"With the exception of the West Coast and most (but not all) of the Northeast, recently enacted abortion restrictions can be found almost everywhere" in the United States, Linda Greenhouse writes in a New York Times opinion piece.
According to Greenhouse, "Since 2011, 10 states, from the Canadian border to the Great Lakes to the Southwest, have each imposed 10 or more new barriers to access to legal abortion." Moreover, another "21 states have enacted between one and 10 restrictions," Greenhouse writes, noting that this "lower number in some cases simply reflect[s] a state's creativity in having already adopted a long menu of anti-abortion measures." Observing that "each of the top 10 states" has a conservative governor, Greenhouse writes, "Politics -- political culture -- outweighs geography."
"Some of what's been happening in states scattered around the country come[s] under the 'you couldn't make this up' category," she continues. As examples, Greenhouse lists "the Wisconsin law (Act 37), struck down by a federal appeals court, that gave doctors a July weekend" to obtain hospital admitting privileges and an Indiana law (HB 1337) that "require[s] cremation or burial for aborted or miscarried fetuses." She also points to Iowa, where the state medical board banned telemedicine abortion -- though the Iowa Supreme Court later ruled that the ban "violated the right to abortion as understood by the Iowa Constitution." Eighteen other states have implemented similar bans.
However, "of all these states, Arizona wins the prize," Greenhouse writes, pointing to a new state [SB 1324] law that "forbid[s] doctors who prescribe the abortion medication mifepristone to deviate from the Food and Drug Administration's specifications that were in effect as of last Dec. 31."
The original label, in effect since 2000, "required a 600-milligram dose and restricted the drug's use to the first seven weeks of pregnancy," Greenhouse explains. However, she notes over time, evidence-based regimens were developed proving "that one-third of the original dose was equally effective with fewer side effects, and that the drug was safe and effective for up to 10 weeks of pregnancy rather than seven." The evidence-based regimen "became standard medical practice, endorsed by leading medical organizations," she writes, noting that "[d]octors commonly refused to give the original dose, on the ground that it was not in their patients' best interest."
Greenhouse states, "As medication abortion grew in popularity ... the dosage issue became a handy target of anti-abortion activism," explaining that states passed laws forcing doctors to follow the original label "knowing that doctors would feel ethically obliged to stop administering medication abortion rather than comply." According to Greenhouse, "Arizona was one of the early adopters of this strategy with a 2012 law [HB 2036] that required adherence to the F.D.A. label." However, this law was struck down as unconstitutional in 2015.
Despite the ruling, "the State Legislature was determined to keep trying," Greenhouse continues. She explains that one day after FDA "announced ... it was revising the label to reflect the evidence accumulated through actual medical practice: a 200-milligram dose, to be administered during the first 10 weeks of pregnancy," Arizona Gov. Doug Ducey (R) nonetheless signed the latest bill, which "specified not just adherence to the F.D.A. label, but adherence to the label that existed last Dec. 31."
Greenhouse writes, "While a half-dozen other states have required adherence to the F.D.A. label (while not interfering with the 'off-label' uses that doctors commonly make of other drugs), Arizona's legislators are the only ones, as far as I know, to take measures to assure that a regulatory change in Washington would not render their efforts useless." According to Greenhouse, "There is no doubt that the courts will quickly dispose of the newly signed law."
Greenhouse states that the updated FDA label "should bring down the curtain on a fascinating and revealing episode in the abortion wars." She notes abortion-rights opponents have focused on medication abortion because it "promises the ultimate in women's empowerment and privacy." With medication there is "[n]o need for a fancy facility" or "a doctor's presence," and there are "[n]o pickets or gauntlet of 'sidewalk counselors' urging women to turn back," Greenhouse explains.
She concludes, "While everyone was looking in the other direction, waiting with hope or fear for the Supreme Court to deliver its next word on abortion, the Obama administration moved with discretion and precision to fix a particular problem. Just one piece of a bigger problem, to be sure, but the result is a changed landscape for abortion access -- east, west, north and south" (Greenhouse, New York Times, 4/13).
