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misoprostol

FDA makes medical abortion safer

Good news, at least until the Legislature reconvenes.

Misoprostol

Texas women will be able to obtain medical abortions later into their pregnancies under newly approved changes by the federal Food and Drug Administration.

The FDA on Wednesday announced revised rules for drug-induced abortions — a method used early in a pregnancy — that will increase the number of days women can take medication to induce abortions from 49 days of gestation to 70 days. Other revisions to the original FDA label for medication that induces abortions include a lower dosage of the drug, known as mifepristone.

First approved in 2000, mifepristone, when taken with another drug called misoprostol, is used to terminate early pregnancies.

Doctors in many states already followed common, evidence-based protocols that strayed from the FDA’s previous label for the drug, but Texas doctors were prohibited from doing so by state law. Among the provisions of the 2013 abortion law known as House Bill 2, Texas doctors were required to follow the FDA’s protocol for drug-induced abortions rather than evidence-based protocols.

[…]

Abortion providers and representatives of the medical community had long asked for an update to the FDA rules, arguing the original FDA label for mifepristone was based on outdated evidence from the 1990s.

“Today, science has prevailed where the state legislature has failed,” said Yvonne Gutierrez, executive director of Planned Parenthood Texas Votes, the organization’s political arm in the state.

While the medication to end a pregnancy must still be administered in Texas by a physician, the FDA revisions also say the second drug can now be taken “at a location appropriate for the patient.” It’s unclear what that means for Texas women who under state law must take the pill in front of a doctor.

A spokesman for the Texas Medical Board, which regulates physicians, said it was “still in the process of analyzing the FDA’s updated regimen.”

Of course, plenty of women have taken matters into their own hands on this, so this is at least a small step in the direction of safety. Don’t expect the Lege to be deterred by this, of course. They will figure out a way to make this as burdensome and punitive as possible. We may get a favorable ruling from SCOTUS in the HB2 case, but this would be a separate matter that would have to be litigated all over again. So enjoy this while you can, it’s got a limited shelf life. Sorry to be such a drag. Think Progress, the Chron, the Press, Daily Kos, and the AusChron have more.

The Mexican abortion option, part 3

Stop me if you’ve heard this one before.

Misoprostol

Between 100,000 and 240,000 Texans have attempted to terminate their pregnancies without medical assistance, according to new research released Tuesday. Based on interviews and a statewide survey, the unprecedented study by the Texas Policy Evaluation Project (TxPEP) estimates that between 1.7 and 4.1 percent of Texas women between the ages of 18 and 49 have attempted to end their own pregnancies outside of a clinical setting.

According to TxPEP’s interviews with Texans who’ve attempted self-induction, the top four reasons they tried to end their pregnancies on their own fall into four categories: financial constraints for the cost of the procedure or travel to the nearest clinic, clinic closures, recommendation from a family member or friend, or an intention to avoid shame or stigma of going to an abortion clinic, especially if they had had an abortion before.

“I didn’t have any money to go to San Antonio or Corpus,” one woman living in the lower Rio Grande Valley told researchers. “I didn’t even have any money to get across town. Like I was just dirt broke. I was poor.”

The study also found that Latina women living near the Texas-Mexico border are more likely to have attempted to induce their own abortions, or know someone who has, than non-Latina Texans.

[…]

Researchers believe the likelihood of self-induced abortion in Texas is higher than elsewhere. According to a 2008 national study by the Guttmacher Institute, less than 2 percent of American women reported taking something to terminate their pregnancies on their own. In 2012, TxPEP conducted a survey of Texans seeking abortions and found that 7 percent of women interviewed spoke to reported taking something to induce their own abortion.

Lead TxPEP researcher Daniel Grossman, a professor of obstetrics and gynecology at the University of California at San Francisco, warned that clinic closures after HB 2 may lead to an increase in self-inductions.

“This is the latest body of evidence demonstrating the negative implications of laws like HB 2 that pretend to protect women but in reality place them, and particularly women of color and economically disadvantaged women, at significant risk,” Grossman said in a press release. “As clinic-based care becomes harder to access in Texas, we can expect more women to feel that they have no other option and take matters into their own hands.”

The most common method women reported using to induce their own abortion was a medication called misoprostol, also called by its brand name, Cytotec.

Spoiler alert: we have heard this before. I have often heard it said that trying to ban or regulate something – guns, drugs, gambling, what have you – doesn’t work and can’t work because people will still want those things, so the net effect is to push the activity in question underground and thus make it more dangerous for everyone involved. Funny how that never seems to be applied to abortions, especially by those who so piously intone that they’re just making them safer because they care so much about women’s health. Thankfully, at least some federal judges have been willing to point out the dangerous absurdity of the recent spate of anti-abortion laws; whether SCOTUS follows suit or not remains to be seen. The AusChron, the Press, and ThinkProgress have more.

The Mexican abortion option, one year later

Exactly as predicted.

Misoprostol

The Alamo flea market sits right off South Texas’s lengthy Highway 83; a sprawling, dusty, labyrinth of a place. Under canopies in the converted parking lot, vendors in dark sunglasses stand behind tables heaped with piles of clothing, barking in Spanish and hawking their wares. The air is hot and muggy, thick with the scent of grilled corn and chili.

Customers browse simple items—miracle-diet teas, Barbie dolls or turquoise jeans stretched over curvy mannequins—but there are also shoppers scanning the market for goods that aren’t displayed in the stalls. Tables lined with bottles of medicine like Tylenol and NyQuil have double-meanings to those in the know: The over-the-counter drugs on top provide cover for the prescription drugs smuggled over the border from nearby cities in Mexico. Those, the dealer keeps out of sight.

I’m here to look for a small, white, hexagonal pill called misoprostol. Also known as miso or Cytotec, the drug induces an abortion that appears like a miscarriage during the early stages of a woman’s pregnancy. For women living in Latin America and other countries that have traditionally outlawed abortion, miso has been a lifeline—it’s been called “a noble medication,” “world-shaking” and “revolutionary.” But now, it’s not just an asset of the developing world.

As policies restricting access to abortion roll out in Texas and elsewhere, the use of miso is quickly becoming a part of this country’s story. It has already made its way into the black market here in Texas’s Rio Grande Valley, where abortion restrictions are tightening, and it is likely to continue its trajectory if anti-abortion legislation does not ease up and clinics continue to be closed.

Over the past several years, dozens of states have restricted abortions. Since 2011, at least 73 abortion clinics in the nation have shut down or stopped providing services; and more than 200 abortion restrictions were legislated throughout the nation. Despite the passage of Roe v. Wade more than 40 years ago, states with pro-life politicians are still gunning to reverse the ruling—in the words of Rick Perry in 2012, “my goal is to make abortion, at any stage, a thing of the past.”

Yet these myriad restrictions on women and abortion providers have set the stage for women to skirt medical institutions to take charge of their own health. A similar story has already been written in many countries around the world, where pro-life legislation has inspired similarly creative solutions. Today, throughout Texas—from the Rio Grande Valley to El Paso—miso’s story is being drafted anew. And in this narrative, it is Latin America that has answers for the United States.

There was a NY Times story about this less than a month after HB2 passed last summer, and so far things have played out exactly as expected. I guess it’s good that there’s still an option for so many women, one that’s clearly better than coat hangers and the like, but it sure is depressing that said option is a black market pill that’s supposed to be taken in conjunction with another pill and which can be harmful if not taken in the proper dosage. How any of this is good for women’s health is of course a mystery. But it’s where we are today, and it’s where we’ll be tomorrow and the next day until we get a Legislature that will undo all this damage and a federal appeals court that doesn’t suck.

Fifth Circuit pretends to hear HB2 appeal

We’re all sure what their decision will be, right?

Appellate judges on Monday challenged lawyers over provisions of Texas’ new abortion law and whether they have unduly caused the closure of about a dozen abortion clinics.

The three-judge panel of the U.S. 5th Circuit Court of Appeals bore down in particular on the shuttering of the only two abortion clinics in the Rio Grande Valley.

The lack of facilities is now requiring women seeking the procedure to travel about 150 miles to a Corpus Christi clinic.

State Solicitor General Jonathan Mitchell defended the state law, saying the state has a right to regulate medical practices as a way to promote women’s health.

“The law does not impose an undue burden,” he told the court.

[…]

Judge Edith Jones was openly skeptical of the abortion rights arguments, saying 150 miles to Corpus Christi did not seem to raise a high hurdle.

Jones said the speed limit along the highway was 75 mph, and it was a particularly uncongested roadway.

She also pointed out that while abortion rights groups argued more than one-third of the doctors would have to quit practicing because of the new law, some of those doctors have been able to obtain admitting privileges.

Clearly, any woman who doesn’t have access to a car or who doesn’t have an extra four-plus hours to spare on top of everything else doesn’t count. And hey, there’s at least one doctor and one clinic left – for now, anyway. What more do you complainers need? Really, the only question is whether Jones wrote her decision before oral arguments were made or not. She surely didn’t need to hear them to know what she was going to say.

Not that it would budge her set-in-stone mind, but it would do Edith Jones some good to read Lindsay Beyerstein’s report on what HB2 has meant to many women.

The Valley used to have two abortion providers — Whole Woman’s Health McAllen (WWHM) and Reproductive Services of Harlingen — but now it has none that currently offer abortions, because their doctors lack admitting privileges. (Emergency rooms are required to provide the same care to all patients, regardless of whether their doctors have admitting privileges there. While the doctors at WWHM are applying for privileges at local hospitals, Reproductive Services of Harlingen’s physician has already been turned down by all the hospitals in his area.) Even if Planned Parenthood wins its lawsuit, abortions will still have to be performed in ambulatory surgical centers by this time next year, which means that neither clinic can continue to operate in its current facility.

WWHM is the only abortion clinic in this border city of 134,000. Right now, according to WWHM’s Fatimah Gifford, if a woman in the Rio Grande Valley needs an abortion, she has to travel 240 miles north to San Antonio. Though Texas’ standard 24-hour waiting period is waived for women who live more than 100 miles from the nearest clinic, that allowance applies only to surgical abortions. To reach San Antonio via Highway 281, a woman has to pass through the Falfurrias border checkpoint, where the Texas Border Patrol will likely grill her about her immigration status, a daunting prospect for an undocumented woman seeking abortion care. Gifford says most of her undocumented patients won’t risk the trip.

A woman seeking a medication abortion must make three trips to San Antonio. A medication abortion, also known as a pill abortion, uses two drugs to induce a miscarriage in the first trimester. Under the new law, the first trip is for the ultrasound, consultation and the first pill, then she must return to the clinic 48 hours later for her second pill. Doctors who offer pill abortions in other states routinely give patients the second dose of pills to take home, but Texas law doesn’t allow it. Finally, she has to go back to the clinic 14 days later for a follow-up visit so that the same doctor can check to make sure that the drugs worked. Many abortion providers travel to clinics across the state or the country, which makes it difficult to ensure that the same doctor will be available for all three steps.

Planned Parenthood argued in court that this provision makes it so difficult for women to obtain abortions that it is equivalent to a ban, which has serious implications for the rights and health of women with existing conditions that make drug-induced abortion the only safe option.

Some women resort to self-induced medication abortions with the ulcer drug misoprostol, widely used in Latin America to terminate early pregnancies. Though it is available only by prescription in the United States, misoprostol can easily be purchased at pharmacies across the border in Mexico or at flea markets in the Valley. WWHM saw about one failed misoprostol self-induced abortion a day.

Andrea Ferrigno, WWHM’s vice president, said that if a woman arrives at the clinic after taking the pills for weeks and is still bleeding, doctors will typically complete the abortion if she’s still pregnant or clean out any residual tissue, as they would for a spontaneous miscarriage. Misoprostol is 85 percent effective, if administered properly, which suggests that many more women self-terminate and don’t need further medical attention.

I’ve noted the Misoprostol option before. You know what that’s going to mean: More calls for tightened border security. Because the Republicans who pushed HB2 care so much about women’s health. Irin Carmon, RH Reality Check, BOR, Texpatriate, and Texas Politics have more.

The Mexican abortion option

Get ready for it.

Misoprostol

At the Whole Woman’s Health center here, a young woman predicted what others would do if the state’s stringent new abortion bill approved late Friday forces clinics like this one to close: cross the border to Mexico to seek an “abortion pill.”

“This law will lead a lot more women to try self-abortion,” said Jackie F., a 24-year-old food server and student who was in the health center last week for a follow-up medical examination after getting a legal abortion.

The woman, who requested that her last name not be used to avoid stigma, was referring to a drug that can induce miscarriages and is openly available in Mexico and covertly at some flea markets in Texas.

In Nuevo Progreso, only yards past the Mexican border, pharmacists respond to requests for a pill to “bring back a woman’s period” by offering the drug, misoprostol, at discount prices: generic at $35 for a box of 28 pills, or the branded Cytotec for $175.

When asked how women should use the pills, some of the pharmacists said they did not know and others recommended wildly different regimes that doctors say could be unsafe.

“The women see it as “a pill to make my period come,’” said Andrea Ferrigno, a vice president of Whole Woman’s Health, which runs a network of abortion clinics. “Often in their minds, it’s not abortion.”

No question, if the new law is upheld you will see a large increase in border crossings for the purpose of acquiring abortion drugs. I predict that within six months of the law taking effect there will be a feature story about it in Texas Tribune. I also predict that if this happens there will be an even greater focus on “border security” by Republicans, in Congress and in Austin, to crack down on this practice. It’s just a question of who gets to author the bill that makes carrying misoprostol across the border a felony. Anyone disagree with me on this?

Lacking health insurance or fearing the stigma of being seen at an abortion clinic, thousands of Texas residents every year are already making covert use of this pill or trying other methods to induce abortions on their own, according to Dr. Dan Grossman, an obstetrician in the San Francisco Bay Area and vice president of Ibis Reproductive Health, a nonprofit research group.

When used properly in the early weeks of pregnancy, misoprostol, which causes uterine contractions and cervical dilation, induces a miscarriage about 85 percent of the time, according to Dr. Grossman. But many women receive incorrect advice on dosage and, especially later in pregnancy, the drug can cause serious bleeding or a partial abortion, he said.

The looming limits on legal abortion follow deep cuts in state support for family planning. Planned Parenthood clinics here in Hidalgo County do not perform abortions, but in 2010 provided subsidized contraception to 23,000 men and women at eight centers; as financing dried up, four of them have been closed. This year, the group will serve only 12,000 clients, and other organizations have not taken up the slack, said Patricio Gonzales, chief executive of the Hidalgo County chapter of Planned Parenthood.

If legal abortions become inaccessible in this part of the state, Mr. Gonzales said, “Planned Parenthood may have to step up” and try to raise $1.5 million or more to build a new surgery center that meets the requirements of the new law.

Lucy Felix, a community educator here with the National Latina Institute for Reproductive Health, said that many of the women she works with do not have legal residency and cannot drive north in Texas through Border Patrol checkpoints or even cross the southern border to buy the pill directly for fear that they may not be able to return to their families in Texas.

“The only option left for many women will be to go get those pills at a flea market,” Ms. Felix said. “Some of them will end up in the E.R.”

[…]

In a tour of the Whole Woman’s Health clinic here, Ms. Ferrigno noted some of the design and equipment requirements in the new law that would force the clinic to shut down. The clinic, part of a chain in Texas and other states, performs about 1,900 abortions a year using doctors that fly in from other states.

The clinic, like most in Texas, performs abortions only through the first 15 weeks of pregnancy, using medications or a suction method that takes 10 to 15 minutes and involves no incisions. The center uses donations to offer subsidies to many women, Ms. Ferrigno said.

The suite does not have the wide hallways required of a surgery center to facilitate the movement of stretchers in an emergency. In nine years and thousands of abortions, she said, the McAllen clinic has sent only two patients to the hospital, both for readily-treated bleeding.

Remember, this is all about the health and safety of women. Because Texas Republicans care so much about those things.