has loosened restrictions in Texas — requiring a lower dose, 200 milligrams instead of 600 milligrams; fewer doctor visits; and allowing the medication up to 10 weeks in a pregnancy instead of seven weeks — more women are choosing the medical abortion option, Wheat and Grossman say.

Exact numbers won’t be available for weeks or months, but “many of the independent abortion providers who have already started using the new FDA regimen are saying their numbers are back up,” Grossman said. “Many women have a preference and prefer this.”

[…]

Now the question is whether Texas lawmakers will weigh in on the issue when they return to work in January.

Planned Parenthood officials say they hope not.

“The restrictions the Legislature put in place were not based in science,” Wheat said. “The FDA is the national expert in how medications are provided, and they approved these updates.

See here for the background. I’d laugh at the futility of hoping that science and rationality would prevail if it weren’t so painful. The best hope as I see it is for HB2 to be sufficiently gutted by the Supreme Court. That will surely only slow down the zealots, but it’s probably the best we can expect until we start electing different leaders.

FDA makes medical abortion safer

Good news, at least until the Legislature reconvenes.

Misoprostol

Texas women will be able to obtain medical abortions later into their pregnancies under newly approved changes by the federal Food and Drug Administration.

The FDA on Wednesday announced revised rules for drug-induced abortions — a method used early in a pregnancy — that will increase the number of days women can take medication to induce abortions from 49 days of gestation to 70 days. Other revisions to the original FDA label for medication that induces abortions include a lower dosage of the drug, known as mifepristone.

First approved in 2000, mifepristone, when taken with another drug called misoprostol, is used to terminate early pregnancies.

Doctors in many states already followed common, evidence-based protocols that strayed from the FDA’s previous label for the drug, but Texas doctors were prohibited from doing so by state law. Among the provisions of the 2013 abortion law known as House Bill 2, Texas doctors were required to follow the FDA’s protocol for drug-induced abortions rather than evidence-based protocols.

[…]

Abortion providers and representatives of the medical community had long asked for an update to the FDA rules, arguing the original FDA label for mifepristone was based on outdated evidence from the 1990s.

“Today, science has prevailed where the state legislature has failed,” said Yvonne Gutierrez, executive director of Planned Parenthood Texas Votes, the organization’s political arm in the state.

While the medication to end a pregnancy must still be administered in Texas by a physician, the FDA revisions also say the second drug can now be taken “at a location appropriate for the patient.” It’s unclear what that means for Texas women who under state law must take the pill in front of a doctor.

A spokesman for the Texas Medical Board, which regulates physicians, said it was “still in the process of analyzing the FDA’s updated regimen.”

Of course, plenty of women have taken matters into their own hands on this, so this is at least a small step in the direction of safety. Don’t expect the Lege to be deterred by this, of course. They will figure out a way to make this as burdensome and punitive as possible. We may get a favorable ruling from SCOTUS in the HB2 case, but this would be a separate matter that would have to be litigated all over again. So enjoy this while you can, it’s got a limited shelf life. Sorry to be such a drag. Think Progress, the Chron, the Press, Daily Kos, and the AusChron have more.