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An Ohio Abortion Law Does More Harm Than Good

Complications of medication abortions have tripled since Ohio put restrictions in place, researchers report.

By Nathan Collins


An anti-abortion display in Celina, Ohio. (Photo: Emmanuel Dunand/AFP/Getty Images)

Among Ohio’s many restrictions on abortion is one that probably seems like a good idea: Women seeking a medication abortion must follow the Food and Drug Administration’s recommendations on the procedure that were in place at the time the law passed. But, in practice, it’s not been innocuous at all: According to a new retrospective study, complications following medication abortions have tripled since the law took effect in 2011.

“There is no evidence that the change in law led to improved abortion outcomes,” a team led by University of California–San Francisco Associate Professor Ushma Upadhyay writes in PLoS Medicine. “Indeed, our findings suggest the opposite.”

The Ohio law concerned how to administer the drugs mifepristone, the subject of great controversy in the 1990s, and misoprostol. In 2011, the FDA recommended that both drugs be administered in a clinic, contrary to international and recently updated FDA guidelines, which state it’s safe to take misoprostol at home. Indeed, it is safe to take misoprostol without a clinician, just as it is safe to take a smaller dose of mifepristone than the FDA suggested at the time, according tostudies that had been published in the decade before Ohio’s restrictions went into effect. It’s also perfectly legal for doctors to use the drugs however they want—FDA guidelines are really recommendations, not laws or regulations, and many drugs are used “off-label” once they’re approved.

Before the law went into effect, 4.9 percent of the women studied had to have some kind of additional treatment, compared with 14.3 percent after the law.

Nonetheless, Upadhyay and her colleagues wanted to see if there had been changes in the outcomes of women who used medication abortions after February 2011, when the law went into effect. To answer that question, they reviewed medical charts from four Ohio abortion providers and compared the results of 1,156 pre-law and 1,627 post-law abortions, with particular focus on whether those abortions were successful and whether there were any complications.

The law’s effect was stark: Before the law went into effect, 4.9 percent of the women studied had to have some kind of additional treatment, compared with 14.3 percent after the law. The most common of those additional treatments were an additional dose of misoprostol (in 8 percent of cases) or an aspiration (in 3 percent of cases). Although adverse events such as an incomplete abortion, hemorrhaging, and infection were uncommon, the rate did increase from about 2 percent before, to about 5 percent after the law went into effect. Because the law required a higher dose of drugs than research showed was necessary, costs increased as well, from an average of $426 pre-law to $511 post-law.

It’s not entirely clear why the law had health impacts on women, but it may be due to a higher dose of mifepristone and the way women took misoprostol—orally, rather than vaginally—in the post-law period, the authors write.