The two pregnancy tests she took early last year had come up negative, but this time a faint plus sign surfaced in the plastic window. Samantha, 21, knew immediately what she wanted to do.
One week later, Samantha and her partner spoke to a counselor at Affiliated Medical Services, a Milwaukee clinic that provides abortions. She determined she would prefer the medication option to the surgical option. This would allow her to terminate the pregnancy earlier by taking two pills.
Carrying a 21-credit load at the University of Wisconsin-Milwaukee and working 40 hours a week at a coffee shop, Samantha hoped to obtain the abortion as quickly as possible.
But then the counselor raised a caveat.
"After she finished explaining the procedure, she hinted to us that it might be a difficult time to procure a medication abortion," said Samantha, who spoke to the Wisconsin Center for Investigative Journalism on condition that her last name not be used to protect her privacy.
Samantha later learned that state lawmakers were planning to change the rules for medication abortions, which could make it more difficult to obtain follow-up care.
"That was really scary," said Samantha, who became pregnant because of a medical condition that rendered her birth control pills ineffective. She decided to wait several weeks to have a surgical abortion as she juggled work and school. She was fatigued and depressed.
A new Wisconsin abortion law, Act 217, went into effect last April. It prompted the state’s two leading abortion providers, Affiliated Medical Services and Planned Parenthood of Wisconsin, to stop providing medication abortions that month.
Affiliated Medical Services resumed offering medication abortions in May, after a legal review. Planned Parenthood, which has filed a federal lawsuit against the law, is still not offering this option.
Billed as a way to make abortion safer for women, the law had the consequence of limiting access to medication-induced abortions, leading more women to have more invasive surgical abortions and putting some women at greater risk by increasing the wait-time for appointments.
Dr. Doug Laube, a University of Wisconsin-Madison professor and former president of the American College of Obstetricians and Gynecologists, has condemned the new law.
"I believe that this law is legislated medicine generated by political ideology and it is a dangerous barrier to women seeking safe and legal nonsurgical abortion," Laube said in a conference call with reporters, organized by Planned Parenthood in December.
Doctors raise several safety concerns
Dr. Fredrik Broekhuizen, medical director for Planned Parenthood of Wisconsin, said surgical abortions require more time with physicians. This causes scheduling delays and increases the risk of complications.
Planned Parenthood and Affiliated Medical Services have reported delays ranging from a few days to more than two weeks. This sometimes means that medication abortions can no longer be done.
Additionally, Broekhuizen said, surgical abortions are less safe or even impossible for women with certain medical conditions.
Others prefer medication abortions for the privacy they offer, said Nicole Safar, public policy director for Planned Parenthood Advocates of Wisconsin. Patients are generally able to take the second pill, which expels the contents of the uterus, from home.
"More than the physical piece, for many women medication abortion is the right choice for her entire self — emotionally, psychologically," Safar said. "Many women would prefer to go through the process at home, with their family."
Since the U.S. Food and Drug Administration approved mifepristone and misoprostol pills for abortions in 2000, Wisconsin women have increasingly relied on this option for abortions in the first nine weeks of pregnancy. In 2011, the state reported, 24 percent of the roughly 7,000 Wisconsin women who had abortions in the state chose the medication option.
Matt Sande, who lobbied for the bill with Pro-Life Wisconsin, said his group is pleased with the new law and not upset that providers in Wisconsin stopped offering medication abortions.
"We applauded that, naturally," Sande said. "If Planned Parenthood and Affiliated Medical Services were to permanently suspend medication abortions, it would reduce the induced abortions in Wisconsin by approximately one-fourth."
But the providers tell a different story. Rather than opting out of abortions, Safar said women are traveling out-of-state for medication abortions, or having surgical abortions instead.
Though Safar said the number of surgical abortions for 2012 will not be available until March, she said doctors have noted an increase in surgical procedures, while the total number of abortions has continued to decline as in most years in the past decade.
Doctors at Affiliated Medical Services also provided more surgical abortions due to their roughly three-week suspension of medication abortions, according to Wendie Ashlock, the clinic’s director. In 2012, Ashlock said, they provided 1,925 surgical abortions, 68 more than the previous year. They also provided 523 medication abortions, 73 fewer than the previous year.
Telemedicine concern spurred new law
Proponents of the change say it is needed to stop doctors from prescribing abortion medication over a webcam, as has happened in Planned Parenthood clinics in Iowa.
Susan Armacost, legislative director of Right to Life Wisconsin, said she and other pro-life advocates feared this practice would spread to Wisconsin, putting women at risk. She cited FDA reports that between 2000 and 2011, 14 women died after taking the drug, though the FDA noted it did not have enough information to attribute the deaths to the medication.
"We thought the doctor should at least see her and give her a physical exam," Armacost said.
But officials at Planned Parenthood say they had no plans to use teleconferences for medication abortions in Wisconsin.
Similar “telemedicine”-targeted laws have been passed in eight other states, but Wisconsin is the first in which Planned Parenthood has responded by suspending medication abortions.
In December, Planned Parenthood of Wisconsin filed a lawsuit in federal court seeking to get Act 217 either clarified or struck down. They specifically challenge two of the requirements in the law for being “unconstitutionally vague.” Violations of the law may lead to civil and criminal penalties, including jail time, for doctors.
First, Act 217 requires the physical presence of a doctor when the medication is "given." Broekhuizen, a plaintiff in the lawsuit, said it’s unclear whether the physician must be with the patient when she takes the second pill, traditionally at home.
Second, the law requires that the physician determine the patient is not being coerced, but Broekhuizen said it does not provide clear enough guidelines for doing so.
“I do not understand what is permitted and what is illegal,” Broekhuizen wrote in a court document. “It is unclear to me what a physician must do to ensure compliance.”
Abortions now harder to obtain
Before Act 217, Planned Parenthood and Affiliated Medical Services already required medication abortion patients to come to a clinic for a physical exam and counseling 24 hours before receiving the pills. As mandated by Wisconsin law, this includes options for continuing or terminating a pregnancy.
The patient swallowed the first abortion-inducing pill at the clinic, took the second at home, and scheduled a third visit to confirm the termination of the pregnancy.
Sande said he hopes by making the same physician present for verifying the woman’s consent and giving her the abortion-inducing pills, a woman will be more likely to change her mind or reveal that she is being coerced if that is the case.
Vicki Saporta, president of the National Abortion Federation, of which Affiliated Medical Services is a member provider, said this requirement is unnecessary and burdensome. She said it has caused delays in scheduling appointments.
Saporta said this can even result in some women not having abortions — the ultimate restriction on their ability to choose.
“Sometimes, it could be the one more hoop they’re not able to go through,” Saporta said. “Most women are able to find a way, but some are not.”
This story was distributed by the nonprofit Wisconsin Center for Investigative Journalism collaborates with Wisconsin Public Radio, Wisconsin Public Television, other news media and the University of Wisconsin-Madison School of Journalism and Mass Communication.
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