Sarah Baum, MPHinvestigator at the Texas Policy Evaluation ProjectAssociate at Ibis Reproductive Health

Medication Abortion Rebounded in Texas After FDA Approved Label Change for Mifeprex®

Sarah Baum, MPHinvestigator at the Texas Policy Evaluation ProjectAssociate at Ibis Reproductive Health

Sarah Baum Interview with:
Sarah Baum, MPH

investigator at the Texas Policy Evaluation Project
Associate at Ibis Reproductive Health What is the background for this study?  

Response: Before 2013, use of medication abortion in Texas mirrored national trends, which have steadily increased since the approval of mifepristone–one of the two medications used for medication abortion–in 2000. However, House Bill 2 (HB 2), which was implemented on November 1, 2013, imposed restrictions on medication abortion and required providers to follow the outdated mifepristone label. HB 2 reduced the gestational age limit to 49 days and generally required four visits.

On March 29, 2016, the US Food and Drug Administration (FDA) approved a revised label for Mifeprex® (mifepristone 200 mg) that reflected evidence-based practice, which essentially nullified the medication abortion restrictions in HB 2. The label change brought medication abortion prescribing guidelines in line with evidence-based practice, reducing the number of required in-person visits from four to two and extending the period when patients can take the pill from seven weeks of pregnancy to 10 weeks. What are the main findings?

Response:  The use of medication abortion bounced back in Texas after a March 2016 FDA-approved label change for mifepristone. Medication abortion constituted 28% of all abortions before HB 2, 10% after implementation of the HB 2 restrictions, and 33% after the FDA label change. What should readers take away from your report?

Response: The new FDA label has allowed Texas providers to offer medication abortion in a way that is consistent with the best medical evidence, rather than being forced to comply with an outdated label imposed by HB 2. This has increased options for Texas women and brought the proportion of medication abortions in the state in alignment with national data.

However, about 900,000 reproductive-age women in Texas currently live more than 150 miles from an abortion clinic, in part due to clinic closures brought about by HB 2. There are currently 20 clinics in Texas, down from more than 40 before HB 2 was passed. Additional barriers remain to accessing medication abortion in Texas, including a ban on telemedicine for the provision of medication abortion, a mandatory ultrasound during an in-person visit at least 24 hours before taking the first pill, and prohibition of insurance coverage for abortion. What recommendations do you have for future research as a result of this work?

Response: Research can continue to monitor the impact of state and national laws on women’s access to abortion care, especially as new laws are being passed rapidly at the state level.


Contraception. 2019 Jan 23. pii: S0010-7824(19)30014-9. doi: 10.1016/j.contraception.2019.01.001. [Epub ahead of print]

Rebound of medication abortion in Texas following updated mifepristone label.

Baum SE, White K, Hopkins K3, Potter JE, Grossman

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Last Updated on April 6, 2019 by Marie Benz MD FAAD