In North Dakota, A Fight for Access, A Fight for Common Sense

The women who come to the Red River Women’s Clinic, in Fargo, N.D., arrive with a range of reasons for choosing medication that induces abortion:
“less traumatic,” “not as invasive,” “no needles,” “more personal,” and on.

The factors women consider in their choice of medication abortion are many, and their decision is steeped in common sense and personal understanding.
The technological advances that made medication abortion possible have made a huge difference for more than one million American women.

Scientists developed the technology in the 1980s, but it wasn’t approved by the U.S. Food and Drug Administration until 2000. Typically, two
types of medications are involved. When a woman in the first nine weeks of pregnancy goes to a reproductive health facility, she takes one tablet of a
drug called mifepristone. This blocks a hormone called progesterone, which is responsible for sustaining a pregnancy.

At this point, the pregnancy stops developing. Sometimes the uterus empties without any further action, but more often women will take a drug called
misoprostol between 24 and 48 hours after the mifepristone to trigger that process.

In the best of situations, this happens when a woman is comfortable, in the privacy of her home, and being supported by a friend or loved one.

Medication abortion is a simple, safe procedure that gives women—under the right circumstances—the chance to go through a difficult process
in a way that affords them more dignity. So anti-choice activists are doing everything they can to stop it.

As with all FDA-approved medications, the agency permits the drug sponsor to market the drug for a particular use with a particular regimen. For many
drugs, additional scientific research is done to find more effective ways to take the medication and to determine whether there are other medical
conditions it can be used to treat. Today, about one out of every five drugs is commonly used for these “off-label” purposes.

Research proved that medication abortion could be extremely effective by making adjustments to the drug sponsor’s regimen. Specifically, studies
proved that three tablets of mifepristone weren’t necessary, and that women didn’t need to take misoprostol at a facility. Doctors
universally adopted the new method. Why? The studies found that the new regimens had fewer side effects and were more effective. They were also more
affordable. Mifepristone also runs about $85 a tablet. Cutting the dosage by as much as two-thirds made this health care service far more accessible.

This difference between the practical application of mifepristone and the regimen on the product label has become an avenue for anti-choice legislators
to restrict women’s reproductive rights. In North Dakota, the legislature passed HB 1297, a law that requires doctors to follow the initial, and
currently outdated, label for the provision of medication abortion and places an unnecessary burden on women by requiring that they take the
misoprostol in a doctor’s presence.

The hostility of this law goes beyond simply robbing women of the privacy and comfort that a medication abortion offers. First, it forces women to
undergo surgery even when it’s medically inadvisable—akin to a doctor being forced to perform open-heart surgery for a condition that could
be treated just as effectively with heart medication.

Secondly, it requires an additional trip to the health care facility, a potentially severe hardship for women in North Dakota, which has just one
abortion clinic. Fifty percent of Red River’s patients come from at least four hours away. Many of them don’t have the money or the time to
make a long trip that is completely unnecessary.

Equally important, misoprostol can work quickly—in as few as 30 minutes. If women had to take it at a facility, it would be almost impossible to
make it to the comfort of their home to complete the abortion.

And economics play a role, too. Red River, like many clinics in less populated areas, operates on a tight budget. Employing a doctor for an additional
day’s work each week—if they could find a doctor with the time—would drive the price of a medication abortion even higher, putting it
out of reach of many.

“I can think of no medical reason why the drugs I utilize in our medication abortion protocol should be treated any differently than other
prescription medications,” said Kathryn Eggleston, a physician at the Red River Women’s Clinic.

No other law in North Dakota denies people in the state off-label prescriptions. In fact, some of the state laws attempt to protect off-label uses for
other medications.

The sole motivation behind this law and others like it is to choke off access to a constitutionally protected health service.

That’s why the Center for Reproductive Rights is in North Dakota today, seeking to win permanent access to safe, effective, legal medication
abortion for all the women who come hundreds of miles to Red River Women’s Clinic.

“It’s crucial that we have Center to help us,” says Tammi Kromenaker, director of the Red River Women’s Clinic. “There’s no way we could have mounted this challenge. We would’ve buckled under. Only the Center can continue to keep this option available for women.”

We’re doing the same on a similarly abusive law in Oklahoma later this spring. We fight these laws because they block vulnerable women from a
reproductive health service that is compassionate, private, and makes total sense.