North Carolina Just Introduced a Bill That Could Dissuade Women From Ever Taking the Abortion Pill

By Robin Marty, Cosmopolitan

12 February 17

 

It takes the unsubstantiated idea of being able to "reverse" an abortion one step further.

new bill in North Carolina has taken the so-far unsubstantiated idea of being able to “reverse” a medication abortion and given it a completely new twist. Now, rather than just provide more information for the rare patient who may change her mind in the middle of the abortion process, it very well may stop those who want a non-surgical abortion from ever seeking one out in the first place.

A medication abortion typically consists of taking Mifepristone (also known as RU-486) in a clinic setting under the supervision of a medical professional and then later taking a dose of Misoprostol (also known as Cytotec) later in private. Mifepristone causes the body to stop producing progesterone to sustain the pregnancy, and Misoprostol then works to expel the embryo from her body.

House Bill 62 seeks to add new language to the state’s “Women’s Right to Know” law, which determines information a doctor must tell a patient 72 hours before performing an abortion. The current version mandates information about fetal development, procedure types, and potential complications – some of which is already not entirely medically accurate. Now, if H.B. 62 passes, it will also require telling a patient that “it is still possible to discontinue a drug induced abortion by not taking the prescribed Misoprostol and taking progesterone to reverse the effects of the Mifepristone” as well as telling them that “how, where, and from whom women can obtain assistance in discontinuing a drug induced abortion is available on the Department of Health and Human Services Internet Web site.”

Legislation requiring providers to tell abortion patients that they can reverse the medication abortion procedure by not taking Misoprostol and instead receiving additional progesterone to help the pregnancy continue has been introduced in Colorado, Utah and Indiana. Courts blocked a similar rule in Arizona, and the state repealed the law as a result. Arkansas and South Dakota both have abortion reversal laws, neither of which have been challenged at this time. But while these previous bills have stuck closely to the recommendations in the model legislation provided by Americans United for Life, an anti-abortion legal group that drafts laws for abortion opponents to propose in their states, North Carolina has added a second element to the bill that could make medication abortions almost impossible to perform.

According to section B of the bill, “Immediately prior to administering the drug Misoprostol, the physician or qualified professional shall provide medical proof to the woman that fetal death has occurred.” In other words, for the roughly 30 to 50 percent of patients for whom Mifepristone alone doesn’t immediately end the pregnancy, obtaining the second medication to finish the abortion may be impossible depending on how this language is interpreted.

Medication abortion protocol has changed significantly since RU-486 was approved by the Federal Drug Administration in 2000. Initially a medication abortion required three separate trips into a clinic – first to receive a 600 milligram dose of Mifepristone (the drug in RU-486), then a second to obtain Misoprostol (or Cytotec) in person, and a third to ensure the abortion was complete. After years of developing best practices through direct patient treatment, doctors learned that only 200 mg of Mifepristone was needed as long as Misoprostol was taken as well, and that patients could simply take the second drug home with them rather than return to the clinic to do it face to face with a physician. FDA guidelines were updated in 2016. According to Guttmacher, a reproductive rights research organization, despite many states introducing restrictions on how and when medication abortion can be performed, the use of the drugs now are responsible for over 30 percent of all abortions – up from 6 percent when it was first introduced – and is how 45 percent of all abortions are performed prior to 9 weeks.

In all cases the doctors always urge both medications. While either medicine on its own has the potential to end pregnancy, together they make the most effective combination. By writing legislation that makes a patient return to the clinic in order to receive Misoprostol, but makes obtaining the medication dependent on “medical proof” that the embryo or fetus is no longer viable, North Carolina legislators in essence telling patients to choose a vacuum aspiration instead, or be ready for the possibility of remaining pregnant – or worse.

While Mifepristone can be used alone, the reality is that without Misoprostol it is not nearly as effective “That's why doing nothing after Mifepristone only results in about 50 percent completion,” says Dr. Gabrielle Goodrick of Camelback Family Planning in Phoenix, Arizona. Goodrick was one of the doctors who opposed the Arizona reversal law that passed in 2015. That ineffectiveness, she says, is what opens the door to doctors who believe they are “reversing” the abortion, rather than the drug simply failing on its own.

Goodrick believes that even if the given intent of the law is to allegedly offer assistance to someone who might change her mind about wanting an abortion, the consequences – whether intentional or not – would be to stop her from having a medication abortion in the first place. “Why would a woman who wants a safe and effective non-surgical abortion pay for a medication that only works 50 percent of the time?” she said. “It's like removing half of your infected appendix, or only taking half of your dose of antibiotics.”

By forcing a patient to have a separate clinic visit in order to obtain Misoprostol, there is the additional risk that she wouldn’t return at all – especially if she lives outside of the urban areas where abortion clinics in the state are located. Adding a second trip could stretch those already struggling to arrange the procedure past their physical and financial limits. And according to Women on the Waves, an international abortion rights group that provides medication abortion to those who live in countries where abortion is illegal, taking Mifepristone without Misoprostol can result in one of three outcomes – an abortion without any complications, an incomplete abortion that would put a person at risk for infection and would require vacuum aspiration to complete, or a continued pregnancy. Currently, studies don't suggest any fetal anomalies occur as a result of taking Mifepristone without Misoprostol, so if the pregnancy continued there shouldn’t be risk of damage to the eventual baby. But the other outcome – essentially a missed miscarriage after fetal demise – can expose the woman to issues like infection, sepsis and even death.

Meanwhile, there is no consensus on how often a Mifepristone-only abortion could result in an incomplete abortion and break down the potential complications because it is impossible to adequately study. To do so would require offering patients this less effective protocol, which is something abortion providers wouldn’t normally consider doing without a law like this to compel them.

“The terrifying thing about this from a medical perspective is we don’t know. There is no data. It certainly could be dangerous for women, but we don’t know because we have effective, evidence-based way to administer medication abortion and that’s how we do it,” Dr. Diane Horvath-Cosper, a Reproductive Health Advocacy Fellow at Physicians for Reproductive Health, said. “We won’t be able to know about the bad consequences – women lost to follow-up [who don’t return for Misoprostol], or infections – until they happen.”

With medication and non-medication abortion both equally safe options for early terminations, Horvath-Cosper also sees this as a means of trying to deter patients from RU-486 even as more patients are picking it as their preferred method for terminating a pregnancy. “Legislation like this is really tipping the scale for people, because it’s saying if you want a medication abortion, you have to choose this additional risk for no benefit,” she said.

HB 62 is sponsored by Rep. Larry Pittman (R.), a pastor and vocal abortion opponent who once suggested that abortion providers should face the death penalty and be subject to “public hangings,” and called Planned Parenthood a “murder for hire” organization. A second sponsor is Rep. Sarah Stevens (R.), the current Speaker Pro Tempore. Neither sponsor has responded to Cosmopolitan.com’s requests by phone and email for further information about the bill.

The bill had its first reading on February 9 and has been referred to the House Committee on Health where it awaits a hearing. While North Carolina currently has a Democratic governor, Republicans have a veto-proof majority in both chambers of the legislature.