Medication abortions still available in NH following Texas abortion pill ruling
Lois Mattson, Jennifer Burzycki, Jill Smart, and Abby Smart attend an abortion rights rally at the State House on May 13, 2022. (Annmarie Timmins | New Hampshire Bulletin)
Reproductive health care providers reassured patients Monday that pill abortions will remain legal, safe, and available in New Hampshire – even if a Texas federal court judge succeeds in blocking access to one of the two medications used.
They described Friday’s preliminary ruling invalidating the Food and Drug Administration’s 23-year-old approval of the abortion pill mifepristone as an attack on abortion rights and access to basic health care.
“When does it end? It doesn’t,” said Jinelle Hobson, executive director of Equality Health Center in Concord, which provides medication abortion up to 11 weeks of pregnancy.
In 2021, Republican executive councilors cut the center’s funding for low-cost or free cancer screenings, birth control, and other reproductive services. The state’s 24-week abortion ban took effect a year ago. Now it’s become harder for patients to get into the clinic, Hobson said.
“We’ve seen an increase in protesters outside in recent months because of the momentum that they think they have,” she said. “For our patients trying to enter this building, it’s horrific for them.”
We asked Hobson and leaders at Planned Parenthood of Northern New England and Lovering Health Center in Greenland what Friday’s ruling means for patients, how they are preparing for next steps, and what political implications we may see.
Friday’s court ruling is unlikely to have immediate implications.
There are many legal paths ahead in this case.
The federal Department of Justice has said it will appeal the Texas ruling, a step that could halt an immediate change in access to mifepristone.
A second federal judge in Washington issued a contradictory ruling Friday, saying the FDA should make no restrictions on access to mifepristone. That dispute could end up before the U.S. Supreme Court.
Providers said they have begun hearing from clients confused by the news they’re hearing.
“People don’t know what this means for them. They don’t know what this means for their ability to access care,” Nicole Clegg, acting CEO of Planned Parenthood of Northern New England, said during a press call. “This is just the first business day since this decision has been released, so we don’t have a complete sense of how this is going to play out in our area. But confusion is certainly top of the list.”
Staff at Planned Parenthood of Northern New England, Lovering Health Center Executive Director Sandi Denoncour, and Hobson said they will continue to provide the same type of medication abortion they offer now. Even with so much uncertainty about future access to mifepristone, all providers said they have no plans to stockpile doses.
Two-pill versus single-pill abortions
More than half of abortions nationally and in New Hampshire are done via medication, which is available up to 11 weeks of pregnancy at most clinics. Lovering Health Center provides medication abortions for up to 10 weeks.
During a press call Monday, Alison Bates, director of medication abortion, sedation, and ultrasound at Planned Parenthood of Northern New England, said more than 70 percent of its patients chose medication abortion. This past summer, the organization’s New Hampshire providers began offering medication abortion via telehealth for patients without health risks.
Patients first take mifepristone, the drug targeted in the Texas case, followed by misoprostol. Where the “morning-after pill” prevents pregnancy, mifepristone and misoprostol terminate a pregnancy by blocking the progesterone needed for a pregnancy to continue. Providers tell patients to expect cramping and bleeding.
Should providers lose access to mifepristone, they said they will offer medication abortion via misoprostol only. It’s a slightly less effective approach, Bates said. Single-medication abortion is 85 to 95 percent effective depending on when a patient seeks termination. When mifepristone is taken first, the procedure is 87 to 99 percent effective, Bates said. A one-dose procedure is also less “patient-friendly,” Bates said.
Denoncour agreed. And medically, it’s not best practice, she said.
“We always want to err on the highest quality evidence-based protocol,” she said. “And we do know that the experience for patients with misoprostol only can be more uncomfortable.”
If providers have to pivot to single-drug abortions, Hobson said Equality Health Center may offer single-medication abortions up to only nine weeks of pregnancy instead of 11 weeks, to account for differences in effectiveness and side effects.
Hobson has wondered if less access to medication abortion would lead to more demand for more invasive, in-office surgical abortions.
“This affects the low-income people, people with lack of transportation or access,” Hobson said. “Offering medication abortion provides people the option to be at home. It’s another travesty here for us, it’s another hit. But we’re going to continue to do what we do, providing the medical care that people are seeking, period.”
That care has increasingly included emotional support for patients following medication abortions, provided by the Reproductive Freedom Fund of New Hampshire.
Launched in 2019, the organization has focused on raising money to assist people with abortion expenses. Executive Director Josie Pinto said the organization has helped over 450 people and raised over $250,000.
Recently, it has begun working with Lovering Health Center and Equality Health Center to provide patients with volunteer doulas who offer emotional support via phone, text, or online following a mediation abortion.
Political implications – for both sides
Anti-abortion advocates have cheered the Texas ruling, as they did the U.S. Supreme Court’s overturning of Roe v. Wade.
Reproductive health care providers and Pinto said they are wondering if they will see an equally vociferous response from abortion-rights groups motivated to protect abortion access.
“I hope the public understands that the organizations providing these services still need their direct support, but that the battle, what will change and protect us for the future, is a political battle,” Denoncour said. “And I hope that folks will learn more about how they can personally become involved in asking their legislators what they need to do to protect access and protect services. I do think people are paying attention.”
There are two abortion bills before lawmakers. House Bill 88 would prohibit further restrictions on abortion access beyond the existing 24-week abortion ban. The other, House Bill 224, would remove the criminal and civil penalties for violating the abortion ban.
Both passed the House with help from Republicans and are now before the Senate. During a Senate Judiciary Hearing on HB 88 last week, 1,231 people registered their support for the bill, while 319 said they opposed it.
New Hampshire has seen other restrictions on reproductive health care in New Hampshire.
The four Republicans on the five-member Executive Council cut funding in 2021 to the three largest providers of state-subsidized reproductive health care.
Prior to the vote, nearly 17,000 people were receiving low-cost or free cancer screenings, STI testing and treatment, birth control, prenatal care, and other non-abortion services from Planned Parenthood of Northern New England, Equality Health Center, and Lovering Health Center. They represented about 80 percent of the people in the state’s Family Planning Program.
In voting down their contracts, Republican councilors cited concerns the three were using some of the federal money for abortion care, despite assurances from the Department of Health and Human Services its review showed they were not.
The department has said no other health care providers stepped forward, leaving four in the program, in Berlin, Laconia, Nashua, and Manchester.
In November, three Republican councilors defeated a $682,000 sex education contract aimed at reducing teen pregnancy in Sullivan County and Manchester, which have the state’s highest teen birth rates.
The three, Joe Kenney of Union, Ted Gatsas of Manchester, and David Wheeler of Milford had previously voted for the decade-old program. Wheeler and Kenney cited concerns about parental involvement, though students can participate only with a parent’s permission.
U.S. Sen. Jeanne Shaheen announced in February that she was working to find federal money to continue the program. Shaheen spokesperson Sarah Weinstein said the application window is still open. The application site said awards could be made in August.
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