Abortion exceptionalism and the mifepristone REMS

Serpico, Jaclyn

doi:10.1016/j.contraception.2021.03.031

Cited by 9 publications

(3 citation statements)

References 6 publications

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“…85,96 A hurdle in the provision of medical abortion is the Risk Evaluation and Mitigation Strategy (REMS) requirement. 97 The REMS stipulates that mifepristone be dispensed only in a clinic, medical office, or hospital, that dispensing clinicians must obtain certification to provide mifepristone, and that patients are required to sign an FDA-approved agreement before receiving the medication and be informed about the potential adverse effects. 97 ACOG opposes the REMS requirement as mifepristone is extremely safe and effective and it substantially limits access particularly to communities facing barriers to care.…”

Section: Therapeutic Advancesmentioning

confidence: 99%

Mifepristone: A Safe Method of Medical Abortion and Self-Managed Medical Abortion in the Post-Roe Era

Schmidt

Katz

Stein³

2022

American Journal of Therapeutics

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Background:The U.S. Supreme Court's Dobbs v. Jackson Women's Health Organization decision on June 24, 2022 effectively overturned federal constitutional protections for abortion that have existed since 1973 and returned jurisdiction to the states. Several states implemented abortion bans, some of which banned abortion after 6 weeks and others that permit abortion under limited exceptions, such as if the health or the life of the woman is in danger. Other states introduced bills that define life as beginning at fertilization. As a result of these new and proposed laws, the future availability of mifepristone, one of two drugs used for medical abortion in the United States, has become the topic of intense debate and speculation.Areas of Uncertainty:Although its safety and effectiveness has been confirmed by many studies, the use of mifepristone has been politicized regularly since its approval. Areas of future study include mifepristone for induction termination and fetal demise in the third trimester and the management of leiomyoma.Data Sources:PubMed, Society of Family Planning, American College of Obstetricians and Gynecologists, the World Health Organization.Therapeutic Advances:The use of no-touch medical abortion, which entails providing a medical abortion via a telehealth platform without a screening ultrasound or bloodwork, expanded during the COVID-19 pandemic, and studies have confirmed its safety. With the Dobbs decision, legal abortion will be less accessible and, consequently, self-managed abortion with mifepristone and misoprostol will become more prevalent.Conclusions:Mifepristone and misoprostol are extremely safe medications with many applications. In the current changing political climate, physicians and pregnancy-capable individuals must have access to these medications.

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Section: Therapeutic Advancesmentioning

confidence: 99%

Mifepristone: A Safe Method of Medical Abortion and Self-Managed Medical Abortion in the Post-Roe Era

Schmidt

Katz

Stein³

2022

American Journal of Therapeutics

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Section: Setting the Contextmentioning

confidence: 99%

“…In what follows, we outline the impacts of "abortion exceptionalism," that is the idea that abortion is regulated both differently and more stringently than other medical procedures that are comparable to abortion in complexity and safety. [1][2][3][4] This exceptionalism has affected nearly every aspect of abortion care during the pandemic and has placed additional burdens on patients and clinic staff alike.While the concept of "abortion exceptionalism" was originally used by legal theorists to describe regulatory issues relating to abortion, in this paper, we extend the meaning of the concept to also encompass the highly politicized and stigmatized status of abortion in American society. We argue that this status has significantly impacted…”

mentioning

confidence: 99%

COVID‐19, health care, and abortion exceptionalism in the United States

Joffe

Schroeder

2021

Perspect Sexual Reproductive

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Context: Few qualitative findings have been published that explore and identify the challenges experienced by independent abortion providers during the COVID-19 pandemic in the United States (US). In this paper, we explore these themes while expanding the concept of "abortion exceptionalism" beyond its original legal meaning to address the impact of abortion stigma.Methods: Twenty abortion providers from independent abortion clinics throughout the US South and Midwest participated in semi-structured interviews in June and July 2020. Interviews explored the challenges of providing abortion care in the wake of the COVID-19 pandemic and sought to identify how clinics strategized and amended their clinical practices to continue providing abortion care during this time.Results: All providers we spoke to noted significant challenges to providing abortion care in the early days of COVID-19. In addition to experiencing the same concerns as other health care institutions, abortion clinics also faced additional, unique burdens that can only be attributed to the politics of abortion exceptionalism. Examples of this abortion exceptionalism include abrupt orders to close clinics, the need to rely on traveling physicians, legislature-imposed limits on telemedicine, heightened activities of protesters, and non-evidence-based regulation of medication abortion. Conclusion:Despite major challenges and differential treatment, independent abortion clinics in the US persevered to continue to provide abortion care throughout the COVID-19 pandemic. SETTING THE CONTEXTCOVID-19 has brought significant challenges to virtually all health care services in the United States (US). Patients' needs for in-person clinical services have had to be weighed against the need to protect both patients and health care providers from contracting or spreading the virus. Health care institutions have made numerous changes to their practices to minimize the threat of infection by both patients and staff. Facilities that provide abortion not only experienced these same challenges but also faced additional and unique challenges. In what follows, we outline the impacts of "abortion exceptionalism," that is the idea that abortion is regulated both differently and more stringently than other medical procedures that are comparable to abortion in complexity and safety. [1][2][3][4] This exceptionalism has affected nearly every aspect of abortion care during the pandemic and has placed additional burdens on patients and clinic staff alike.While the concept of "abortion exceptionalism" was originally used by legal theorists to describe regulatory issues relating to abortion, in this paper, we extend the meaning of the concept to also encompass the highly politicized and stigmatized status of abortion in American society. We argue that this status has significantly impacted

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