2011 Ohio law made abortions riskier, more costly

[August 31, 2016]  By Andrew M. Seaman

(Reuters Health) - After Ohio enacted a law forcing abortion providers to prescribe an outdated drug regimen, women who received medication abortions there were more likely to experience complications and higher prices, a study shows.

"That’s what happens when laws aren’t based on scientific evidence," said lead researcher Ushma Upadhyay, of the Bixby Center for Global Reproductive Health at the University of California, San Francisco.

Medication abortions use drugs to end early pregnancies. The 2011 Ohio law forced prescribers to use a two-drug regimen approved by the U.S. Food and Drug Administration (FDA) in 2000 - even though later research showed that a lower dose of one of the drugs (mifepristone) and a higher dose of the other drug (misoprostol), plus some other changes in the regimen, lead to better outcomes.

The Ohio law forced providers to follow the old 2000 method, which went against international guidelines and was not used by most U.S. abortion providers, the researchers write in PLoS Medicine.

To assess the impact of the 2011 law, researchers studied women who had medication abortions at four Ohio abortion clinics, including 1,156 treated in the year before the law went into effect and 1,627 treated in the three years afterward.

Before the law was enacted, about 14 percent of women needed additional treatments - like more medication or aspirations - to end their pregnancy. With the law in place, women's odds of needing those additional treatments were three times as high.

After accounting for factors like age and weight that may contribute to a need for those extra treatments, the risk was increased by about 10 percent.

The proportion of women experiencing side effects such as nausea and vomiting increased from about 8 percent before the law to about 16 percent afterward.

Before the law, about 4 percent of women needed more than one follow-up visit. Afterward, that rose to about 6 percent.

In the meantime, the price of medication abortions rose by about 16 percent.

"Those additional treatments required additional visits," said Upadhyay. "Also, women opting for medication abortions had more side effects than women before the law. They also had higher costs because the protocol is a bit more expensive."

The FDA updated its regimen in March 2016, and women in Ohio and other states with similar laws can now receive medication abortions backed by the most recent science, the researchers note.

But ongoing studies may again change how providers use these medications, in which case women in those states may again be left behind, Upadhyay said.

"There are a lot of advances that women in these states won't be able to take advantage of," she said.

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