Why Barriers To Abortion Can Be Fatal In A Pandemic

The COVID-19 pandemic has given a big boost to methods of bringing health care to people remotely, known as "telemedicine." If there's a lethal contagion going around, a doctor's office is one obvious place to avoid, if at all possible, and virtual visits make that option more feasible.

So, last year, the federal government took steps to spare Americans from risking their health in pursuit of treatment. The Department of Health and Human Services allowed Medicare to cover more remote services while letting physicians prescribe controlled substances without examining the patient in the flesh.

The Centers for Disease Control and Prevention encourages doctors to use telemedicine and advises patients to get prescriptions delivered. "We are empowering medical providers to serve patients wherever they are during this national public health emergency," said an HHS official.

But there is one big, bad exception. The Food and Drug Administration still demands that women seeking medication abortions troop to a doctor's office to get the prescribed drug. It's a requirement that never made sense as a way to protect women's health. During a pandemic, it means deliberately forcing them into conditions that are bound to spread the virus and cost lives.

The abortion pill at issue is Mifeprex, also known as RU-486. Taken in combination with another drug in the first ten weeks of pregnancy, it is 97 percent effective in inducing abortion. It is also very safe. The FDA reports that "major adverse events" such as serious bleeding are "exceedingly rare." A woman is about 14 times more likely to die from childbirth than from abortion.

The number of American women who die each year from abortion complications is in the single digits — and the mortality risk is lowest for medication abortions. By contrast, more than 3,000 women of childbearing age have died of COVID-19.

Yet the FDA somehow thinks it wise to subject women to the large risks of the virus in the name of protecting them from the minuscule risks of abortion pills. As it happens, the rule doesn't even advance its supposed purpose. Doctors may evaluate and advise the patient remotely. She then has to travel to the clinic or hospital to get the drug, even if she isn't seeing the physician or getting any other services. She is not allowed to get it at a pharmacy of either the walk-in or mail-order variety.

Whatever tiny health hazard there is in a medication abortion, of course, comes only later, when she takes the pill. Any adverse reaction would occur then. But the FDA doesn't insist that she swallow it in a medical facility under the watchful eye of a doctor or nurse. She can do it at home, at work or at a remote backcountry campsite, as far as the agency is concerned.

The American College of Obstetricians and Gynecologists notes, "Mifeprex and its generic are the only FDA-approved drugs for which the FDA regulates where the patient can obtain the drug, but neither specifies where the patient must take it nor requires any supervision of the patient as the drug is administered." The logic is beyond comprehension.

Forcing a pregnant woman to go to a clinic to get the pill is like forcing a football player to wear a helmet when he's watching TV. It serves no purpose. In the case of these women, though, it can be a real obstacle — requiring travel, expense, time off from work and child care arrangements. The journey, even if it's just across town, can also mean more potential exposures to the virus.

Last year, the American College of Obstetricians and Gynecologists filed a lawsuit to lift the rule, and in July, a district court blocked its enforcement. But that decision was overturned, leaving the mandate in place. And the Biden administration, which has taken steps to expand access to abortion counseling and services, has yet to rescind this obviously unfair and dangerous requirement.

Advocates of strict regulation of abortion providers invariably claim to be trying to protect the health of women. But the infallible effect — and the true purpose — is to make abortion harder to get, forcing some women to endure the far higher risks of childbirth. The FDA restrictions on abortion pills do the same thing, compounded by the additional peril of COVID-19.

The rule erects a troublesome hurdle for women exercising a constitutionally protected freedom. But it's not just a needless burden. For some women, in a pandemic, it is bound to be a fatal one.

Steve Chapman blogs at http://www.chicagotribune.com/news/opinion/chapman. Follow him on Twitter @SteveChapman13 or at https://www.facebook.com/stevechapman13. To find out more about Steve Chapman and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.