Abortions brought on by medications used to be almost completely inaccessible to women in Texas because of state abortion regulations. But in the year since the Food and Drug Administration changed the label for a widely used abortion pill last year, medication-induced abortions have been increasing in Texas.
In 2013, Texas lawmakers passed House Bill 2, a sweeping abortion law that required providers to follow an outdated label on abortion drugs like mifepristone, rather than an "evidence-based protocol." The law put abortion providers in a weird spot by requiring them to prescribe lower doses of the drug.
“Doctors were like, ‘Well, it's not really medically ethical to follow a way that we know isn’t as good for our patients now that we know there is a better way,’” said Kelly Hart with Planned Parenthood of Greater Texas.
Because of that conflict, she said, a lot of providers started pulling back on using the abortion pill since an extra dose was required, which often meant an extra trip to a clinic. The old label also limited when women could use medication abortions.
“Now they [had] to make four trips to the doctor,” Hart said. “They [had] less of a window when they're allowed to use it. So, it just made it a lot less convenient option for women – and so our numbers dropped to less than 1 percent of women who opted for this.”
But in March 2016, the FDA changed the label to the protocol most doctors outside of Texas were already using.
The dosage went down and so did the number of trips women had to take to a clinic in Texas. The label also allowed women to use it for up to 10 weeks of pregnancy, instead of just seven.
Hart said in the first fiscal quarter of 2017, Planned Parenthood of Central Texas saw usage of medication abortions increase to 37 percent of all abortions, compared to 8 percent during the same time last year.
Daniel Grossman, an investigator with the Texas Policy Evaluation Project, said that’s about the percentage of women in the state who have said they prefer medication abortions, so he’s not surprised.
“Many women have a very strong preference for having a medication abortion,” he said. “They see it as less invasive, more private. They are able to have the abortion essentially at home.”
Grossman said when his team was interviewing women after HB 2 but before the label changed, the lack of access to medication abortions was a big issue.
“We interviewed women who talked about how frustrating it was that they couldn't access their preferred method of abortion," he said, "and it really made them really unsatisfied with the care that they got."
In some cases, he said, women would even delay getting an abortion until they could find a clinic that provided the medication, which wasn't always possible.