A recent FDA decision has improved, but not fixed, the problem of states passing medication-abortion laws that are not based on the best scientific evidence, Susan Wood and her colleagues warn.
State Medication Abortion Laws Not Based on Science, Warns Women’s Health Issues Commentary
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WASHINGTON, DC (May 24, 2016)—Several states have passed laws on medication abortion that are not based on the best scientific evidence, and a recent U.S. Food and Drug Administration (FDA) decision has improved the situation but not fixed the underlying problem, warns a new commentary in the journal Women’s Health Issues. The piece notes FDA’s March 2016 approval of a new label for the abortion drug Mifeprex (mifepristone) has the effect of making laws in North Dakota, Ohio, and Texas less problematic for women’s health. But it does not change the fact that several states have adopted policies that create barriers for women seeking medication abortions, the authors say.
Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University. Susan F. Wood, PhD, the Executive Director of the Jacobs Institute of Women’s Health, is the lead author of the commentary, “For Medication Abortion, Science Should Guide Policy,” which was published online today and will appear in the journal’s July/August issue.
Several states have passed laws requiring that medication abortions be performed precisely according to the Mifeprex label, which until its recent update reflected evidence from clinical trials conducted in the 1980s and 1990s, rather than more recently conducted research. Standard clinical practice quickly advanced to use a lower dosage of mifepristone; use for pregnancies of up to 70 days (rather than 49 days as the original label specified); and to allow home use of the second drug in the medication abortion regimen, misoprostol, rather than requiring women to return to clinics to receive it. These changes and others have reduced many obstacles to medication abortions – but, the commentary notes, states that required adherence to the old Mifeprex label were effectively making medication abortion less accessible.
“Thanks to this updated label, women in states that have passed laws requiring providers to follow the FDA approved label now face fewer barriers to medication abortion,” said Wood. “I applaud FDA for making this change and hope we will see additional changes in the future, as the revised label is still far more restrictive than labels of prescription drugs with similar safety profiles.”
The commentary describes other state laws that have the effect of restricting women’s access to abortion or require providers to give women information that is not based on scientific evidence. Currently, 37 states allow only physicians to provide medication abortions, although research shows mid-level providers such as nurse practitioners and physician assistants can provide it safely and effectively, and 18 states effectively prohibit the use of telemedicine for medication abortion. Such restrictions are especially problematic in areas with few physicians, such as rural areas, the authors note.
Arizona and Arkansas have also enacted laws requiring physicians to give women information stating it may be possible to reverse a medication abortion after the woman takes the first drug in the process. This claim is based on speculation and a single, highly flawed article; the authors note that some physicians will not be able to provide this information in good conscience given the dearth of scientific evidence behind it.
Laws that have the effect of limiting women’s access to abortion make it harder for women to obtain abortions earlier in their pregnancies, when risks are lowest, Wood and her colleagues point out. “Lawmakers should not pass legislation with the expressed purpose of safeguarding women’s health when evidence demonstrates they are likely to have the opposite effect,” they write.
About Women’s Health Issues: Women's Health Issues is the official publication of the Jacobs Institute of Women's Health, and the only journal devoted exclusively to women's health care and policy issues. The journal has a particular focus on women's issues in the context of the U.S. health care delivery system and policymaking processes, although it invites submissions addressing women's health care issues in global context if relevant to North American readers. It is a journal for health professionals, social scientists, policymakers, and others concerned with the complex and diverse facets of health care delivery and policy for women. For more information about the journal, please visit http://www.whijournal.com.
About Milken Institute School of Public Health at the George Washington University: Established in July 1997 as the School of Public Health and Health Services, Milken Institute School of Public Health is the only school of public health in the nation’s capital. Today, more than 1,900 students from 54 U.S. states and territories and more than 50 countries pursue undergraduate, graduate and doctoral-level degrees in public health. The school also offers an online Master of Public Health, MPH@GW, and an online Executive Master of Health Administration, MHA@GW, which allow students to pursue their degree from anywhere in the world.