• David M. Rubin

REPUBLICANS TAKE AIM AT THE MORNING AFTER PILL

When the Supreme Court reverses Roe v, Wade later this spring, do not assume that anti-abortionists will declare victory and cease their 50-year war on a woman's reproductive freedom.

The next front is the so-called morning after pill, or "medication abortion." This is a procedure in which a pregnant woman takes the pill mifepristone to stop a pregnancy from progressing. Then, within the next 48 hours, she takes a second pill, misoprostol, that causes her uterus to empty.

This procedure has been approved by the FDA since 2000; it is reported to be between 95 and 99 percent effective in ending a pregnancy.

Not surprisingly, Red State legislatures, including South Carolina's, are gunning for the morning after pill. They are employing the same strategies they used effectively for fifty years to undercut a woman's right to control her reproductive freedom. They are passing laws so burdensome that obtaining the morning after pill will be very difficult, or illegal.

Republican legislatures eviscerated Roe by shrinking the time frame in which an abortion could be performed; mandating waiting periods and multiple visits to a doctor; limiting the kinds of facilities where an abortion could be performed; and much more. A year-old Tennessee law (now stayed be a federal judge) illustrates how the same incremental strategy is being used against the morning after pill.

The law requires providers of morning after pills to inform women that the process can be reversed. If a woman has second thoughts after having taken the first pill, she can reverse the effects by taking a large dose of progesterone.

This is junk science, but we will get to that in a moment.

The Tennessee law orders providers of the pills to inform a woman about the option of "reversal" at least 48 hours before she takes the first pill. This waiting period will force her to think further about the implications of what she intends to do.

After she takes the first pill but before she takes the second pill, the law requires she be told once again about the "reversal" option. In addition, the provider must post signs in the facility stating, in large letters, that reversal of the process is possible. Providers who fail to do this can be prosecuted for a felony punishable by up to six years in prison, and the health facility can be fined $10,000 a day for failure to display the signs.

As I noted, this law is based on junk science---the sort of science Republicans prefer when it comes to climate change, vaccines, and now medication abortion.

There is no evidence that this "reversal" process works. Typical of Republican junk science, it started with an anti-abortion doctor in California who advanced the claim for progesterone injections on the basis of a half dozen patients he had treated. He never designed a study acceptable to any reputable scientific journal to substantiate his claim. In fact, when one scientist did set up such a study, it had to be halted because three of the women in the study suffered serious bleeding.

"The impact on patients of mifepristone, combined with high doses of progesterone is virtually unstudied," according to Kathryn Eggleston, medical director of the lone North Dakota abortion clinic. She stated this in an affidavit obtained by HuffPost and quoted by the website Vox.

Similarly, Mitchell Crenin, an OB-GYN doctor and professor at UC Davis, told Vox that medication abortion is safe. What is not safe is encouraging women to try this untested reversal process. "That's really dangerous," he said.

By means of this law, Tennessee is compelling health care providers to give pregnant women false information that could harm them. This interferes with the relationship between a health care provider and the patient. It also violates the First Amendment rights of the health care provider. The First Amendment not only protects the right TO speak, but it also protects individuals from being COMPELLED TO SPEAK by government.

South Carolina's Republican Legislature is now catching up to Tennessee, Ohio, Arkansas, North Dakota, and others to restrict medication abortion. Last week, Senate Minority Leader Brad Hutto, a Democrat from Orangeburg, walked out of a Senate Medical Affairs Committee hearing in order to halt debate on a pernicious collection of new abortion restrictions, including one concerning the "reversal" procedure as outlined in S. 907

S 907, introduced by Republican committee chair Danny Verdin, requires that anyone providing the morning after pill must include a printed statement with the pills that begins: PLEASE READ BEFORE TAKING SECOND PILL. The statement must tell users about the "reversal" option. It matters not to Verdin that this is junk science and that his bill endangers women.

It is already illegal in South Carolina to use telemedicine to get access to the morning after pills. As yet we don't have Tennessee-type fines and jail terms for not providing junk science about "reversal," but they will come. That's the game plan.

As they draft more legislative attacks on the morning after pill, Republican legislators might want to consider the implications of the sort or surveillance state they want to create:

What if a South Carolina woman uses telemedicine to get a prescription from a doctor out of state, beyond the jurisdiction of South Carolina? Is that illegal?

What if a South Carolina woman travels outside the state to get the pills and brings them back to use in South Carolina? Will she be prosecuted?

What if the pills are offered online by providers who don't require any medical referral and who mail them directly to women? Could that be stopped?

How is the state even going to know about this activity? Do Republican legislators intend to take a leaf out of the Texas playbook and deputize citizens to arrest women and turn them in for using the morning after pill? On March 8 the Washington Post reported that a Missouri Republican has introduced legislation to permit any Missouri citizen to sue anyone who helps a Missouri resident obtain an abortion out of state! Missouri will no longer be the "Show Me" state. It's the Abortion Surveillance State.

In the post-Roe era, South Carolina Republicans will be free to criminalize all sorts of activity related to reproductive freedom. Maybe condoms and the IUD will become illegal. Far fetched?

The battle over the morning after pill is proof that nothing is off the table. Perhaps voters will consider that when legislators like Danny Verdin are up for re-election. Democrats should make that a key campaign strategy.

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