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Fargo clinic director expects rebound in medication abortions after FDA decision

BISMARCK - The director of North Dakota's lone abortion clinic expects a rebound in the percentage of abortions performed through medication, after the approval this week of a revised drug label that essentially cancels out the effects of a 2011 ...

BISMARCK – The director of North Dakota’s lone abortion clinic expects a rebound in the percentage of abortions performed through medication, after the approval this week of a revised drug label that essentially cancels out the effects of a 2011 state law pushed by abortion foes.

“This is what our patients were asking for,” Red River Women’s Clinic Director Tammi Kromenaker said Thursday.

The law, which banned medication abortions involving the off-label use of a prescription drug, took effect in late October 2014 after the state Supreme Court reversed a district judge’s ruling that had declared it unconstitutional.

Kromenaker said the effects were dramatic.

The clinic started providing medication abortions in late 2007 for women at up to nine weeks of pregnancy. In 2008 and 2009, the method accounted for 27 percent and 28 percent of the clinic’s total abortions, respectively.

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The percentage bounced between 16 percent and 19 percent from 2010 to 2013 but slipped to 14 percent in 2014, when the clinic performed 174 medication abortions. The clinic didn’t offer the option for the last two months of that year, as it was developing a new protocol to comply with the 14-year-old label for the abortion drug Mifeprex as required by the new law.

Kromenaker said medication abortions resumed in late April 2015 but numbered only 50 for the entire year, or about 4 percent of the roughly 1,165 total abortions.

The new protocol meant a higher dosage and cost for Mifeprex, shorter window for when it could be used and an extra trip to the clinic for the other drug used in the procedure, misoprostol, which previously could be taken at home.

“It was a significant impact, and so we are very pleased that the method that our patients want and clearly have taken advantage of is back,” Kromenaker said.

On Wednesday, the U.S. Food and Drug Administration approved new labeling that extends the authorized use of Mifeprex from seven weeks to 10 weeks of pregnancy, cuts the number of Mifeprex doses from three to one and reduces the number of required visits to a doctor.

Kromenaker said the change will make the option cheaper, as each Mifeprex pill costs $68, and the clinic will go back to charging the same amount for medication and suction abortions.

Former state Rep. Bette Grande of Fargo, who was the chief sponsor of the bill in 2011, said the FDA decision “is what it is.”

“If that’s what the FDA has determined is safe – if you can call an abortion ever safe – safer for the woman, then that is the intention of the law,” she said.

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But Grande raised concerns that the new label puts more distance between patient and doctor and could lead to an increase in abortions overall.

“The woman who had to wait, was unable to get that chemical abortion, may have chosen then not to,” she said. “That (FDA decision) could rebound their numbers back, meaning more babies are lost.”

Abortions at the Fargo clinic in 2015 were the lowest in at least five years, according to state Department of Health statistics. The clinic performed 1,247 abortions in 2011, 1,330 in 2012, 1,182 in 2013 and 1,264 in 2014.

Kromenaker noted that the abortion rate is down nationwide. She cited a Guttmacher Institute report that attributed the decline to a drop in unintended pregnancies, while abortion opponents like to credit the additional state restrictions.

“We’re seeing about 10 percent less patients, on trend with the rest of the country,” she said. “There’s just fewer unintended pregnancies, which is a good thing.”

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