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About a million women have abortions every year in the U.S. Nearly a quarter of them end their pregnancy through the use of drugs. But just as states have been passing restrictions on surgical abortion, a growing number are trying to limit this method as well. NPR's Jennifer Ludden starts with one of the nation's toughest laws against medication abortion in Ohio.
JENNIFER LUDDEN, BYLINE: To understand Ohio's law, you need a little history. Back in 2000, the FDA approved mifepristone, or RU-486, for abortion. It laid out guidelines - three trips to a doctor, two drugs taken two days apart and only within the first seven weeks of pregnancy. Then, doctors kept experimenting. Lisa Perriera, a Cleveland obstetrician, says they found women can take a much smaller dosage and up to two weeks later, at nine weeks. They can also take the second drug on their own.
LISA PERRIERA: We made it better by making it less costly, by making it easier to use for women. We know it's just as effective, probably actually safer, with fewer side effects.
LUDDEN: Chrisse France heads Preterm Clinic in Cleveland. She says a lot of women preferred drugs to surgery.
CHRISSE FRANCE: Because they could do it in the privacy of their home. It was more comfortable. They could have their partner with them. It felt more natural to them.
LUDDEN: And that's how it works in all but three states. But Ohio law says providers have to follow those original FDA guidelines - more doctor visits, more drugs and earlier cutoff. Preterm Clinic and others fought but lost. A U.S. appeals court ruled the restrictions don't pose an undue burden. Chrisse France disagrees. She says with some of Ohio's clinics closing, it's especially tough for women who must travel a greater distance.
FRANCE: We give them the second medication, and often they'll start cramping and bleeding in their car on the way home. And our legislators have determined that this is good medicine.
MIKE GONIDAKIS: RU-486 isn't just an aspirin, take one and call you in the morning.
LUDDEN: Mike Gonidakis heads Ohio Right to Life.
GONIDAKIS: This is a major drug that you need to be in front of your doctor. That doctor-patient relationship is critical.
LUDDEN: Gonidakis says the law is in the best interest of women's health. Deviating from the original FDA regimen, he says, is watering down the standard of care.
GONIDAKIS: The FDA is the gold standard in our country. The FDA could change the guidelines on RU-486, but they haven't.
LUDDEN: Actually, it's up to the drug manufacturer to apply for new guidelines, a lengthy, expensive process and, medical experts say, totally unnecessary. In fact, last year, the 9th Circuit Appeals Court struck down another law just like Ohio's. In that case, Arizona also argued the FDA guidelines were better for women's health. But the court said the basis for that claim was, quote, "nonexistent." If Ohio has some of the toughest restrictions on medically-induced abortion, the other end of the spectrum is Iowa.
PENNY DICKEY: My name's Penny Dickey. I'm the chief clinical officer for Planned Parenthood of the Heartland.
LUDDEN: Dickey says doctors used to drive hours to remote clinics to provide abortion drugs to women in rural areas. But in 2008, Planned Parenthood started using telemedicine.
DICKEY: The physician and the patient connect via a HIPAA-compliant videoconferencing system.
LUDDEN: The doctor reviews the woman's ultrasound online, asks about her medical history. Then, Dickey says, the doctor clicks his computer to open a locked drawer where the patient is sitting.
DICKEY: Then it will say, are you sure you want to do this? And they'll click again. And the drawer will open.
LUDDEN: The woman takes the mifepristone in view of the doctor. A clinic staffer sitting with her confirms instructions on taking the second drug at home. At first, Iowa's board of medicine agreed this works well. But in 2013, after a Republican governor appointed new members, the board ordered the telemedicine program shut down. The board declined an interview but said in a statement that it's essential for a physician to do an in-person exam before providing abortion drugs. Planned Parenthood sued. The case is now before Iowa's Supreme Court. Meanwhile, 16 other states have proactively banned telemedicine for abortion with a flurry of more bills this year.
DAN GROSSMAN: Medical abortion has the potential to be a real disruptive technology and change the way women access and experience abortion.
LUDDEN: Dan Grossman is an obstetrician and researcher with Ibis Reproductive Health. He says medication abortion is so safe, so easy, you can imagine not needing to visit a clinic at all.
GROSSMAN: So it would really be quite easy for women to actually use this on their own and potentially access this medication directly from a pharmacy.
LUDDEN: Maybe even over-the-counter - not that he expects that to happen in the U.S. anytime soon. But Grossman thinks it does explain the fierce fight from abortion opponents. Jennifer Ludden, NPR News.
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