Conservative politicians often insist that their goal in passing severe abortion restrictions is to protect women's health. But new study published in PLOS Medicine, which focuses on a 2011 Ohio law that required abortion providers to follow outdated requirements for the abortion pill, found that specific legislation had the exact opposite effect: Women who took the abortion pill while the law was in effect needed additional treatment, experienced more side effects, and incurred higher costs than those who sought the pill before the law was passed.
"There is no evidence that the change in law led to improved abortion outcomes," the study's authors write emphatically. "Indeed, our findings suggest the opposite."
The study, which was published yesterday, looked at the health records of almost 3,000 women from four Ohio clinics between 2010 and 2014; researchers wanted to understand what kind of effects the law had on women who sought medication abortions in the state. Prior to February 2011, physicians followed an evidence-based protocol when administering a medication abortion, in which women were given a 200 mg dose of oral mifepristone. Later, they'd take 800 mcg of misoprostol, either buccally or vaginally, at home.
But Ohio legislators (as well as those in Texas and North Dakota, which have similar laws) thought it best for abortion providers to follow the regimen approved by the FDA in 2000, which called for a higher dose of oral mifepristone and a lower dose of oral misoprostal, both to be taken at a physician's office. This is despite the fact that it was an outdated protocol and the American College of Obstetricians and Gynecologists, the National Abortion Federation, and the World Health Organization all recommend following evidence-based regimens.
Ushma Upadhyay is the lead author on the study and an associate professor of obstetrics, gynecology, and reproductive sciences at University of California, San Francisco. She says it's incorrect to assume the FDA would be the best entity to manage the use of these abortion drugs. "The FDA doesn't keep up with all of the latest clinical evidence and research, including all of the improvements in care," she tells Broadly. That's why it's legal for doctors to treat their patient as they see best, including prescribing off label.
After analyzing the data, Upadhyay and her team found that not only did more women in the post-law period experience side effects like nausea and vomiting (15.6 percent, compared to 8.4 percent in the prelaw period), but they were three times as likely to need additional doses of either drug to complete the abortion.
Women in the post-law period also faced unnecessary logistical burdens to complete their care. According to the study, "Between February 2011 and March 2016, women needed to make a minimum of four visits instead of two, resulting in potential increases in transportation and childcare costs and more time away from work and school." And because the misoprostol had to be administered in the doctor's office, some women reported their side effects kicking in on their drive home.
Additionally, researchers found that women were spending more money because of the higher cost of mifepristone: "The average patient charge increased from $426 in 2010 to $551 in 2014, representing a 16 percent increase after adjusting for inflation in medical prices."
Critics of the law have noted that it limited a method of abortion considered by many to be less invasive. This study confirms that argument: According to their findings, between 2010 and 2014, there was an 80 percent decline in medication abortions.
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For its part, the FDA finally updated its protocol in March to match the clinical research, meaning women seeking medication abortions today in Ohio, Texas, and North Dakota will receive the lesser dose of mifepristone and can take the misoprostol at home. But as there are further advances in research, Upadhyay notes, women in the states that have these kinds of laws on the books won't benefit from the latest developments.
Anti-abortion groups, of course, have their take on the new study. A spokesperson for Americans United for Life, which supports restrictions on medication abortions, released a statement to The Guardian condemning the findings, saying they "should be met with the same skepticism we would give to tobacco industry findings that their products are 'safe.'"
In an editorial for the New York Times, Upadhyay reiterates how safe medication abortion is: "Less than a third of one percent of cases resulting in a serious adverse event," she writes.
Her hope, she tells Broadly, is that the results of this study will reveal the importance of reviewing all of the relevant research when passing health care policies. In the instance of Ohio's law, she says it's apparent legislators did not really consider any clinical evidence. "They didn't ask what would the health outcomes be for women," she says.