On Tuesday (January 3), the United States Food and Drug Administration (FDA) finalised a rule that would allow retail pharmacies in America to provide mifepristone, one of two drugs (along with misoprostol) used in medication abortions, for the first time. For more than 20 years, the FDA had limited dispensing to speciality offices and clinics. In December 2021, owing to the Covid-19 pandemic, it lifted the in-person requirement for patients to obtain a prescription through a healthcare provider. A prescription is still required under the new rule, but patients can now pick up the pill at a store or through mail order. Medication abortion accounts for more than half of U.S. abortions and would now become more accessible in states where abortion remains legal, Reuters reported. The American College of Obstetricians and Gynaecologists called the move "an important step". What the new abortion pills rule says On its official website, the FDA noted that in 2021, it conducted a review of the Mifepristone Risk Evaluation Mitigation Strategy (REMS) Program, the system under which the drug is available, and “determined that the available data and information support modification of the REMS to reduce burden on the health care delivery system and to ensure the benefits of the product outweigh the risks.” Under the new rule, those seeking the medicine can get it more quickly from retail pharmacies, provided they are certified to dispense mifepristone after completing a Pharmacy Agreement Form. The rule adds that such pharmacies “must ensure mifepristone is dispensed to the patient in a timely manner.” Once pharmacies begin dispensing the drug in states that allow abortion, it “will make it much easier to access the pill,” said Naomi Cahn, a professor at the University of Virginia School of Law, to Reuters. What about states that have reduced access to abortion? Last year, after the American Supreme Court’s conservative majority struck down the 1973 Roe v. Wade judgment that federally legalised abortion in the US, states such as Alabama, Arkansas, Texas, West Virginia, and Wisconsin have near-total bans on abortions. Others such as Georgia have a six-week ban in effect, making abortions largely inaccessible. Bans in some states also target mifepristone. “FDA's new regulation will not help patients get abortion pills in states that have banned abortion, said Amanda Allen of the Lawyering Project, a legal group that defends abortion rights,” to Reuters. But the rule could make it easier to travel out of state for a medication abortion by a patient obtaining the prescription and the pill in that state. Reuters reported that as of November 2022, 16 states that permit abortions at some level had laws restricting mifepristone, including requirements that it be provided by a physician. Whether the pharmacies must comply with these state laws or the federal FDA rule is not clear yet. Are there any legal hurdles here? America has a long history of anti-abortion groups that identify as "pro-life", and claim to oppose abortion on moral and religious grounds. Alliance Defending Freedom, a conservative legal group that calls itself the "world's largest legal organization committed to protecting religious freedom, free speech, the sanctity of life, marriage and family, and parental rights", filed a lawsuit in November seeking to undo the FDA's approval of mifepristone for abortion, alleging concerns over safety. "All abortions end the life of the child and pose risks to the mother. But chemical abortions are far more dangerous to the mother than even surgical abortions. The FDA must protect the health, safety, and welfare of women and girls by rejecting dangerous chemical abortion drugs,” it said on its website. If former US President Donald Trump-appointed judge Reed O’Connor rules in favour of suspending the FDA's approval of the drug, it would effectively pull the drug from the market nationwide and render the latest FDA rule moot, Reuters reported. The judge earlier ruled that the healthcare reform law, the Affordable Care Act, was unconstitutional. Abortion laws in India Before the Medical Termination of Pregnancy (MTP) act of 1971, abortions were criminalised under the Indian Penal Code. The MTP changed that but still imposed heavy restrictions, especially pertaining to unmarried women. As per the 2021 amendment, the act allows abortion in a number of circumstances, most based on the health and safety of the woman. The law allows abortion during the first 20 weeks, with approval from a medical practitioner and from the 20 to 24 weeks with authorisation by two medical practitioners. In cases involving a severe foetal anomaly after the 24-week mark, a three-person medical board must confirm the diagnosis with the final decision resting with a judge. The Ministry of Health and Family Welfare notes regarding the procedure, “In the case of termination of early pregnancy up to 7 weeks using RU-486 with Misoprostol, the same may be prescribed by a Registered Medical Practitioner (RMP) as defined under clause (d) of section2 of the Act and Section 4 of MTP Rules, at his clinic.” But a lack of access to medicinal intervention has been flagged in India, too. A 2020 study on the availability of medical abortion drugs in Assam, Delhi, Haryana, Madhya Pradesh, Punjab and Tamil Nadu by the Foundation for Reproductive Health Services (FRHS), a non-government provider of clinical family planning services said: “(53.4%) of all chemists cited legal issues/barriers such as strict regulations, specific communication not to sell MA (Medical Abortion) drugs by the local drug authority and government ban as reasons for not stocking MA drugs. 30.8% reported that low demand for these drugs was a deterrent. 43.9% in Madhya Pradesh and 38.2% in Delhi reported “too much paperwork /documentation requirement” as a reason for not stocking MA drugs. 36.8% of chemists in Assam who were not selling MA drugs at the time of the survey reasoned that these drugs are harmful for women’s health.”
