Texas abortion providers say the percentage of women at their clinics opting for drug-induced abortions to terminate early pregnancies has climbed significantly since March — when the federal Food and Drug Administration updated its rules for the medication.
Representatives from Whole Woman’s Health and Planned Parenthood say drug-induced abortions dropped dramatically after Texas lawmakers passed House Bill 2 in 2013. Among other restrictions, that measure requires providers to narrowly follow FDA guidelines for taking the medicine instead of updated evidence-based protocols.
The original FDA label for mifepristone — which induces abortions when taken with a second drug called misoprostol — was based on medical evidence from the 1990s. The FDA's March change reduces the drug dosage, decreases the number of visits a woman must make to the doctor from three to two and extends how long into her pregnancy she can take the drug from seven weeks to 10. Those are medically accepted guidelines that providers in most states, including Texas, had already been following before HB 2 passed.
Women in Texas must still make an additional trip to the doctor under state law, meaning their visits were reduced from four to three.
“Once the FDA relabeled, we saw an almost immediate change,” Whole Woman’s Health Vice President Andrea Ferrigno said. She said the percentage of women seeking drug-induced abortions at Whole Woman's Health's three Texas clinics jumped from 9 percent right before the label change to 40 percent immediately after it.
By mid-June, the percentage of women opting for drug-induced abortions had grown even higher — to 70 percent at Whole Woman's Health's McAllen clinic and 50 percent at its San Antonio and Fort Worth clinics. Before HB 2 took effect, about 40 percent of women seeking abortions from Whole Woman's Health had gone the drug-induced route.
Planned Parenthood clinics in Austin, Dallas and Fort Worth reported a similar uptick, with about 25 percent of their patients seeking drug-induced abortions in April, compared to just one percent of patients prior to the FDA label change in March. That percentage was 40 percent prior to HB 2, the organization says.
A spokeswoman for Planned Parenthood in Houston said the organization has seen a particular increase in women opting for drug-induced abortions seven to 10 weeks into their pregnancy, as opposed to surgical abortions.
Planned Parenthood's San Antonio clinic did not provide percentages, but a spokeswoman said in an email, “Patient interest in medication abortion has been observably higher since the FDA updated the guidelines.”
State-reported figures show drug-induced abortions in Texas decreased from 19,081 in 2012 to 16,756 in 2013. (Most of the provisions of HB 2 took effect in November of that year.) Data on drug-induced abortions performed in 2014 — the first full year after HB 2 — is not yet available. But the total number of abortions performed in Texas dropped significantly in 2014, with almost 9,000 fewer procedures than the year before.
Before HB 2, Ferrigno said, many women preferred drug-induced abortions because they could take the second pill at home. Once HB 2 went into effect, they were required to visit the doctor’s office for the second pill as well, per the FDA label.
Some women who wanted the medication traveled more than 600 miles to New Mexico, where restrictions are less stringent, Ferrigno said. Other women living close to the border traveled to Mexico, where misoprostol — the second pill in the regimen — is sold as an ulcer drug and is available over the counter.
While the FDA label change has eased the restrictions on drug-induced abortions in Texas, Ferrigno said, women still face barriers to accessing care due to provisions of HB 2.
That law, which is the subject of a U.S. Supreme Court case that could be decided as early as Thursday, requires doctors performing abortions to have admitting privileges at hospitals within 30 miles of an abortion clinic and requires clinics to maintain the same standards as hospital-like ambulatory surgical centers.
Supporters of the law argue that the restrictions are necessary to protect women's health and safety.
There were more than 40 abortion clinics in Texas before the Legislature passed HB 2 in 2013. Today, 19 remain. If the Supreme Court upholds the law, that number could fall to less than 10 — all located in major metropolitan areas.
Disclosure: Planned Parenthood has been a financial sponsor of The Texas Tribune. A complete list of Tribune donors and sponsors can be viewed here.