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The next legal fight over abortion may center on a pill called mifepristone, which the U.S. Food and Drug Administration has ruled to be safe. Shortly after the U.S. Supreme Court ruled that the Constitution does not protect the right to an abortion, Attorney General Merrick Garland said:
We stand ready to work with other arms of the federal government that seek to use their lawful authorities to protect and preserve access to reproductive care. In particular, the FDA has approved the use of the medication Mifepristone. States may not ban Mifepristone based on disagreement with the FDA’s expert judgment about its safety and efficacy.
Axios said online sales of mifepristone will rise right away:
More abortion pills are expected to be ordered online and delivered through the mail after Friday’s Supreme Court decision to overturn Roe v. Wade.
Abortion care through telemedicine is expected to increase, but with Roe overturned, the prescribed drugs that terminate pregnancies are likely to become the next major contention between abortion rights activists and opponents of abortion rights, Axios’ Jacob Knutson reports.
The pills used to terminate a pregnancy — mifepristone and misoprostol — are FDA-approved for use in the first 10 weeks of pregnancy and are frequently prescribed online and mailed to patients.
In 2020, the majority of U.S. abortions (54%) were medication abortions, up from 39% in 2017, according to the Guttmacher Institute. In some European countries, up to 90% of abortions are done using pills, according to the Plan C information campaign.
Pew Stateline reports on how several states have attempted to control mifepristone and misoprostol:
Since January, legislators in at least 20 states have proposed bills that would restrict or ban access to abortion pills approved more than two decades ago by the U.S. Food and Drug Administration.
This year’s flurry of bills was spurred in part by an FDA ruling during the coronavirus pandemic that eliminated a long-standing requirement that patients consult with prescribers and pick up the pills in person.
Under the FDA’s temporary ruling, which was made permanent in December, patients for the first time can consult with prescribers via telehealth and receive the pills by mail.
In response, lawmakers in Georgia, Kentucky, Louisiana, Maryland, Minnesota, Missouri, Nebraska, Ohio, South Dakota and Tennessee quickly proposed bills that would reinstate the old FDA rules.
The bills would require patients to pick up the pills at a medical facility rather than receive them in the mail, and in South Dakota, take the pills under observation by a medical professional.
Lawmakers in Iowa, Massachusetts, Minnesota and Missouri proposed bills that would ban telehealth consultations and instead require one or more in-person visits to a medical facility to receive abortion pills.
Outright bans on dispensing or using the FDA-approved medications have been proposed in Alabama, Arizona, Iowa, South Dakota, Illinois, Washington and Wyoming.
Lawmakers in 13 states also proposed legislation requiring physicians to tell patients that medication abortions can be reversed by administering doses of progesterone, a controversial treatment the American College of Obstetricians and Gynecologists says is not based on science and does not meet clinical standards.
Where states do try to control abortion pills, women may turn to online and telehealth services or buy the pills from offshore sources such as “Aid Access,” which has been supplying abortion pills since 2018 and charges fees adjusted to income. Aid Access outlines how it responds to women in the U.S.:
In the US states: Alaska, California, Colorado, Connecticut, DC, Idaho, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New York, New Jersey, New Mexico, Nevada, Oregon, Rhode Island, Vermont, Virginia and Washington, our US doctors can provide abortions with the medicines mifepristone and misoprostol, which you will receive by mail within a few days. The costs of this service in 150 USD.
For other US states and other countries, our European doctors can provide the prescriptions for abortions with the medicines mifepristone and misoprostol. You will be informed about a trustworthy pharmacy in India who will ship the medicines to you by mail. The delivery of the packages take 1 to 3 weeks after shipment. The cost of this service is 95 Euro or 110 USD.
80 district attorneys say they will not enforce abortion bans
80 prosecutors signed a document that says, in part:
Not all of us agree on a personal or moral level on the issue of abortion. But we stand together in our firm belief that prosecutors have a responsibility to refrain from using limited criminal legal system resources to criminalize personal medical decisions. As such, we decline to use our offices’ resources to criminalize reproductive health decisions and commit to exercise our well settled discretion and refrain from prosecuting those who seek, provide, or support abortions.
Prosecutors are entrusted with immense discretion. With this discretion comes the obligation to seek justice. And at the heart of the pursuit of justice is the furtherance of policies and practices that protect the well-being and safety of all members of our community.
Abortion bans will also disproportionately harm victims of sexual abuse, rape, incest, human trafficking, and domestic violence. Over the past several decades, law enforcement has rightly worked to adopt evidence-based, trauma-informed approaches that recognize that not all victims of such crimes are able or willing to immediately report, and that delays in reporting or a reticence to report are consistent with the experience of trauma.
As prosecutors, we also know that the process of reporting can be retraumatizing for many survivors. We are horrified that some states have failed to carve out exceptions for victims of sexual violence and incest in their abortion restrictions; this is unconscionable. And, even where such exceptions do exist, abortion bans still threaten the autonomy, dignity, and safety of survivors, forcing them to choose between reporting their abuse or being connected to their abuser for life. Laws that revictimize and retraumatize victims go against our obligation as prosecutors to protect and seek justice on behalf of all members of our community, including those who are often the most vulnerable and least empowered. Our obligation to exercise our discretion wisely requires us to focus prosecutorial resources on the child molester or rapist, not on prosecuting the victim or the healthcare professionals who provide that victim with needed care and treatment.
The 80 prosecutors are in Georgia, California, Missouri, Virginia, New York, Maryland, Alabama, Colorado, Maryland, Minnesota, Wisconsin, North Carolina, Texas, Illinois, Tennessee, Oregon, Maine, Ohio, Pennsylvania, Massachusetts, Oregon, New Mexico, Florida, North Carolina, Louisiana and Kansas.
Are we underreacting to monkeypox?
The World Health Organization’s emergency response committee ruled this weekend that monkeypox does not pose enough of a concern to be called an “international public health emergency.” But the committee said it is concerned about the outbreak and, if it keeps spreading, the committee will meet again and reconsider.
There have been 173 documented cases of monkeypox in 24 U.S. states, and the figures are growing daily. Around the world, the case count now tops 3,400 confirmed cases and about as many suspected cases. In two weeks, the number of cases worldwide has tripled. 72 people have died in eight African countries.
All of this raises the question of when Americans will get concerned after more than two years of living in a COVID-19 pandemic.
Like COVID-19, monkeypox is constantly evolving into new variants.
The Center for Infectious Disease Research and Policy notes:
The strain of the virus in the current monkeypox outbreak in nonendemic countries likely diverged from the monkeypox virus that caused a 2018-19 Nigerian outbreak and has far more mutations than would be expected, several that increase transmission, according to a study today in Nature Medicine.
The study comes from Portugal’s National Institute of Health in Lisbon, which was the first institution to genetically sequence the current strain behind more than 3,000 cases of monkeypox in Europe, North America, and other regions that had never seen the virus until this year.
The WHO recently updated its guidance on how to treat people who may be exposed to monkeypox. Health officials say they are continuing to see “a notable proportion of cases in gay, bisexual and other men who have sex with men.”
CIDRAP reports on the guidance:
The World Health Organization (WHO) said it does not recommend mass vaccination campaigns at this time to limit the outbreaks, and instead emphasized contact tracing and isolation to limit the further spread of the poxvirus.
In new interim guidance on vaccine use against monkeypox, the WHO said contacts of cases should be offered post-exposure prophylaxis (PEP) with a vaccine within four days of first exposure to prevent onset of disease.
Pre-exposure prophylaxis (PrEP) is recommended at this time only for health workers at risk, laboratory personnel working with orthopoxviruses, clinical laboratory staff performing diagnostic testing for monkeypox, and others who may be at risk as per national policy, the WHO said.
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