This spring, the U.S. Food and Drug Administration gave Texas women seeking abortions a boost when it changed the label on mifepristone, a drug that can be used to medically induce abortion. The new label calls for a smaller dose of the drug to be administered in a wider time frame and is in line with the way doctors prefer to to prescribe mifespristone.
In Texas, 2013's House Bill 2 requires doctors to follow the label guidelines when patients seek a medical abortion, but that bill was written before the FDA updated the original label, which was issued when the drug first became legal in the United States in 2000.
Although the change to mifepristone's labeling is still relatively new, data is emerging, both anecdotally and from providers, about the effect it's had on abortion care in Texas. Here are five things to know about non-surgical abortion in Texas as the U.S. Supreme Court weighs other restrictions in HB 2 in the biggest summer for abortion rights in the state since Roe v. Wade became law in 1973.
1. House Bill 2 disproportionately affected medical abortion: According to research from the Texas Policy Evaluation Project, the number of abortions in Texas went down 14 percent in the six months following the partial implementation of HB 2 compared with the six months that preceded its implementation. The number of medical abortions went down 70 percent over the same period, the project's lead researcher, Dr. Daniel Grossman, says.
2. There was no good reason for doctors to follow the old label: Doctors often prescribe medications for off-label uses, and the way mifepristone was being prescribed wasn't even really off the label. Over the 15 years it's been legal in the United States, doctors had fine tuned the way it was given, limiting the number of visits a woman might need for a medical abortion to as few as one. That didn't make medical abortion less safe, Grossman said, it made it even safer.
Combined with other Texas requirements, a woman seeking a post-HB 2 surgical abortion might face as many as four visits to a clinic, all of which require time off work, potentially extensive travel and, often, facing a throng of protesters on the way into the clinic. Add in the costs — mifepristone is expensive and often not covered by insurance — and HB 2 made non-surgical abortion difficult.
3. Medical abortion has bounced back: According to Planned Parenthood of Greater Texas, its clinics have seen a fourfold increase in medical abortion since the label change. The Texas Policy Evaluation Project hasn't yet published any research on the subject — the changes only went into effect on March 31 — but Grossman says conversations he's had back up what Planned Parenthood is reporting.
"We don't have any hard numbers, but certainly talking to most of the providers in the state, my understanding is that most of them are now offering medication abortion according to the updated FDA labeling and that they're reporting already that their numbers are back up," he says. "It seems like it's made a very big difference in Texas."
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4. The are still big problems facing Texas women: Texas law still puts up plenty of obstacles to abortion. No matter what type of abortion a woman seeks, she has to have an appointment at least 24 hours prior to surgery or taking a pill during which a doctor is required to give her inaccurate medical information — including promotion of a debunked link between abortion and breast cancer — and a sonogram with description of fetal development.
Because more than half of the 44 clinics that were open in the state before House Bill 2 passed have already closed, getting two appointments on a now overcrowded schedule is not easy. Grossman says he has encountered women who have carried unwanted pregnancies to term either because they couldn't get appointments in the appropriate time frame or they couldn't get time away from their lives for the appointments. If HB 2 is upheld, more than half of clinics that have remained open will close, leaving the state with nine. That, Grossman says, would likely undermine any increase in medical abortion caused by the label change.
5. There is one more thing the FDA could do that would change everything: If the FDA changes the classification of mifepristone so that it can be dispensed by pharmacies, it would completely alter women's healthcare in the United States. Women seeking an abortion early in their pregnancies could head to their OB-GYNs, get a prescription for mifepristone and its companion drug misoprostol and take the pills at home.
Currently, the FDA requires that mifepristone be dispensed only by a doctor. If that changes, medical abortion and telemedicine could help restore access to women in rural areas and other places traditional abortion care is not available.