Tuesday, August 10, 2021
By Kelly Folkers (Aug. 10, 2021)
As the COVID-19 pandemic continues, increasing numbers of patients are seeking care through telemedicine, allowing them to communicate with their doctors and be prescribed medicines without leaving home. Access to abortion medication is a part of this trend, with more pregnant people seeking to terminate early pregnancies by requesting access to medication they can self-administer at home. Despite the FDA’s decision earlier this year not to enforce a previous requirement that abortion medications be administered in person, access to medication-induced abortion remains vastly inequitable as conservative state legislatures target the practice.
Current Food and Drug Administration (FDA) regulations on abortion medication officially require that the first dose be administered in a healthcare setting or under the supervision of a provider specifically certified to prescribe the medication. In 2020, the ACLU filed a lawsuit on behalf of the American College of Obstetricians and Gynecologists (ACOG) challenging the in-person dispensing requirement, which resulted in a nationwide injunction preventing the FDA from enforcing the rule. But the Supreme Court lifted the injunction in January 2021 and held, in a 6-3 decision, that the district court should have deferred to the FDA’s expertise, avoiding the question of whether the rule imposed an undue burden on the constitutional right to abortion. After President Biden took office, the FDA announced in April 2021 that it would not enforce the in-person dispensing requirement for the duration of the COVID-19 pandemic.
The agency is now considering permanently removing the in-person dispensing requirement. But as access to abortion hangs in a precarious balance as the Supreme Court prepares to hear a direct challenge to Roe v. Wade later this year, have passed laws in 2021 targeting medication-induced abortions.
There are two types of abortion: surgical and medication. While a surgical abortion is a medical procedure that must be performed in a clinic or medical office, the procedure for most medication-induced abortions requires that patients take two medicines, mifepristone and misoprostol, at least 24 hours apart, respectively. ACOG has stated in its most recent guidance on medication-induced abortions, that patients can safely and effectively take abortion medications at home. But the FDA issued a Risk Evaluation and Mitigation Strategy (REMS) for mifepristone when it was approved in 2000, requiring that the medication be ordered, prescribed, and dispensed under the supervision of a health care provider who is specifically certified to administer it. The agency issues REMS to “reinforce medication use behaviors and actions that support safe use of that medication.” While there have been some reported adverse events, including a handful of deaths, associated with use of mifepristone, the medication is widely considered to be safe and effective, with over 3.7 million patients having been prescribed the drug since its approval.
Though the FDA announced that it would not be enforcing the REMS on mifepristone during the pandemic, even before the pandemic, the restriction had long frustrated abortion rights advocates, who believe it is too restrictive and politically motivated. In 2019, former FDA Commissioner Dr. Jane Henney argued in the New England Journal of Medicine that the restrictions on distribution of mifepristone made at its approval in 2000, before the drug was widely used and in the United States and additional safety and efficacy data collected, may no longer be appropriate.
Despite ACOG’s assertion that the in-person dispensing requirement has no medical benefit for patients, conservative state legislatures have used the Supreme Court’s decision to target medication-induced abortions. Montana has effectively banned telehealth for abortion. Ohio has a similar law in effect, which is being challenged by Planned Parenthood and other advocacy groups in court. Indiana not only required that the first dose of medication be administered in the presence of a healthcare professional, patients must be advised that their abortions can be reversed with progesterone, which is not scientifically supported. The law has since been blocked by a federal judge. At least 20 states prevent telemedicine appointments for abortion pill prescriptions, and more than 30 require that physicians must write the prescriptions, rather than nurse practitioners or physician assistants who are otherwise able to prescribe medication.
Though laws limiting access to medication-induced abortion continue to threaten reproductive rights, there is hope that under the new Democratic Administration, the FDA will end the restrictive in-person dispensing requirement.
Tuesday, August 3, 2021
By Fallon Parker (Aug. 3, 2021)
Last week marked the 31st anniversary of the Americans with Disabilities Act (ADA), which seeks to affirm and protect the rights of people with disabilities. Among other provisions, the act guarantees equal opportunity to person with disabilities in employment, transportation, services, accommodations, and other areas. While the ADA has resulted in significant changes for the disabled community, persons with disabilities who use reproductive healthcare still struggle to gain access to services.
Disability rights and reproductive justice have always been closely linked. Buck v. Bell, which has not been overturned, allowed for sterilization of institutionalized persons in order to benefit the “welfare of society.” Eugenics, which was espoused as a way to “improve society” and specifically targeted disabled persons, among other marginalized groups, motivated some early supporters of birth control.
Today, it is recognized that persons with disabilities have the same reproductive and sexual health needs as persons without disabilities, and yet studies show that persons with disabilities do not access reproductive care at the same rates as their peers. According to the National Council on Disability, disabled persons reported avoiding regular gynecological visits because they were difficult to obtain, and that healthcare workers often refrained from discussing contraceptives or STD screening with disabled persons and expressed surprise to learn disabled persons were sexually active. Persons with disabilities are also likely to have fewer pap tests and mammograms than persons without disabilities. Additionally, disabled persons are poorer on average than non-disabled persons, and income is directly related to ability to access reproductive services. And some disabled persons who rely on Medicaid do not have access to insurance coverage for abortion services.
Recently there has been an influx of attention to the intersection of disability rights and the reproductive justice movement. Britney Spears, the singer who has been under a conservatorship for 13 years, finally had her day in court and revealed, among other things, that her conservatorship forces her to wear an IUD. While the exact terms and genesis of the conservatorship are not public, it reportedly followed an involuntary temporary psychiatric hold filed on her 13 years ago based on an assessment that she was a possible danger to herself or others.
This year, Spears expressed to a court her desire to have more children and her frustration with not having any control over that decision. In response to Spears’s testimony, several websites have published accounts from disabled persons noting the similarities between Spears’s lack of bodily autonomy and the restrictions that disabled persons face daily. Sara Luterman, a journalist who is disabled, was interviewed for Slate and broke down how difficult it is for people to remove themselves from a conservatorship or guardianship. Luterman mentioned Ryan King, a man with an intellectual disability who could not remove his conservatorship, even though his conservators, who were his parents, asked the court to remove it. Like it is for King, Luterman fears it will be difficult for Spears to remove herself from her conservatorship.
Spears’s conservatorship and her fight for bodily autonomy highlight a common reality for many disabled persons, especially those with reproductive needs. While the ADA was a significant moment in the fight for disability rights, it has fallen short in providing reproductive justice for disabled persons. Within the mainstream reproductive justice movement, disabled persons are often left out of the conversation. The anniversary of this landmark legislation is an opportunity to reaffirm commitment to the importance of disability rights in the fight for reproductive justice and consider how the next 30 years can be used to ensure equitable access to reproductive healthcare for all.