In the fall of 2007, Jackie* called to schedule an abortion appointment. She said she had heard of a way to have an abortion with medicine and asked if we offered that at our clinic. I informed her that we did have the medicine and had all of our protocols written up and ready to go, but had not yet implemented them. She replied, “Let’s get it done!” A week later, Jackie received the very first medication abortion at Red River Women’s Clinic, the only abortion provider in the state of North Dakota. Jackie’s call gave us the impetus to make medication abortion a regular part of our services. Over the next several years, medication abortion grew to about 20 percent of our practice.
In 2011, however, the North Dakota legislature passed a bill that restricted medication abortion to an outdated U.S. Food and Drug Administration (FDA) regimen from 2000 that runs counter to current, evidence-based medical practice and complicated women’s access to abortion care. With the help of the Center for Reproductive Rights, we challenged the law in district court in 2013, and won. Jackie called, asking if I remembered her. She said she’d been following the case in the local news and that she felt personally attached to the outcome. I told her I did remember her. She said she was happy we were fighting the restrictions.
Following our win, the state appealed to the North Dakota Supreme Court. An injunction that kept the bill from taking effect allowed us to continue to offer medication abortions under the evidence-based regimen. In late October of 2015, the North Dakota Supreme Court ruled against us – putting the outdated FDA regimen into place. We had about 10 days before the ruling went into effect. When that day arrived, I told the last medication abortion patient of the day, Amelia, that she would be the last patient obtaining this regimen. I told her I would remember her, like I remembered Jackie.
Reluctantly, we implemented the outdated FDA regimen, and the number of our patients obtaining medication abortion plummeted. Only about five percent of women opted for this regimen.
Fast forward to this spring, when the FDA finally approved the new label on Mifeprex, in accordance with the evidence-based research and standards. We implemented the new protocol immediately and witnessed the instantaneous difference it made in the lives of our patients. Emily wanted a medication abortion and was scheduled the day of the regimen update. She lived six hours from Fargo and was just past the seven-week gestational limit of the old FDA regimen. When we informed her of the regimen change and that she could now have the medication abortion with only one visit to Fargo, she burst into tears, saying, “But on the phone, you said I couldn’t do it, you said I wasn’t eligible.”
We told her that yesterday she hadn’t been eligible, but today she was. We showed her the FDA website with the updated Mifeprex label. I told her about Jackie. I told her about Amelia. I told her I would now remember her as the first patient using the updated protocol. She hugged me and said she was so happy, that this was what she really, really wanted. It has been about seven weeks since the FDA updated its regimen, and 25 percent of women seeking abortions in North Dakota are now using medication abortion to end their pregnancies.
I have been hoping Jackie calls again. If she does, I’ll tell her that I do remember her and that we are, once again, getting it done.
*Patients’ names have been changed to protect patient identity.
