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Texas law restricting access to abortion pills takes effect as 6-week ban remains

Fort Worth Star-Telegram logoFort Worth Star-Telegram 12/2/2021 Ciara McCarthy, Fort Worth Star-Telegram

Dec. 2—Women in Texas will no longer have access to medication abortions after seven weeks of pregnancy, a time frame shorter than federal regulators allow.

Medication abortion involves taking two drugs in a regimen that was first approved by the Food and Drug Administration in 2000. The agency has determined that the medications are safe and effective for use up to 10 weeks of pregnancy, and multiple studies have concluded that serious adverse events occur in less than 1% of medication abortions in the U.S.

Starting Dec. 2, Texas lawmakers are restricting access to medication abortions through Senate Bill 4, which the Texas Legislature passed during its second special session this year. Supporters of the bill said medication abortions are less safe than other types of abortion and that its use should be restricted.

Six reproductive health experts contacted by the Star-Telegram said the science says otherwise.

"They seem to be ignoring the determination that the FDA came to," said Liz Borkowski, a researcher at the George Washington Milken University School of Public Health.

The law was passed by anti-abortion Texas legislators who said the law would help protect women.

"I am a pro-life legislator who believes in the sanctity of lives and saving lives," said State Sen. Eddie Lucio, a Democrat from Brownsville, during testimony for the bill. "I don't like the fact that there's going to be an abortion. (But) this bill attempts to make sure there's not two deaths."

Experts said the bill's supporters vastly overstate the risk of medication abortion. Of 3.7 million medication abortions reviewed by the FDA over 18 years, 24 women died after taking the drug, although the FDA could not definitively say whether the drug itself caused all of those deaths. (At least two of the 24 women died by homicide, according to the FDA.)

Experts noted that the risks of medication abortion are far lower than the risks of childbirth. In the U.S., it is estimated that between 700 and 900 women die from pregnancy-related causes each year, according to the best national estimates.

"It seems like Texas lawmakers are thinking they know more about the science behind medication abortion than the FDA does," Borkowski said. "And that seems unlikely to be true."

What we know about abortion pills

Overall, multiple nonpartisan research studies have concluded that abortion in the U.S. is safe. Perhaps the most comprehensive review of safety data was published in 2018, when the National Academics of Science, Engineering and Medicine published what's known as a consensus study on the safety and effectiveness of abortion care in the U.S.

The report concluded that all four methods of legal abortion are safe, and that "serious complications are rare and occur far less frequently than during childbirth." Rates of maternal mortality are particularly high for Black, American Indian, and Alaska Native women, who are two to three times more likely to die from pregnancy-related causes than white woman, according the U.S. Centers for Disease Control and Prevention.


Video: Legal battles far from over after US Supreme Court's ruling on Texas abortion law (WFAA-TV Dallas-Ft. Worth)

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Of the four legal types of abortion, the abortion pill and aspiration abortions, which use a gentle vacuum, are by far the most common. The most recent data available from the Guttmacher Institute found that about 39% of abortions in 2017 were medication abortions. And while the total number and overall rate of abortions in the U.S. has declined dramatically since a peak in the 1980s, the abortion pill has become a more popular option for people deciding to end a pregnancy.

Mifepristone, the only drug currently approved to induce abortion in the U.S., was approved by the FDA in 2000. Since then, the frequency of medication abortions has increased dramatically in the U.S., even as the total number and rate of abortions has declined in the last 40 years. Most medication abortions involve the use of two drugs, mifepristone and misprostol. The first drug, mifepristone, blocks hormones needed to continue a pregnancy. Misoprostol is taken 24 to 48 hours later.

Although there is a small reported difference in the risks of aspiration abortions and medication abortions, experts say both are safe options, especially compared to other drugs and medical procedures.

Dr. Sarah Prager, a professor at the University of Washington School of Medicine, said risks of serious adverse events are incredibly rare.

"As with everything, there's a risk-benefit analysis," Prager said. "We don't put the same onus on taking an antibiotic, or getting a colonoscopy. Those risks are assumed and they are acceptable."

And even pregnant people who have had medication abortions without medical supervision, by accessing the drugs through an online pharmacy or other provider, have reported few adverse events. A population-based study of self-managed abortions in Ireland reported low rates of adverse events after women took the medications.

The medication abortion law is the latest restriction on abortion in Texas, and one that disproportionately affects poor women.

The majority — at least 75% — of women who have abortions are poor or low income, according to research from the Guttmacher Institute. The institute, which supports abortion rights, produces the most comprehensive survey on the demographics of people who get abortions in the U.S. And about 60% of those who get abortions are women of color.

What the law means for Texans

Medication abortions are already highly regulated drugs in the U.S.

Patients cannot pick up the drug at a pharmacy, but rather have to receive it in certain healthcare settings like clinics and hospitals. Because of the COVID-19 pandemic, the FDA agreed to "exercise enforcement discretion" regarding the requirement that the drug be dispensed in-person. During the pandemic, more women have been prescribed medication abortions via telemedicine, and received the drugs in question via mail.

In response to these relaxed regulations, Texas lawmakers also included a provision in the new law that criminalizes providing or aiding a pregnant woman in acquiring abortion-inducing drugs outside of the law's stipulations. The law requires a doctor to prescribe abortion pills and to examine the pregnant woman in person, and for the pregnant woman to take the first drug in the regimen while in the doctor's presence.

State Rep. Stephanie Klick, a Republican from Fort Worth who co-authored the law, wrote in a Facebook post that "out-of-state doctors have been taking advantage of this loophole, prescribing abortion-inducing drugs that are delivered through the mail with no medical supervision. As a nurse, I believe we had to act in order to go after these out of state individuals who are flagrantly violating Texas laws, and that is why I filed legislation to do so."

The law limiting the use of abortion pills will not immediately have a dramatic affect on abortion access in Texas, because it comes after Senate Bill 8, the law that banned all abortions in the state after fetal cardiac activity can be detected, which usually happens at about six weeks of pregnancy. The six-week mark of a pregnancy is before many people have realized they are pregnant. As long as Texas' six-week abortion ban remains in place, almost no abortions past the six-week mark are permitted in Texas, via medication abortion or any other method.

Meanwhile, as both of Texas' new abortion laws remain in place, the Supreme Court seemed poised to uphold a Mississippi law that bans abortions after 15 weeks of pregnancy. When the court rules on the Mississippi law, it could also decided whether to uphold the precedent set in Roe v. Wade, which establishes a constitutional right to an abortion before a fetus is viable.

In the meantime, both laws limiting access to abortion in Texas remain in effect. In the first 30 days after Senate Bill 8 went into effect in September, legal abortions in the state dropped by half, according to a group of researchers at the University of Texas at Austin.

This story was originally published December 2, 2021 12:00 AM.

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