New Research Shows Ohio Law Harmed Women

In 2004, Ohio Governor Bob Taft signed House Bill 126, which required physicians to prescribe mifepristone (previously called RU-486) at a dosage level set by FDA protocol. The law was challenged in courts, and finally took effect in 2011. While physicians in other states prescribed a single mifepristone pill to induce abortion, Ohio physicians were forced to use three times that dosage. In 2016, FDA protocol was lowered to the single-pill dosage used by most physicians. New research from the Public Library of Science journal, PLOS Medicine, shows that not only was that requirement unnecessary, it has caused Ohio women to experience worse outcomes than women who just took one pill.

NARAL Pro-Choice Ohio Executive Director Kellie Copeland offered the following statement:

When a woman has decided to have an abortion, it is important that she have access to safe medical care. Ohio politicians do not have a license to practice medicine; however, time and again they interfere with how doctors treat patients. This study clearly shows that political interference resulted in Ohio women suffering a significant increase in medical interventions, side effects, and costs. The takeaway for the Kasich administration and members of the Ohio Legislature is this: leave the practice of medicine to the professionals and keep your ideological and political views out of Ohio’s laws.

Research information

The study from Ushma D. Upadhyay, et al, is titled Comparison of Outcomes before and after Ohio’s Law Mandating Use of the FDA Approved Protocol for Medication Abortion. Her research shows that Ohio’s higher medication abortion protocol included a greater need for additional intervention, more visits, more side effects, and higher costs for women relative to the evidence-based protocol. Additionally, the study showed there is no evidence that the change in law led to improved abortion outcomes.

Using chart data from 2,783 women who obtained a medication abortion between 2010 and 2014 collected retrospectively from four clinics in Ohio, researchers examined the proportion of women who received an additional medical intervention to complete the abortion, the experience of side effects, and the rate of medication abortion versus aspiration abortion in Ohio.

The data showed that women who had medication abortions when Ohio required increased doses were three times as likely to need additional interventions to complete their abortion compared to women in the previous period. In addition, side effects such as nausea and vomiting were significantly more likely among women after the law change, and there was an 80% decline in medication abortion in Ohio between 2010 and 2014.

Additional background

Medication abortion is a nonsurgical abortion in which two medications are taken to induce an abortion. Mifeprex is the brand name for the drug mifepristone. Mifepristone is used in combination with misoprostol for a medication abortion. While it is sometimes called a medical abortion, we use the term medication abortion because it most accurately represents the use of drug-based methods that can terminate pregnancy.

It is legal and common practice in the US for physicians to prescribe pharmaceuticals off-label; one study estimated that 21% of all US prescriptions are for off-label use. Health care providers prescribing medications off-label have the responsibility to be well informed about the product and to base its use on firm scientific rationale and sound medical evidence. Indeed, it is precisely because of off-label use that abortion providers and researchers have been able to refine the medication abortion regimen to maximize effectiveness and minimize side effects.

Abortion providers in Ohio also used off-label evidence-based regimens for medication abortion. However, in February 2011, an Ohio law took effect mandating that abortion providers use the FDA-approved protocol for medication abortion. The law prohibits off-label use of mifepristone, and thus, at the time it was enacted, it prohibited use of the evidence-based regimens for medication abortion.

HB 126 was introduced in March, 2003, by Rep. Tom Brinkman (R-Cincinnati) and was co-sponsored by Rep. Keith Faber (R-Celina), among others. The bill was sent to the governor in June, 2004. Rep. Brinkman also introduced HB 228 around the same time, which was a total abortion ban. After a time out of office, Rep. Brinkman returned to the Ohio House in 2014. As president of the Ohio Senate, Keith Faber has worked to advance an anti-abortion agenda, including introducing SB 214 in 2015 to block Planned Parenthood from accessing state funds for breast and cervical cancer funds, HIV tests, and other preventive health services.

In response to the growing body of clinical evidence, the FDA approved a revised label in March 2016 to bring the medication abortion protocol in line with the off-label prescribing of mifepristone and misoprostol that had become the standard of care. Thus, between February 2011 and March 2016, all abortion providers in the state of Ohio were legally required to use the FDA protocol as approved in 2000.

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