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Business News/ Opinion / Views/  Abortion rights in the US are under fire from multiple sides
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Abortion rights in the US are under fire from multiple sides

Abortion pills under attack tells us something about conservatism

Viagra has led to more emergency cases in the US than mifepristone. reutersPremium
Viagra has led to more emergency cases in the US than mifepristone. reuters

It’s been almost 11 months since the US Supreme Court overturned Roe vs Wade, and access to abortion just keeps getting worse. A six-week abortion ban advanced again in South Carolina. Legislatures in North Carolina and Nebraska passed measures banning abortion at 12 weeks. Meanwhile, the legality of the abortion pill mifepristone was sharply questioned at a hearing at the 5th Circuit Court of Appeals, a federal court in Louisiana.

These events are stark reminders of why legislators and judges shouldn’t be interfering with women’s medical decisions. Even if we could set aside the basic issues of privacy, liberty and bodily autonomy— which we can’t—it’s clear that many officials don’t get how pregnancy works, why some women seek abortions after 12 weeks or how doctors care for patients who need to terminate their pregnancies.

The six-week ban passed by the South Carolina House shows that lawmakers there failed to hear what the state Supreme Court told them in January: that six-week bans violate the state’s constitution because they don’t give women enough time to both realize that they are pregnant and take steps to end the pregnancy if they desire. About 1 in 3 women don’t realize they’re pregnant until after six weeks. The 12-week bans that advanced in Nebraska and North Carolina are portrayed by their Republican supporters as moderate. But they are only moderate in their treatment of abortion as a political football. Medically, there’s nothing moderate about a 12-week limit. Consider the North Carolina ban, which was passed over the governor’s veto. In addition to prohibiting most abortions after 12 weeks (6.3% of all abortions in the state) it imposes longer waiting periods, additional doctor’s visits and reams of new paperwork. While the law makes exceptions for rape, “life-limiting" foetal abnormalities and the life of the pregnant person, in practice it is difficult to imagine a doctor facing a medical emergency running through a lawyerly checklist of stipulations—not to mention a patient in distress initialling each part of the consent form, as required by the law. This is how partisans, not doctors, approach medicine.

Egregiously, a panel of three 5th Circuit judges questioned the clear safety profile of mifepristone (now used for most abortions in the US) and seemed to misunderstand how it is dispensed. They also appeared to be fully comfortable with challenging the expertise of scientists at Food and Drug Administration, a position made clear when Judge James Ho, an appointee of former President Donald Trump, told Justice Department lawyer Sarah Harrington to “focus on the facts of this case, rather than have this sort of ‘FDA-can-do-no-wrong’ theme." And yet none of the judges showed much empathy. Ho’s colleague on the bench, Judge Cory Wilson, suggested that recent FDA changes allowing mifepristone to be prescribed via mail order or by a provider other than a doctor (for example, by a nurse or midwife) would make it more likely that patients would require emergency care. Under Wilson’s logic, that could put ER doctors who oppose abortion in the position of having to participate in the termination of pregnancies.

Yet, there is no proof that those patients wind up in the ER more often or that medication abortion is unsafe. Complications have arisen in less than 1% of users taking a combination of mifepristone and misoprostol. In most such cases, women don’t need surgery and aren’t at serious risk. Their abortions are just incomplete, and the usual treatment would be a second round of pills obtained from the same medical provider who prescribed the first dose. These patients don’t need to go to the emergency room—or throw themselves on the mercy of doctors who oppose abortion. In fact, more people are admitted to the ER every year for complications of Viagra than for mifepristone.

The FDA has been anything but cavalier in its approach abortion pills. Indeed, the agency has been overly cautious, failing to acknowledge reams of data supporting less restrictive use. Guidelines currently treat mifepristone and misoprostol like dangerous drugs, requiring pharmacies that fill prescriptions to apply for a special licence. But the evidence shows these pills are safer than Tylenol. The proceedings in the 5th Circuit were a worrisome reminder that courts, without medical expertise, feel free to interpret data in a way that undermines the FDA’s authority. That’s dangerous for abortion access, and could pose a threat to pharmaceutical innovation in the US.

Pregnancy is risky for many women, as is evident by the US’s appalling and worsening rate of maternal deaths. Unfortunately, it’s unlikely to get safer in a country where so many policymakers are all so intent on making comprehensive reproductive care harder to get. ©bloomberg

Lisa Jarvis & Sarah Green Carmichael are, respectively, columnist covering biotech, health care and the pharmaceutical industry, and editor at Bloomberg Opinion.

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Published: 22 May 2023, 10:45 PM IST
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