The anti-choice movement would like the media to focus as much as possible on proposed bans on later-term abortions, because those are the abortions that cause more unease. However, it's important to understand that anti-abortion politicians are also quietly mounting attacks on access to earlier-term abortions, trying to make them harder to get and more expensive, often resulting in a rise in demand for those post-20 week abortions we're all hearing so much about. The Supreme Court moved a little closer on Thursday toward bringing this battle, which tends to get less press coverage than clinic shutdowns, to the forefront by asking the Oklahoma Supreme Court to clarify a law it had struck down—a law that would have created an obstacle to abortion in the state.
At stake: the availability of RU-486, the abortion pill. (Not to be confused with Plan B emergency contraception, which prevents pregnancy and is available over-the-counter.) Medication abortion typically takes place before nine weeks gestation. It helps expand abortion availability, because you don't need the same types of facilities to hand out pills that you do to perform surgical abortions. Subsequently, nearly 1 in 10 abortion providers only provide RU-486. Seventeen percent of legal abortions are now done with an abortion pill. Medication abortion reduces the wait, the suffering, and the hunt for a decent provider. No wonder the anti-choice movement wants to attack it.
There are a handful of strategies being employed to reduce access to medication abortion. One is to require any abortion provider to meet hospital-level surgical facility standards, even if they only do medication abortions. (The contested Texas bill has just such a provision in it.) Another is to ban telemedicine abortion, where doctors communicate remotely with women taking the pill through the Internet, which gives rural women who are very early in their pregnancies abortion access. One of the most popular methods—and the one that may come before the Supreme Court soon—is to require that doctors follow Food and Drug Administration recommendations and not prescribe the pill in a manner considered "off-label." That's the requirement that Oklahoma passed into law, and that was the requirement that the Oklahoma Supreme Court shut down.
It's a tricky little law because it seems so reasonable on its surface to require doctors to follow simple FDA recommendations. In reality, however, the FDA recommendations are way out of date. The original recommendations required three trips to the doctor: One trip to take mifepristone or methotrexate, another trip a few days later to take misoprostol, and a third trip two weeks later to make sure the uterus emptied out completely. Further research has shown, however, that the second pill can be taken at home, and in fact a lot of doctors prefer to do it this way to make it easier on the patient. In addition, if a patient takes one pill at the doctor and doesn't follow up to get the second one—a sadly common problem for some women who struggle to get one day off work, much less two—there could be complications from taking the first pill that terminates the pregnancy but not the second one that flushes it out. Better to be safer and just send women home with dose No. 2. By forcing doctors to stick to outdated recommendations, anti-choice legislators make medication abortion harder to get and could very well be putting women's health in danger.
That's why the Oklahoma court said that the law "can serve no purpose other than to prevent women from obtaining abortions" and struck it down. It will be interesting to see what happens if this comes back around to the Supreme Court. Right now, the anti-choice movement is focusing on later-term abortions and passing regulations they claim are there to make abortion safer for women (but are in fact about making abortion harder to get). This law, however, only serves to make earlier abortions harder to get, while making it harder for women to finish abortions in a timely, safe manner. This Supreme Court is mostly abortion-hostile, but perhaps the contradictions will be too much even for them.