On Abortion Rights, Science & States Are At Odds

photographed by Sage McAvoy.
It seems that lawmakers across the country are competing to see who can make people seeking abortions suffer the most.
Iowa Gov. Kim Reynolds just signed a law banning virtually all abortions in the state – the most restrictive abortion ban in the nation – and Kentucky recently banned a safe and medically-proven method of abortion (that law is blocked as litigation proceeds). Last month, Mississippi Gov. Phil Bryant signed into law a ban on nearly all abortions after 15 weeks of pregnancy (that law is also blocked), and Louisiana is now considering a copycat 15-week ban that would take effect if the Mississippi law is upheld in court. Meanwhile, West Virginia – which like Kentucky, Mississippi, and four other states, is served by just a single abortion clinic – is contemplating an amendment to completely remove protections for abortion under the State Constitution.
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As extreme politicians race to outdo each other with punitive anti-abortion measures, it’s essential to remember that these laws are not only unconstitutional – they are also medically unnecessary and scientifically baseless.
A new report from the National Academies of Science, Engineering and Medicine (NASEM) confirms that abortion is a safe and effective medical procedure that can be performed in an outpatient clinic setting by a range of healthcare providers. Published in March, the non-partisan, rigorous research reaffirms what advocates for reproductive health have been saying for years.
NASEM’s groundbreaking research wholly supports the ACLU’s efforts in Maine, where we are currently challenging a state law that forbids qualified health professionals from providing abortion care. According to NASEM, most abortion procedures can be safely performed by physicians as well as by advanced practice clinicians including physician assistants, certified nurse-midwifes, and nurse practitioners.
With its physician-only restriction, Maine’s law not only prevents qualified health professionals from providing a service they are well-equipped to offer; it also significantly limits the care available to patients throughout the state. In the most rural state in the country (which saw a whopping 10 feet of snow this winter!), some patients must travel more than five hours, and delay necessary care, to reach one of the three Maine cities where there are physicians performing abortions, rather than obtaining care from a perfectly capable provider in their own communities. For many low-income people, such travel means paying for transportation, as well as arranging for child care and unpaid time off of work, that many simply cannot afford.
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Maine’s case illustrates precisely what the NASEM report concludes: The biggest threats to quality abortion care are medically unnecessary restrictions that burden patients seeking this care and block qualified health care professionals from providing it.
In Hawaii, too, people seeking abortion care are at the mercy of burdensome restrictions that have been plainly debunked by science. On the remote Hawaiian island of Kauai, where there are no abortion providers, Mifeprex – the prescription medication commonly known as the “abortion pill” – would be a simple solution for patients seeking an abortion up to 10 weeks of pregnancy. But FDA restrictions prevent retail pharmacies from dispensing Mifeprex; instead, a clinician who wants to provide this care must arrange to stock and dispense it onsite at their medical office, clinic, or hospital—which many are unable to do. These restrictions do exactly nothing to protect patient health: once a woman’s healthcare provider has prescribed the pill, which she can take at home, it makes no medical difference whatsoever whether she is standing in a clinic or in a pharmacy when she receives the pill in her hand. And as a result of these restrictions, patients seeking abortions are forced to fly to another island for care, often delaying them by weeks – even though there are providers on Kauai willing to prescribe the abortion pill.
The ACLU’s lawsuit in Hawaii seeks to erase these barriers by calling out the FDA’s unconstitutional restrictions on Mifeprex, which have persisted without proof of medical benefit. “Prescribing medication abortion is no different from prescribing other medications,” the NASEM report confirms, and the FDA itself acknowledged in 2016 that the abortion pill “has been increasingly used as its efficacy and safety have become well-established by both research and experience, and serious complications have proven to be extremely rare.” Other leading medical authorities, including the American College of Obstetricians and Gynecologists, also support making this safe medication available by prescription at a pharmacy. So why is the FDA singling out the abortion pill for onerous restrictions that it does not require for equally or less safe drugs?
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The science on abortion is clear, and the real threat to patients’ health is the proliferation of abortion bans and medically unnecessary restrictions. No one should have to get on a plane, cross state lines, or travel hundreds of miles to get an abortion.
With the health and reproductive freedom of millions of people at risk in states across the country, we at the ACLU must continue to fight back. And we can be confident that science is on our side.
Julia Kaye is a staff attorney for the Reproductive Freedom Project at the American Civil Liberties Union (ACLU). The views expressed are her own.
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