Demand for abortion pills on the rise

American women are ending pregnancies with medication almost as often as with surgery, marking a turning point for abortion in the United States, data reviewed by Reuters shows.

The watershed comes amid an overall decline in abortion, a choice that remains politically charged in the United States, sparking a fiery exchange in the final debate between presidential nominees Hillary Clinton and Donald Trump.

When the two medications used to induce abortion won U.S. approval 16 years ago, the method was expected to quickly overtake the surgical option, as it has in much of Europe. But U.S. abortion opponents persuaded lawmakers in many states to put restrictions on their use.

Although many limitations remain, innovative dispensing efforts in some states, restricted access to surgical abortions in others and greater awareness boosted medication abortions to 43 percent of pregnancy terminations at Planned Parenthood clinics, the nation’s single largest provider, in 2014, up from 35 percent in 2010, according to previously unreported figures from the nonprofit.

The national rate is likely even higher now because of new federal prescribing guidelines that took effect in March. In three states most impacted by that change – Ohio, Texas and North Dakota – demand for medication abortions tripled in the last several months to as much as 30 percent of all procedures in some clinics, according to data gathered by Reuters from clinics, state health departments and Planned Parenthood affiliates.

Among states with few or no restrictions, medication abortions comprise a greater share, up to 55 percent in Michigan and 64 percent in Iowa.

Denise Hill, an Ohio mother who works full time and is pursuing a college degree, is part of the shift.

Hill, 26, became extremely ill with her third pregnancy, sidelined by low blood pressure that made it challenging to care for her son and daughter. In July, eight weeks in, she said she made the difficult decision to have a medication abortion. She called the option that was not available in her state four months earlier “a blessing.”

The new prescribing guidelines were sought by privately-held Danco Laboratories, the sole maker of the pills for the U.S. market. Spokeswoman Abby Long said sales have since surged to the extent that medication abortion now is “a second option and fairly equal” to the surgical procedure.

“We have been growing steadily year over year, and definitely the growth is larger this year,” Long said.

Women who ask for the medication prefer it because they can end a pregnancy at home, with a partner, in a manner more like a miscarriage, said Tammi Kromenaker, director of the Red River Women’s Clinic in Fargo, North Dakota.

GAME CHANGER

Medication abortion involves two drugs, taken over a day or two. The first, mifepristone, blocks the pregnancy sustaining hormone progesterone. The second, misoprostol, induces uterine contractions. Studies have shown medical abortions are effective up to 95 percent of the time.

Approved in France in 1988, the abortion pill was supposed to be a game changer, a convenient and private way to end pregnancy. In Western Europe, medication abortion is more common, accounting for 91 percent of pregnancy terminations in Finland, the highest rate, followed by Scotland at 80 percent, according to the Guttmacher Institute, a nonprofit research organization that supports abortion rights.

In the United States, proponents had hoped the medication would allow women to avoid the clinics that had long been targets of protests and sometimes violence.

But Planned Parenthood and other clinics remain key venues for the medication option. Of the more than 2.75 million U.S. women who have used abortion pills since they were approved in 2000, at least 1 million got them at Planned Parenthood.

Many private physicians have avoided prescribing the pills, in part out of concern that it would expose their practices to the type of protests clinics experienced, say doctors, abortion providers and healthcare organizations.

At the same time, the overall U.S. abortion rate has dropped to a low of 16.9 terminations per 1,000 women aged 15-44 in 2011, down from 19.4 per 1,000 in 2008, according to federal data. The decline has been driven in part by wider use of birth control, including long lasting IUDs.

In March, the U.S. Food and Drug Administration changed its prescribing guidelines for medication abortion. The agency now allows the pills to be prescribed as far as 10 weeks into pregnancy, up from seven. It cut the number of required medical visits and allowed trained professionals other than physicians, including nurse practitioners, to dispense the pills. It also changed dosing guidelines.

The changes were supported by years of prescribing data and reflect practices already common in most states where doctors are free to prescribe as they deem best.

Ohio, Texas and North Dakota took the unusual step of requiring physicians to strictly adhere to the original guidelines. Many abortion providers were reluctant to prescribe the pills under the older guidelines, which no longer reflected current medical knowledge, said Vicki Saporta, President and CEO of the National Abortion Federation.

Randall K. O’Bannon, a director at the anti-abortion National Right to Life organization, criticized the new guidelines but said his organization had no plans to fight them.

“What they did was make it more profitable,” O’Bannon said. “It will increase the pool of potential customers.”

Planned Parenthood said both types of abortion typically cost from $300 to $1,000, including tests and examinations. The group charges a sliding fee based on a patient’s ability to pay, regardless of which type of abortion they choose.

VARIED ACCESS

Despite a landmark U.S. Supreme Court ruling that abortion is a woman’s right, access varies widely by state. Some states maintain restrictions on both surgical and medication abortions; others have worked to increase access.

In rural Iowa, where clinics are few and far between, Planned Parenthood is using video conferencing, known as telemedicine, to expand access.

The way it works is, a woman is examined in her community by a trained medical professional, who checks vital signs and blood pressure and performs an ultrasound. The information is sent to an off-site doctor, who talks with the woman via video conference and authorizes the medications.

Since the telemedicine program began in Iowa in 2008, medication abortions increased to 64 percent of all pregnancy terminations, the highest U.S. rate.

In New York, Hawaii, Washington and Oregon, a private research institute, Gynuity Health Projects, works with clinics to send abortion pills by mail to pre-screened women.

“Medication abortion is definitely the next frontier,” said Gloria Totten, president of the Public Leadership Institute, a nonprofit that advises advocates.

And in Maryland and Atlanta, the nonprofit organization Carafem opened centers in the last 18 months that offer birth control and medication, but not surgical, abortions. It promotes its services with ads that read: “Abortion. Yeah, we do that.”

(Reporting By Jilian Mincer; Editing by Michele Gershberg and Lisa Girion)

http://www.reuters.com/article/us-usa-healthcare-abortion-exclusive-idUSKBN12V0CC

Source: Reuters

Well, suppose it’s time for me to give the obligatory “Year in Review” report on abortion rights.    

I’ve always been a bit of an optimist when it comes to the future of Roe and access to abortion, but I’m not so sure anymore.  Sure, when it comes to the basic right to abortion, we’re still in decent shape in the Supreme Court.  They don’t have the votes to overturn Roe.  But all we need is an anti-abortion President to be elected in 2016 and, without the threat of a filibuster (thanks to the Democrats in the Senate), it may be a little more difficult to stop an extremist from being appointed to the Court.   And, depending on which legal authority you subscribe to, all the antis need is maybe one vote to reverse Roe.  Indeed, I really wish some of the older more liberal justices would resign now so Obama can at least make those seats secure.

But when it comes to access issues, there is no doubt the anti-abortion movement is on a legislative roll.  In 2013 alone, 22 states adopted 70 different restrictions, including late-abortion bans, doctor and clinic regulations and limits on the use of the abortion pill. Twenty-four states have barred abortion coverage by the new health exchanges and nine of them forbid private insurance plans, as well, from covering most abortions. A dozen states have barred most abortions at 20 weeks of pregnancy, based on a theory of fetal pain that has been rejected by major medical groups. Such laws violate the viability threshold and have been struck down in three states, but proponents hope the Supreme Court will come up with a new standard.

What’s most frightening, however, are the laws that on their face seek to “protect the health of women seeking abortions” by imposing severe regulations on the clinics.  Such regulations include absurd requirements like mandating that hallways be a certain width (to get the gurney out when a woman has an emergency).  Personally, I have never heard of a patient getting stuck in a hallway and it might not sound like a big deal to some to widen the hall, but when you think about how much it might actually cost to get the necessary permits, hire construction crews, etc., it’s an onerous and very expensive proposition.   Some of the new laws also require the clinic to provide more parking spaces, as if that’s an easy thing to do, especially in a more urban environment. 

We know that this is all a bunch of crap, that the antis do not give a hoot about making the abortion experience “safer,” but the anti-abortion legislators, like those in my home state of Virginia, are buying it. They just get their marching orders from their local “Right to Life” chapter and vote in lock step.  Chalk up another victory for “women’s health!” 

But, truth be told, these regulations are starting to severely restrict access to abortion services.  For example, there is now only one clinic left in the state of Mississippi and in North Dakota and both of them are hanging by their fingernails in the face of a legislative onslaught led by the local anti-abortion forces. 

The bottom line is that more and more clinics are closing and women are now travelling further to get abortions.  Please note what I said – many of them are STILL getting abortions, even if it means having to miss several days of work to travel to another state.  On the other hand, many other women are simply deciding to give birth to an unwanted child instead of losing three days of pay. 

The only thing we can hope for is that ultimately there will be a backlash in this country on the political front and there is some evidence that that may be occurring.  For example, right here in Virginia we recently elected an outspoken pro-choice Governor who will hopefully reverse some severe clinic regulations that were passed two years ago that threaten the existence of several clinics in the state. And the National Abortion and Reproductive Rights Action League points to other recent successes on the political front.

Let’s hope it is not too late.

Abortion Rights Sebelius

Abortion Rights Sebelius

The pro-choice groups are understandably up in arms over HHS Secretary Kathleen Sebelius’ decision to overrule the FDA and prohibit the “morning after pill” from being available over the counter to minors.  By now, they have issued their press releases condemning the action and personally castigating President Obama.   Some groups, like Physicians for Reproductive Choice and Health have been particularly aggressive, which is part of their relatively new effort to convince others that they are now a leading advocacy organization (i.e., “please send us money because we’re really fighting for you”).  But I digress.

The day after the decision the President – the pro-choice president – said that he agreed with Sebelius, expressing concern that a young girl might not use the medication properly.  Suddenly, he was the Father in Chief, clearly thinking about thirteen year old daughter, Malia.

Morning After Pill?

Morning After Pill?

I am going to assume that Obama knew what Sibelius wanted to do.  I mean, c’mon folks, do you really think that she would make that kind of decision without discussing it with the President?  So, if you accept the assumption that they discussed it before hand, the question then becomes was Obama’s decision to support Sibelius based on science or politics?

Actually, that question is too simple.  It suggests that the President or any other politician only examines an issue from one perspective.  But the President (and some of those other politicians) is actually a smart guy and he can analyze an issue from several perspectives.  Heck, he does it all the time.

Abortion Rights

Abortion Rights

From the substantive point of view, he is a father first.  He’s got two young daughters who may soon be having sexual thoughts.  And Obama clearly had to be thinking about the possibility (although highly unlikely) of his daughters going down the drugstore one day to get a box of these pills.  Then, he must have envisioned them in a state of panic taking the wrong dosage or not being physically capable of taking the drug.  He must have projected his fatherly perspective to the thousands and thousands of other fathers (and mothers) who might ultimately be in the same situation.

Then there was the political side of the issue.  It’s no secret that it will be a tough re-election and he has to woo a number of interest groups, including the Catholics and independents.  The problem is that many, if not most, Catholics believe these pills cause an abortion.  Now, if they really thought it through, versus simply taking marching orders from a virgin Pope, they would realize that the pills actually prevent an abortion on a developing fetus.  But that’s another story.  Meanwhile, Obama must have dreamt about the commercials from Newt or Mitt painting him as promoting promiscuity among little teenage girls (cue the dark foreboding music).

Continuing his political analysis, there is his relationship with the pro-choice groups, which has been somewhat strained because of the health care “surrender” and a few other issues.  He certainly knew that he would piss them off if he supported the Secretary’s decision, but he is also smart enough to know that the pro-choice groups have no place to go.  Let’s face it, they cannot support someone who wants to reverse Roe v. Wade, so pro-choicers would have to at least vote for him.  The calculated risk he took was whether or not he would make them less enthusiastic about his campaign?  Would they withhold money from him, not work on the campaign, not run independent commercials like they did in 2008?  He probably concluded what I would have concluded:  that when they hear the Republican nominee talking about banning abortion and the polls are a dead heat, they’ll forget this little tussle and will jump on the bandwagon.

His position on this controversial issue is risky and it’s hard to say whether substance or politics ruled the day.  But we need Obama to be re-elected so, as much as I hate to say it, I think he made the right decision.

Ugh.

Mississippi

Mississippi.    

Is there a more pathetic state in the Union?   I mean, does anyone know of a state that is more regressive in terms of income, health, education, baseball teams?   Indeed, can you name a Third World country that is as bad as Mississippi?    

And, now, to push the state even further into the dark ages, their voters on Tuesday will probably pass a resolution that will totally outlaw abortion.  The specific question that the voters will be asked to approve says:  “Should the term ‘person’ be defined to include every human being from the moment of fertilization, cloning or the equivalent thereof?”   Now I can’t imagine anyone in that state who knows what the term “thereof” means, but the gist of this measure is there will be no more abortions and lots more kids to add to the misery that is life in Mississippi.  Indeed, the person who is spearheading this effort, a guy named Les Riley, is the founder of “Personhood Mississippi” and he is the father of TEN children.  I guess old Les is hoping that others in his neck of the woods will bear the same number of kids, if not more, so they can get the classroom sizes up to at least 50 kids per room which would push their rate of academic achievement below that of Somalia.  Quite a role model, that Les!

The interesting thing about this resolution is that many “mainstream” pro-life groups actually oppose it because they are smart enough to realize that it is too extreme.  But, it ain’t too extreme for the Bubbas in Mississippi.  Indeed, outlawing abortion ain’t enough for these folks.  An analysis of the resolution shows that certain forms of birth control would be outlawed (thus creating even more children living in poverty) and it would limit in vitro fertilization.  But, for now, let’s stick to the abortion side of the equation. 

This is Johnny, oh wait, Marie, oh wait "it" has no sex yet.

When the measure passes, the next day Planned Parenthood will challenge it in court and the lower courts will grant an injunction prohibiting the measure from going into effect.  Here’s the thing, however.  Let’s say Mitt Romney (or one of the other Republican nominees) becomes President in 2013.  Despite his previous support for the right to choose, he has now courageously “seen the light” and is all of a sudden pro-life.  What a guy, a true Profile in Courage.  As President, he would be beholden to the pro-life movement and

sooner or later some more Supreme Court judges are going to kick the bucket.  That means that Romney (or, conversely, Obama) might get to make 2 or 3 appointments.  If it’s Romney, you know damn well he is going to appoint judges who are pro-life and that could tip the scales. 

Yes, many lawyers suggest that the court could not uphold a measure like this because of “legal precedent.”  That’s garbage.  It might have been the case years ago when our judicial system, not to mention the executive and legislative branches, were more deferential to their body’s previous actions but not anymore.  I am convinced that when the Supreme Court gets this (or any other) case, the justices, with the possible exception of Justice Kennedy, make up their minds immediately, then instruct their clerks to construct their rationalization.  If you think they sit there objectively, listening intently to the arguments of the learned counsel then come to a decision, you’re in La La land.  I mean, think about it.  Do you really think Clarence Thomas and Anton Scalia would NOT find a way to uphold the Mississippi law?  

So, this case will ultimately make it to the Supreme Court in a few years.  And that makes the next Presidential election so extremely important when it comes to abortion rights.  I feel like we’ve been through this drill before, but this time it’s extremely serious. 

Martini Reader

A very loyal pro-life reader who enjoys his martinis recently sent me the following note: “Dear Pat: I have read your blog for years and you are clearly the most articulate voice in the pro-death movement. Indeed, several times I have come close to converting to your side based on some of your very persuasive arguments. But after the effects of the martini wore off, I came to my senses. Now, my question is do pro-lifers have the right to break the laws that protect the killers and their helpers?’

Well, I appreciate those very kind comments.  Now, let’s get to the question.

Let me first lay out my qualifications (or lack thereof). I went to law school for one year then dropped out, so I am NOT a lawyer. Indeed, I totally bombed on my constitutional law final exam. In addition, I am a former “hippie” who actively opposed the Vietnam War but was never arrested. And I’m too lazy to do a lot of Google research on the definition of “rights.” But I’m smart enough to realize that I am somewhat of a pro-choice “voice” and that this is one of those “gotcha” questions that we all pose in the hopes of trapping our opponents and, if successful, letting the world know about it. But I really don’t care about being “caught” in a seemingly contradictory position or providing some “evidence” that I might have some reservations about the abortion issue (as I have suggested when it comes to third trimester abortions).

Still, my answer on this question is NO.

Of course, those of you who oppose abortion have the ability to break any law you want, including the one that says you can’t murder anyone, bomb a building or trespass on private property. It’s happened in the past and will happen again. So, if you are willing to deal with the consequences, folks, knock yourself out.

But I think it is inherently contradictory to suggest that you have a “right” to break a law. If that were the case, there would only be chaos. When you break the law, you are taking the chance that you will be caught and punished. Now some might harken back to our Founding Fathers who, during their deliberations on the Declaration of Independence, knew they were committing treasonous acts. In fact, many argued that they had an obligation to break the law. But I don’t think any of them would have suggested that it was their “right” to commit treason. Then, later, there were the abolitionists who felt the same moral obligation to free the slaves but they also suffered the legal consequences for some of their unlawful actions.

When I was up to my eyeballs in anti-Vietnam protests, I might have thought that I was doing the moral thing, but I never ever in my wildest dreams would have thought that it was my “right” to violate any laws. Yes, it was my right to protest, Free Speech and all, but only within certain parameters and if I chose to cross those lines, I knew I could be arrested. And, if I was arrested, I could never with a straight face defend myself by suggesting it was my “right” to violate the law.

Looming behind this question is the old “justifiable homicide” argument that Paul Hill made famous. He basically suggested that it was his right to kill a doctor who was going to perform an abortion – but no court ever bought it. Indeed, most pro-lifers never agreed with him either. The purpose of this question that has been posed is designed to get me to agree that killing an abortion doctor is legally defensible.  So, nice try, my pro-life friend, but no dice.

Enjoy your martini!

Yellow Pages Search "The Old Days"

Once a woman decides to have an abortion, the next step is to find a facility in her area that actually can perform the abortion.  In years past, most women would go to their closet, get out the Yellow Pages and let their fingers do the walking to the “Abortion” category.  Once there, she would see a number of ads placed by the clinics.

What a lot of women didn’t realize, however, was that a number of the ads were actually placed by anti-abortion facilities or “crisis pregnancy centers.”  The ads were slick, never really saying whether or not they performed abortions.  The goal was to try to get unsuspecting women to come to their facility where they would then try to dissuade them, often using hard-handed and questionable “information” to do so.  The abuses are pretty well documented.  Indeed, once these “phony abortion clinics” were exposed, the Yellow Page Association was forced to create a new separate category entitled “Abortion Alternatives” for anti-abortion facilities.  I am intimately aware of the course of these events because I was on the staff of the National Coalition of Abortion Providers at the time – the organization that spearheaded the effort to make sure women knew exactly who they were calling.

Today, most patients do not go to the Yellow Pages for abortion services.  Heck, they don’t go to the Yellow Pages for anything anymore.  Instead, they go to Al Gore’s Internet.  And now, the problem of sketchy advertising is rearing its ugly head again.

A woman who has decided to have an abortion will probably do a Google Search for “abortion” or “abortion services” or “abortion clinics.”  If she were interested in getting the pro-life perspective, she might search for “pro-life” or “anti-abortion information” or words to that effect.  But if she wants the abortion, she will do her search, get to that page and immediately sees a number of ads listed in the “sponsored links” section.  That means those facilities are actually paying Google to be advertised in those prominent positions.  And, lo and behold, included in some of the sponsored links are some anti-abortion crisis pregnancy centers!  Then, when you click into their ad and get to their website, it’s the same old story.  They use phrases like “abortion counseling,” “abortion stories,” and “abortion information.”  I searched and searched and found nothing that says “we are anti-abortion.”

Now, I get that the cpcs could argue that they are in fact providing “abortion information” or “counseling.”  But I think the more honest approach would be to say you are providing “anti-abortion counseling.”   Also, I’m sure the pro-lifers who read my world famous blog will come up with examples of how the advertising for the clinics can be “deceptive.”  Indeed, if you DO have examples let us know and we’d be happy to respond.

The point is why do folks play such games with women who are in very emotionally sensitive situations?  Why not be totally up front about what you want to offer?  Then let the women make up their minds if they want to utilize your services.   Meanwhile, I think it would very interesting if someone (perhaps those that manage www.abortion.com) sent an inquiry to the folks at Google and the other search engines asking them to devise something like the Yellow Page folks did years ago so the Internet advertising was just a little more “honest.”

Don’t the women deserve that much?