Why 2020 presidential candidates should support over-the-counter access to abortion pills

Abortion access is facing a monumental crisis, as states across the nation continue to advance and enact restrictive abortion laws, the Trump administration puts in place reproductive health policies that ignore science, and the Supreme Court is set to decide a major case on abortion regulations next year.

Amid this treacherous landscape, two key factors will help determine the future of abortion in the United States: the outcome of the 2020 presidential election, and the outcome of ongoing efforts to make medication abortion (also called the abortion pill) easier for people to get.

So far, the Democratic presidential candidates have not engaged in a robust conversation about their views on the crucial issue of expanding access to medication abortion. But they should. And fortunately, that is starting to change.

Just last month, the Democratic presidential candidates responded to a New York Times survey about their positions on abortion, including a question about whether they would make mifepristone and misoprostol — the two pills used in medication abortion —available over the counter. Seven candidates said they supported OTC medication abortion, two were unsure and seven didn’t answer the question.

Growing crisis of abortion access

While there has been public discussion about OTC access to birth control pills, there has been little buzz about making abortion pills available without a prescription. The public response to the survey results has ranged from concern about abortion pills being sold like aspirin, to relief that this could ease the growing crisis of abortion access.

Six states have only one abortion clinic left, and some states could soon have none, depending on how the Supreme Court rules in the Louisiana case it has accepted.

I’ve been doing research related to OTC access to medication abortion for several years, both in the United States and abroad, and the reality is that this is not an immediate panacea. More studies are needed, and it is likely several years before the Food and Drug Administration will review an application to make abortion pills available without a prescription.

Even so, it’s an important step that the Democratic candidates were even asked about this policy change, which has the potential to radically transform how people access and experience abortion care.

Rally at the Supreme Court on May 21, 2019. (Photo: Andrew Caballero-Reynolds/AFP/Getty Images)

Research increasingly indicates that people are interested in OTC access to abortion pills. In a 2017 survey we conducted of over 7,000 U.S. women ages 18-49 about their interest in obtaining abortion pills over the counter, 37% said they supported OTC access to abortion pills. They often cited advantages related to convenience and how it would facilitate access to care earlier in pregnancy. In another survey we did of abortion patients in states with limited access to the service, 80% said they supported OTC availability.

As a practicing OB-GYN, I have few concerns about the safety of making medication abortion available without a prescription or clinical evaluation. This treatment is simple and involves taking the two medications, usually 24 hours apart, which leads to cramping, bleeding and expulsion of the pregnancy.

Most of the eligibility assessment for the abortion pill involves a simple list of questions that patients themselves could easily complete. For example, we ask patients whether they have an intrauterine device in place, because it needs to be removed before using abortion pills, and we ask whether they’re taking blood thinners, which can increase bleeding.

Research shows these pills are safe

Currently, medication abortion is FDA-approved for use up through 10 weeks of pregnancy; after this point, the drug regimen changes. If abortion pills were available without a prescription, one question is whether patients could accurately self-assess their gestational age, and another is whether they might choose to use the pills beyond 10 weeks because they had limited alternatives. We are conducting a study of the accuracy of gestational age self-assessment, which will help answer at least the first question.

In many parts of the world, people already have access to abortion pills without a prescription. In most of Latin America, where abortion is largely restricted, misoprostol is often available in pharmacies without a prescription — and its expanded access has been associated with a reduction in deaths and complications from unsafe abortion.

Research from Peru and Bangladesh suggests that women can safely and effectively use abortion pills they obtain without a prescription.

Our research shows: Abortion laws are not based on facts and can even harm women

Of course, over-the-counter abortion pills are not the answer for everyone. Many patients appreciate the support they receive from clinicians and clinic staff. The future of patient-centered abortion care must include a range of options, including facility-based services.

As in other countries, there are an increasing number of reports about U.S. women accessing abortion pills without a prescription, including through online sources, which the FDA claims is illegal.

At least 21 people have been arrested or criminally investigated for allegedly attempting to self-induce their abortion or for helping someone else, and women of color have been disproportionately targeted for criminalization. 

Make abortion pills easier to get now

An FDA move toward approving OTC abortion pills would help decriminalize and destigmatize self-managed abortion. But first, in order for the FDA to approve medication abortion for over-the-counter sale, a pharmaceutical company would need to perform specific research showing that women can safely and effectively use the product without medical supervision. That would take at least three to five years, assuming the studies go well and there is no political interference in the FDA approval process.

Out of step: Trump’s new Title X plan requires ineffective birth control most women don’t want

That timeline is too long to make a difference for people living in the South and Midwest who are facing an immediate and potentially worsening crisis of abortion access. But there are steps policymakers could take now to improve access to the abortion pill and help people obtain safe care early in pregnancy: lifting medically unnecessary regulations that prohibit doctors from prescribing the pill for dispensing at a pharmacy, lifting restrictions in almost 20 states on telemedicine (which research shows is safe and effective for medication abortion), and allowing nurse practitioners and other advanced practice clinicians to provide the abortion pill (fewer than 20 states do now, though outcomes are similar).

As more abortion patients seek out online options for self-managed care, it’s time to meet their needs with services like over-the-counter access to medication abortion. This is the future of reproductive health care, and we must continue to ask politicians, including those currently seeking the presidency, about how they plan to make it a reality.

Daniel Grossman, M.D., is a professor of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco and director of Advancing New Standards in Reproductive Health. Follow him on Twitter: @DrDGrossman

You can read diverse opinions from our Board of Contributors and other writers on the Opinion front page, on Twitter @usatodayopinion and in our daily Opinion newsletter. To respond to a column, submit a comment to [email protected].

Source: Read Full Article