Access and allies

The Food and Drug Administration has revised the guidelines for a pill that induces abortion. The changes allow women to take the pill further into their pregnancy and reduced the number of required visits to the doctor. The pill, mifepristone has increased in use in recent years, and the debate over their use from anti-abortion leaders has heightened in parallel.

The new guidelines reduce the number of required visits from 3 to 2 and allow the medication to be taken up to 10 weeks into pregnancy, up 7. This has in fact been standard practice in most states as doctors have been following the new research and prescribing in line with that evidence under the common practice of off label use. Many states have passed laws to restrict the use of the pill since it was approved by the FDA.

These laws include requiring the pill to be administered by physicians rather than nurses or physician assistants, or requiring the prescribing doctor be present with the patient while the pill is taken which abortion rights activists point out as a strategy to block many women living in rural areas to receive the medication at all. Some states required that physicians follow the label instructions strictly, so the new language from the FDA could have a real impact.

In 2014, a mother of three in rural town Pennsylvania went to jail for ordering mifepristone online to induce a miscarriage for her 16 year old daughter. The nearest clinic to their home was about 75 miles away and  Pennsylvania requires women seeking abortions to get counseling and wait 24 hours before they can return for the procedure. A first-trimester abortion is typically between $300 and $600 and that does not include the added costs of time off work and travel. To order this pill cost this family $45.  This mother was charged with a felony for offering medical consultation about abortion without license and three misdemeanors for endangering the welfare of a child, dispensing drugs without being a pharmacist and assault.

Bioethicists, when discussing abortion, can often get mired in questions on personhood and the moral status of a fetus. Legal questions usually cover the rights granted to a fetus. This post takes for granted that abortion is part of medical practice and care for women in the United States and asks us to weigh the risks of the use of this pill without direct presence of a physician versus the large need for resources related to abortion for those who are lower income, or living in rural areas far from available clinics. It also brings to light the systemic criminal treatment of those who seek this abortions.

-Grace