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Research study

Ohio’s Transfer Agreement and Medication Abortion Laws

- back to the Evaluation of Abortion Restrictions Project

Transfer agreements

Background

In 2013, Ohio enacted a law requiring all abortion facilities to have transfer agreements with private hospitals. Unable to obtain such agreements, many facilities have had to close as a result. 

Objective

To understand the effects of clinic closures on women who attempt to access abortion care at a closed facility.

Study design

In collaboration with providers currently at risk of closing or that have closed, we recruit women whose appointments were canceled or could not be scheduled due to the clinic closing.  Women will be referred to the study by clinic staff, and a phone interview will be conducted with participants three weeks following their last contact with the closed clinic.

Key findings

Forthcoming

FDA protocol for medication abortion

Background

In 2011, an Ohio law took effect mandating use of the FDA-approved protocol for medication abortion. The protocol in place at that time, which was approved in 2000, restricted medication abortion to gestations ≤7 weeks LMP, used a higher, more expensive dose of mifepristone, and required an additional visit for misoprostol to be provided in clinic (see Table below). In March 2016, the FDA approved a label change for mifepristone, which brought the protocol in line with the current evidence base for medication abortion. At equivalent gestations, the evidence-based regimens have higher effectiveness rates than the outdated FDA-approved regimen. It is routinely administered throughout the U.S. and the world, and is the regimen recommended by guidelines of the American College of Obstetricians and Gynecologists, the National Abortion Federation, and the World Health Organization.

Protocol comparison

 

FDA-approved regimen

Current evidence-based regimen

Maximum days gestation

49 days from LMP

70 days from LMP

Mifepristone dose

600 mg. orally in office

200 mg. orally in office

Misoprostol dose

400 mcg. orally
(2 tablets)

800 mcg. vaginally/buccally
(4 tablets)

Misoprostol timing

48 hours after mifepristone

6-72 hours after mifepristone

Misoprostol location

Provider’s office

Home

Follow-up visit

14 days after mifepristone

5-14 days after mifepristone

Cost

Higher

Lower

Minimum number of office visits
(including Ohio’s required consent visit)

4

3

Adapted from: Reproductive Health Access Project. LMP=last menstrual period

Objectives

To understand whether implementation of the state-mandated FDA protocol in Ohio led to increases in the need for subsequent intervention among medication abortion patients; to examine changes in the sociodemographic composition of women obtaining medication abortion; and to assess the percentage of women accessing medication abortion compared to aspiration abortion prior to and following the law’s implementation.

Study design

A retrospective cohort study, comparing outcomes of medication abortions in the pre-law period to those in the post-law period. Researchers collected patient data from four Ohio abortion facilities to compare the rate of additional intervention before and after implementation of the FDA protocol.

Key findings

  • More medical treatments: Women in the post-law period had three-times the odds of needing at least one additional medical treatment to complete their abortion as women in the pre-law period—medical treatments increased from 4.9% pre-law to 14.3% post-law.
  • More follow-up visits: Women were required to come into the clinic four times to complete their abortion post-law compared to three times pre-law. Significantly more women had to have two or more additional follow-up visits to complete their care—4.2% pre-law vs. 6.2% post-law.
  • Side effects: Among women having a medication abortion after the law change, 8.4% reported at least one side effect in the pre-law period, compared to 15.6% post-law.
  • Higher costs: Due to the higher dose of the costly drug mifepristone, average patient charge for medication abortion rose from $426 to $551 between 2010 and 2014, reflecting a 16% increase in price after adjusting for inflation.
  • Decline in use: The four clinics in the study saw an 80% decline in medication abortions between 2010 and 2014 compared to a 17% decline in all abortions over same time period. The proportion of all abortions provided in these clinics that were medication abortions declined from 22% in 2010 pre-law to 5% post-law.

See also our issue brief Impact of Ohio’s law mandating use of the FDA-approved protocol for medication abortion and our infographic on the impact of the law

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ANSIRH is a program within the UCSF Bixby Center for Global Reproductive Health and is a part of UCSF's Department of Obstetrics, Gynecology & Reproductive Sciences.

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