Pro-abortion rights advocates hope a new lawsuit challenging federal restrictions on the so-called abortion pill would make it easier for women on Hawaii Island to get medical abortions, where access appears to be limited.
Pro-abortion rights advocates hope a new lawsuit challenging federal restrictions on the so-called abortion pill would make it easier for women on Hawaii Island to get medical abortions, where access appears to be limited.
The American Civil Liberties Union filed the suit this month on behalf of Kauai physician Graham Chelius, along with three health care associations. The lawsuit seeks to allow patients to obtain Mifeprex, the brand name for the drug mifepristone, by prescription at retail pharmacies. Mifeprex is one of two medications often referred to as the abortion pill which together end pregnancies up to 10 weeks.
Mifeprex, taken first, blocks the hormone needed to grow a pregnancy. The second drug, misoprostol, generally taken within two days later, induces a process similar to an early miscarriage.
Under current U.S. Food and Drug Administration requirements, Mifeprex only can be distributed to patients at clinics, medical offices and hospitals under supervision of a health care provider who has “registered with the drug manufacturer, attested to their ability to safely prescribe Mifeprex” and has arranged to order and stock the drug at their facility, according to the ACLU complaint.
Chelius told the Tribune-Herald there are no abortion pill providers on Kauai. As a result, island residents generally must fly to Oahu to get the drug which can sometimes delay the process beyond the 10-week limit factoring in time spent arranging transportation, getting prior authorization and scheduling appointments.
Chelius said he doesn’t stock Mifeprex “out of respect for my staff who have an objection to it” and to avoid “a substantial amount of conflict in the workplace.”
“The problem is, we still have women over here who, due to their life circumstances, find the travel over to Oahu creates a barrier,” Chelius said. “A woman comes in, she’s missed maybe two periods, and she’s already really far along that gives us a very limited window … When they’re actually able to go to Oahu, it’s too late to get the pill and they have to have a surgical abortion which some don’t prefer … For our population, we regularly have problems getting women over there.”
“There’s no medical justification for the restrictions they have in place,” he added. “All it does is create problems for patients.”
It’s unclear how many — if any — doctors on Hawaii Island provide abortions. Several people in the industry told the Tribune-Herald on condition of anonymity that a handful of private physicians perform abortions for their own patients but general access by referral is only available at registered abortion facilities on Oahu and Maui.
Requests for comment to those alleged private abortion providers were declined.
Providers are not required by law to disclose if they perform abortions or if they dispense the abortion pill. Under current state law, any licensed physician or surgeon can perform abortions of a nonviable fetus, often considered to be up to 24 weeks. Law also says the state cannot interfere with a female’s right to obtain an abortion nor can a hospital or person be liable for refusing to participate in an abortion.
The Guttmacher Institute, a reproductive health/pro-abortion rights organization, said there were 29 abortion facilities in Hawaii in 2014 though it did not specify where facilities were located. It also said about 40 percent of counties in Hawaii had no abortion-providing clinics in 2014 and 5 percent of Hawaii women lived in those counties.
A Planned Parenthood clinic in Kailua-Kona had previously offered abortions until it closed in 2014. Spokeswoman Katie Rogers said Planned Parenthood is studying the “funding and feasibility” of reopening a Kona clinic.
Honolulu-based obstetrician and gynecologist Shandhini Raidoo, who performs abortions, told the Tribune-Herald she sees patients from Hawaii Island and said many “find it’s very burdensome … to make it out here.” She said the procedure can be covered by insurance but neighbor island women might also foot additional expenses such as child care and time away from work without pay.
Raidoo also said most of her patients have no problems taking the drug combo at home.
“By and large, women are having (much) of the process at home on their own now and most women do very well,” she said. “It’s rare anyone has a complication they need to see a provider for during that process.”
Not everyone agrees.
Eva Andrade, director of the Hawaii Family Forum, said the anti-abortion organization thinks abortion has “short-term and long-term risks to women,” including mental health effects, heavy bleeding, nausea and persistent stomach pain.
Hawaii Family Forum opposes expanding access to the abortion pill, Andrade said, and if the lawsuit is successful, it would be concerned as to whether state-based doctors would be forced to write prescriptions.
“Obviously we’re opposed to abortions in any form,” Andrade said. “We just have strong concerns that when a woman receives this prescription and goes home there are some health complications and risks.”
In 2014, there were 3,760 abortions performed in Hawaii, down 33 percent from 2011, according to the Guttmacher Institute. Not all of those abortions were provided to state residents and some residents might have accessed the procedure in another state.
Email Kirsten Johnson at kjohnson@hawaiitribune-herald.com.