BILL ANALYSIS Ó
AB 2134
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Date of Hearing: April 19, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 2134
(Waldron) - As Amended April 13, 2016
SUBJECT: Clinics: notice: abortion pill reversal.
SUMMARY: Requires licensed clinics that perform abortions to
post a notice advising clients that it may be possible to
reverse the effects of the abortion pill. Specifically, this
bill:
1)Requires a licensed facility that performs abortions to post
the following public notice in English and the primary
threshold languages for Medi-Cal beneficiaries, as determined
by the Department of Health Care Services for the county in
which the facility is located:
"It may be possible to reverse the effects of the abortion pill.
If you change your mind after taking the abortion pill, time
is of the essence. Contact the Abortion Pill Reversal Hotline
."
2)Requires the notice to be at least 8.5 inches by 11 inches,
written in no less than 22-point type, and posted in a
conspicuous place where individuals wait that may be easily
read by those seeking services from the facility.
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EXISTING LAW:
1)Requires the Department of Public Health (DPH) to inspect and
license health facilities, including but not limited to
clinics.
2)Provides for exemptions from licensing requirements for
certain types of clinics, including federally operated
clinics, local government primary care clinics, clinics
affiliated with an institution of higher learning, clinics
conducted as outpatient departments of hospitals, and
community or free clinics. Provides for exemptions for
community or free clinics that are operated on separate
premises from the licensed clinic and are only open for
limited services of no more than 20 hours per week (also known
as intermittent clinics).
3)Authorizes DPH to take various types of enforcement actions
against a primary care clinic that has violated state law or
regulation, including imposing fines, sanctions, civil or
criminal penalties, and suspension or revocation of the
clinic's license.
4)Establishes the California Reproductive Privacy Act, which
provides that the state shall not deny or interfere with a
women's right to choose or obtain an abortion prior to
viability of the fetus, or when the abortion is necessary to
protect the life or health of the woman, and makes legislative
findings and declarations that every individual possesses a
fundamental right of privacy with respect to personal
reproductive decisions, and that every woman has the
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fundamental right to choose to bear a child or to choose and
to obtain an abortion, as specified.
5)Enacts the Reproductive Freedom, Accountability, Comprehensive
Care, and Transparency Act (Reproductive FACT Act) and
requires clinics and other facilities that provide family
planning or pregnancy-related services to provide specified
notices to clients.
6)Defines a "licensed covered facility," for the purposes of the
Reproductive FACT Act, as a licensed clinic or an intermittent
clinic operating under a primary care clinic whose primary
purpose is providing family planning or pregnancy-related
services, and that satisfies two or more of the following:
a) The facility offers obstetric ultrasounds, obstetric
sonograms, or prenatal care to pregnant women;
b) The facility provides, or offers counseling about,
contraception or contraceptive methods;
c) The facility offers pregnancy testing or pregnancy
diagnosis;
d) The facility advertises or solicits patrons with offers
to provide prenatal sonography, pregnancy tests, or
pregnancy options counseling.
e) The facility offers abortion services; or,
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f) The facility has staff or volunteers who collect health
information from clients.
FISCAL EFFECT: This bill has not been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, any licensed
facility providing pregnancy-related services is required to
post a sign in the waiting area alerting visitors to
California's free and low-cost public programs for family
planning, prenatal care, and abortions. The author states
that this bill will require a license covered facility to post
a sign notifying the public about the option to reverse the
effects of the abortion pill. The author states that the
"RU-486" abortion drug is a combination of mifepristone and
misoprostol, which is used to terminate a pregnancy. The
author contends the abortion reversal protocol can reverse the
effects of the first drug administered, mifepristone, by
administering progesterone into a woman's body. The author
asserts that progesterone blocks the effects of mifepristone,
found in the first step of the abortion pill, which cancels
its effects and that this gives a pregnant woman the option in
a timely manner to reverse the abortion if she changes her
mind.
2)BACKGROUND.
a) Abortion data. According to a 2014 Guttmacher Institute
document titled "State Facts About Unintended Pregnancy:
California," contraceptive use is a key predictor of
women's recourse to abortion. The very small group of
American women who are at risk of experiencing an
unintended pregnancy but are not using contraceptives
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account for more than half of all abortions. Many of these
women did not think they would get pregnant or had concerns
about contraceptive methods. The remainder of abortions
occur among the much larger group of women who were using
contraceptives in the month they became pregnant. Many of
these women report difficulty using contraceptives
consistently. According to the Guttmacher Institute, at
current rates, about three in 10 American women will have
had an abortion by the time she reaches age 45.
Approximately 58% of women having abortions are in their
20s; 61% have one or more children; 85% are unmarried; 69%
are economically disadvantaged; and 73% report a religious
affiliation. No racial or ethnic group makes up a
majority: 36% of women obtaining abortions are white
non-Hispanic; 30% are black non-Hispanic; 25% are Hispanic;
and, 9% are of other racial backgrounds.
According to the Centers for Disease Control and Prevention
(CDC), in 2012, 699,202 legal induced abortions were
reported to CDC from 49 reporting areas. The abortion rate
for 2012 was 13.2 abortions per 1,000 women aged 15 to 44
years, and the abortion ratio was 210 abortions per 1,000
live births. Compared with 2011, the total number and
ratio of reported abortions for 2012 decreased 4%, and the
abortion rate decreased 5%. Additionally, from 2003 to
2012, the number, rate, and ratio of reported abortions
decreased 17%, 18%, and 14%, respectively. Given the large
decreases in the total number, rate, and ratio of reported
abortions from 2011 to 2012, in combination with decreases
that occurred during 2008 to 2011, all three measures
reached historic lows.
b) Abortion procedures. Medical abortion, which involves
the use of medications rather than a surgical procedure to
induce an abortion, is an option for women who wish to
terminate a first-trimester pregnancy. Although the method
is most commonly used up to 63 days of gestation
(calculated from the first day of the last menstrual
period), the treatment also is effective after 63 days of
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gestation. The CDC estimates that 64% of abortions are
performed before 63 days of gestation. Medical abortions
currently comprise 16.5% of all abortions in the United
States and 25.2% of all abortions at or before nine weeks
of gestation. Mifepristone, combined with misoprostol, is
the most commonly used medical abortion regimen in the
United States.
"Abortion reversal" is a procedure in which the hormone
progesterone is injected into a patient after she has taken
mifepristone in an effort to reverse its effects. It was
developed by an anti-abortion doctor, who in a 2012 article
in the Annals of Pharmacotherapy claimed to have injected
progesterone into six women to reverse the effects of
mifepristone, which resulted in four of those women giving
birth. The article concluded that some women who take
mifepristone wish to reverse the medical abortion process
and that progesterone competes with mifepristone for the
progesterone receptor and may reverse the effects of
mifepristone.
According to Physicians for Reproductive Health, if a woman
takes both pills as part of RU-486 it is 98% effective and
it is not known what taking just the first pill does to the
effectiveness, regardless of the attempt to reverse the
effects. Because there have been no clinical trials the
"abortion reversal procedure" has not been tested for
safety, effectiveness, or the likelihood of side effects.
The approach is not recommended in the American Congress of
Obstetricians and Gynecologists' (ACOG) clinical guidance
on medication abortion. Indeed, ACOG and the American
Medical Association agree that there is no reliable
evidence that medication abortions can, in fact, be
'reversed' through a course of treatment.
An article published in the May 2015 journal Contraception,
"Continuing pregnancy after mifepristone and "reversal" of
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first-trimester medical abortion: a systematic review,"
notes that, women rarely change their minds after beginning
a medical abortion. According to reports that physicians
are required to submit to the drug's manufacturer, between
2000 and 2012, less than 0.004% of women taking
mifepristone in the US later chose to continue the
pregnancy, and notes that in such a case, a women should be
counseled that there is a reasonable chance (10 to 45%)
that the pregnancy will continue. The review found no
credible evidence that using medication after ingestion of
mifepristone is better than expectant management (watchful
waiting) in assuring a continuing pregnancy and suggesting
otherwise is scientifically untenable. The article
concludes that legislative interference in the
patient-physician relationship is unwarranted and
dangerous.
3)SUPPORT. The California Catholic Conference (CCC) supports
this bill stating, all women, particularly those who are
low-income or poor, deserve the opportunity to be supported in
their choice to parent a child by those who offer more
personal and familial options than those clinics who offer
primarily medical services and abortion. CCC concludes the
state of California owes women the opportunity to exercise
"their reproductive rights" by presenting all possible and
available options.
4)OPPOSITION. NARAL Pro-Choice California (NARAL) opposes this
bill stating, "Abortion pill reversal" is a highly
controversial experimental procedure that has not been well
tested, and medical providers have argued it is not
responsible to present women with the option. NARAL also
notes, in addition to the risk of notifying patients about a
medically unproven procedure, giving women information on
medication abortion "reversal" is based on the false
assumption that women who seek abortion care are not informed
about their decision.
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Planned Parenthood Affiliates of California (PPAC) oppose this
bill noting that the bill forces health care professionals to
provide abortion patients with information that is medically
inaccurate and could be harmful to a woman's health. PPAC
concludes that this bill impedes a woman's ability to make an
informed decision because the abortion "reversal" procedure
isn't just scientifically unproven, it could be dangerous.
5)RELATED LEGISLATION.
a) AB 2775 (Gallagher) requires facilities that offer
abortion services to disseminate a notice to clients
providing a telephone number for a specific organization,
and stating that non-profit pregnancy centers can provide a
variety of specified services. AB 2775 is pending in
Assembly Health Committee.
b) AB 2081 (Grove) provides that a health care service plan
is not required to include abortion as a covered benefit,
and would prohibit the Director of the Department of
Managed Health Care from denying, suspending, or revoking a
plan's license, or otherwise sanction or discriminate
against a health plan, if the health plan excludes coverage
for abortions.
6)PREVIOUS LEGISLATION.
a) AB 775 (Chiu and Burke), Chapter 700, Statutes of 2015,
enacts the Reproductive FACT Act and requires clinics and
other facilities that provide family planning or
pregnancy-related services to provide specified notices to
clients.
b) AB 1254 (Grove) of 2015, was substantially similar to AB
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2081. AB 1254 failed passage in the Assembly Health
Committee.
c) AB 2336 (Grove) of 2014, would have prohibited a person
from performing, or attempting to perform an abortion if
they know the pregnant woman is seeking the abortion on
account of the gender of the unborn child. AB 2336 failed
passage in the Assembly Health Committee.
d) ACA 5 (Grove) of 2014 would have prohibited, except in
the case of an emergency, a physician from performing an
abortion on an unemancipated minor unless the physician has
notified one of her parents, or a judge has granted the
unemancipated minor a waiver of the notification
requirement. ACA 5 failed passage in the Assembly Health
Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
California Catholic Conference, Inc.
Opposition
American Civil Liberties Union
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American Congress of Obstetricians and Gynecologists, District
IX, California
Community Action Fund of Planned Parenthood of Orange and San
Bernardino Counties
NARAL Pro-Choice California
Planned Parenthood Affiliates of California
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Mar Monte
Planned Parenthood Northern California Action Fund
Analysis Prepared by:Lara Flynn / HEALTH / (916) 319-2097