Source: The Guttmacher Institute
Table of medical abortion regimen.
Now to the Southwest where a fight is unfolding over abortion rights.
Starting April 1st, Arizona's health department is poised to implement new abortion regulations, but Planned Parenthood is asking a judge to stop them. The Fronteras Desk's Jude Joffe-Block explains the debate is over how doctors perform one type of abortion.
At Planned Parenthood of Arizona’s Phoenix call center on a recent afternoon, half a dozen customer service representatives are answering phones. They are scheduling medical appointments, including abortions.
“Have you taken a positive pregnancy test?” asks one operator to the woman on the other end of the line.
Last year Planned Parenthood of Arizona did more than 2,500 medication abortions. Those are the type done with drugs — typically two pills — rather than surgery. Forty percent of Planned Parenthood patients chose the medication abortion if they were eligible for it.
“Normally they ask how far along you have to be for a medication abortion,” said Claudia, a customer service representative manning a phone.
Claudia said helping women get abortions could make her the target of violence, so we are not using her last name.
As for what she tells patients?
“It is recommend they be seen as soon as possible for the initial ultrasound because they do need to be under nine weeks for the medication abortion,” Claudia said.
But that window will become seven weeks starting April 1.
That’s because the Arizona Department of Health is putting out new regulations based on a 2012 state law.
One will require doctors doing medical abortions to follow the Food and Drug Administration’s instructions on the medication’s label. The FDA guidance for the drug mifepristone says it can be used until the seventh week of pregnancy.
But in a lawsuit filed this week, Planned Parenthood of Arizona is asking a judge to block the state's rule from from taking effect. The organization is joined in the lawsuit by a Tucson abortion provider.
They argue the FDA’s guidance on this drug from the year 2000 is outdated, and the state’s regulation would deprive women of their right to a safe abortion.
“Women will be required to receive 14-year-old health care,” said Bryan Howard, president of Planned Parenthood of Arizona.
Since the FDA’s instructions came out, a group of doctors came up with a medication abortion regimen they say is safer and more efficient. It’s currently used by abortion providers in Arizona and most parts of the country, and has been endorsed by various medical organizations.
That regimen, in addition to allowing the procedure up until the ninth week of pregnancy, significantly lightens the dose of the first pill, and permits the woman to take the second pill in her own home.
“Those are improvements that have been learned over past 14 years that under state law we’ll have to pretend never happened,” Howard said.
Howard said reverting back to the FDA instructions could increase the cost of the procedure by as much as $180 since it demands a larger dose.
He said the regulations could put medication abortions at risk at the Flagstaff Planned Parenthood clinic — which is the only site in the state offering any abortion services outside of Phoenix and Tucson.
Currently, one doctor visits the Flagstaff clinic only once a week. But the new rules will require women to come back to see the doctor an extra time.
“So unless we were able to find yet another physician for that second visit it could spell the end of abortion care in Northern Arizona,” Howard said.
The state already has in place a number of restrictions that have limited the availability of abortion in recent years. They include a rule that requires women to get counseling and an ultrasound 24 hours before an abortion, and another that prohibits nurses from providing medication abortions.
Howard said the intent of this rule is to make abortions less accessible in Arizona.
But backers of the change deny that is the motivation behind the regulation.
“This is not about putting an undue burden on a woman’s right to an abortion,” said Josh Kredit, a lawyer with the Center for Arizona Policy, a pro-life think tank that pushed the law.
“It is simply about making sure the abortion medication is used consistent with how the FDA approved it.”
Kredit said the requirement to follow FDA guidelines is about safety.
“We are as concerned about the health and safety of women entering abortion clinics as we are about the preborn children,” Kredit said.
But this would be the first time the state requires doctors to follow the FDA instructions for a particular drug. Why make an exception for this one?
Kredit said the FDA put the abortion drug mifepristone in a high-risk category.
“It is not like this is Tylenol that was approved and can be used for anything,” Kredit said.
But professional medical organizations disagree with Kredit’s analysis.
“It is very concerning that state legislatures that don’t have any medical training are trying to dictate what doctors can actually do,” said Dan Grossman, a member of the American College of Obstetricians and Gynecologists.
ACOG, along with the American Medical Association, came out against this type of regulation in other states.
Grossman said the FDA did put mifepristone in a strict category for how it could be distributed. But he said it is standard for the medical community to establish evidence-based protocols for administering drugs that differ from the FDA label.
“I think medical professionals should be concerned about this, because this is attacking the practice of off-label use of medication that is exceedingly common in the practice of medicine,” Grossman said.
The Arizona Department of Health’s director is the named defendant in the lawsuit. The agency has not yet issued a comment.
Meanwhile, the Arizona legislature continues to work on other ways to regulate abortion in the state. Earlier this week the House of Representatives passed a bill that would allow health officials to conduct surprise visits at abortion clinics.
Many observers believe it is likely that law will wind up in court, too.