Abortion restrictions relying on 'junk science,' rights advocates say

Abortion rights advocates say new legislation to restrict access is being based on 'junk science'

In Montana, the Legislature has approved and sent to the governor a bill that would require a fetus to be anesthetized before an abortion is performed so it would not feel pain.

In Arizona and Arkansas, doctors are now required to tell women that drug-induced abortions can be "reversed" mid-procedure, even though the American Congress of Obstetricians and Gynecologists says the reversal claims are "not supported by the body of scientific evidence."

And in Idaho, the Legislature passed a bill endorsing telemedicine as a safe way to expand rural healthcare. Days later, however, it barred doctors from remotely administering abortion-inducing drugs, saying telemedicine for this procedure is unproven and risky. Republican Gov. C.L. "Butch" Otter signed both bills into law.

The 2015 legislative session is shaping up to be a primer in what abortion rights advocates call "junk science," with elected officials across the country passing new laws based on theories that have been called into question or debunked by the wider medical community.

Pointing to bills recently passed in the states mentioned, as well as in Oklahoma and Kansas, Guttmacher Institute policy analyst Elizabeth Nash said: "We're seeing more unsubstantiated science. The problem is that legislators are buying into it and using it."

But to state Sen. Fred Thomas, who carried the Montana fetal anesthesia bill, the new laws are about updated and accurate information, and about "old science," which says a fetus can't feel pain until the third trimester of pregnancy, versus "new doctors," who have shown otherwise.

"The new doctors are saying, 'Yeah, it's there, it's pain,'" Thomas said during a floor debate last week. "We ought to be stepping forward and saying, 'Yes, if you're going to perform surgery or abort that baby at 20 weeks, you should provide pain relief to this child.'"

A broad analysis of fetal pain studies published in the Journal of the American Medical Assn. in 2005 concluded that "evidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester," or about 27 weeks of pregnancy.

The JAMA analysis added that there is "little or no evidence" to address whether fetal anesthesia is effective or how safe it is "for pregnant women in the context of abortion."

In 2012, the American Congress of Obstetricians and Gynecologists said in a statement that no new studies published since the JAMA analysis "have changed this dominant view of the medical profession."

That analysis is disputed by abortion foes, however. The Montana bill, HB 479, says "substantial scientific evidence recognizes that an unborn child is capable of experiencing physical pain and suffering by not later than 20 weeks," and that the state has a "compelling interest" in minimizing fetal pain during an abortion.

After a physician tells a woman that a fetus can feel pain during an abortion or surgery, the woman may refuse the fetal anesthesia.

HB 479 is headed to Montana Gov. Steve Bullock's desk. Abortion rights activists hope Bullock, a pro-choice Democrat, will veto the bill and two other efforts passed by the Republican-controlled Legislature to chip away at abortion rights. Once Bullock receives the bill, he will have 10 days to act.

Gregg R. Trude, executive director of Right to Life of Montana, said the fetal anesthesia bill was simply an effort to raise the standard of care for women and fetuses.

"Any surgical procedure, including abortion, on a fetus at 20 weeks of gestation or greater would require anesthesia for the fetus," said Trude, who also serves on the National Right to Life board of directors. "Science has now proven that fetuses feel pain at that age."

Surgical abortion is not the only procedure to be targeted this session. Medication abortion — which uses the drugs mifepristone and misoprostol — has also come under attack.

The Food and Drug Administration approved mifepristone for early, non-surgical abortions 15 years ago. Such abortions require two steps. First, a healthcare provider gives the patient mifepristone while she is at a clinic. The drug blocks the hormone progesterone, causing the lining of the uterus to break down. Two days later, while at home, the patient takes misoprostol, which causes the uterus to contract and empty.

This legislative session, two states passed laws requiring doctors to tell women that a medication abortion can be reversed if they change their minds and want to continue their pregnancies.

Arizona acted first, enacting legislation requiring that a woman be told "orally and in person" at least 24 hours before an abortion that "it may be possible to reverse the effects of a medication abortion if the woman changes her mind but that time is of the essence."

Arkansas' law was signed days later. It requires that women be given similar information at least 48 hours before the procedure.

Dr. George Delgado, a San Diego family physician, is a leading proponent of the theory that drug-induced abortions can be reversed. In 2012, he published in the Annals of Pharmacotherapy the results of a small study, outlining six cases in which women changed their minds after taking the first abortion drug. Four of the six women, he wrote, "were able to carry their pregnancies to term" by taking large doses of progesterone.

In an interview, Delgado said 89 women have now delivered healthy infants and 75 more are currently pregnant after changing their minds and following his protocol to reverse the medication abortion.

"This hasn't been published yet, but it will be," said Delgado, who is medical director of Abortion Pill Reversal. "You can't call it junk science. It's early science."

But Dr. Daniel Grossman, a clinical instructor in the department of obstetrics, gynecology and reproductive sciences at UC San Francisco, said there was no scientific evidence that it was possible to reverse a medication abortion and that telling a woman otherwise "would be medically incorrect."

Mifepristone by itself is "not a very good abortion drug," Grossman said. "If a woman just takes mifepristone in a very rare situation where she changes her mind, the best thing to do is watch and wait and do nothing.... There is a 25% to 30% chance of continuing the pregnancy after mifepristone alone."

Kansas and Oklahoma also have acted this legislative session to further curb abortion. The two states outlawed what is widely viewed as the safest method of surgical abortion in the second trimester, so-called dilation and evacuation.

Kansas Gov. Sam Brownback, a Republican and staunch opponent of abortion, signed the Kansas Unborn Child Protection From Dismemberment Abortion Act on April 7. Both houses of the Legislature had overwhelmingly approved it.

By outlawing dilation and evacuation abortions, said the Guttmacher Institute's Nash, "what you're talking about is essentially limiting access to abortion after 12 or 14 weeks.... When a woman learns she's pregnant at eight weeks, she has a very short time frame to make an appointment, pull together the funding and get to the clinic."

North Carolina lawmakers are considering another tactic. HB 465 would make several changes to the state's abortion law, and effectively bar two state medical schools from training physicians in abortion procedures.

"No department at the medical school at East Carolina University or the University of North Carolina at Chapel Hill shall permit an employee to perform or supervise the performance of an abortion as part of the employee's official duties," the bill says.

Rachel Sussman, director of state policy and advocacy at the Planned Parenthood Federation of America, sees such laws as part of the effort to end access to legal abortion.

"You cannot exist in a world where you care about women's health and safety and require doctors to tell women things that are medically untrue," Sussman said.

maria.laganga@latimes.com

Twitter: @marialaganga

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