This was interpreted as allowing the use of mifepristone 200 mg followed 2 days later by misoprostol 800 mcg orally, a regimen supported by limited evidence. Finally, under HB2 providers could either use the regimen included in the Mifeprex ® labeling with 600 mg of mifepristone, which is considerably more expensive than the evidence-based regimen, or they could use the drug dosages in the 2005 ACOG Practice Bulletin on medical abortion. These visit requirements, in addition to the 2011 law requiring women living less than 100 miles from an abortion facility to have an ultrasound at least 24 hours before the procedure, meant that most women seeking medical abortion needed four clinic visits after November 2013. HB2 limited the gestational age to 49 days and required women to return to the facility for misoprostol, as well as for a follow-up visit. ![]() Prior to HB2, most facilities in Texas provided medical abortion using the evidence-based regimen of mifepristone 200 mg followed 24–48 hours later by misoprostol 800 mcg administered buccally at home up to 63 days’ gestation. The restrictions on medical abortion imposed several important changes to practice. The American College of Obstetricians and Gynecologists and the American Medical Association oppose these restrictions, highlighting the safety of outpatient abortion in the United States and concerns that HB2 would negatively affect women’s health. The first three provisions went into effect on November 1, 2013, and the ASC requirement is scheduled to go into effect September 1, 2014. In July 2013, the Texas legislature enacted House Bill 2 (HB2) that put into place four supply-side abortion restrictions: abortions are banned after 20 weeks “post-fertilization” excluding certain exceptions physicians performing abortion must have admitting privileges at a hospital within 30 miles of the facility the provision of medical abortion must follow the labeling approved by the Food and Drug Administration (with some allowances for drug dosages) and all abortion facilities must meet the standards of an ASC. One of the few studies on supply-side restrictions found a substantial decline in the number of abortions performed after 16 weeks to Texas women following enactment of a law requiring later procedures to be performed at ambulatory surgical centers (ASCs). More recently, states have passed laws focused on the “supply” side of abortion that make it more difficult for facilities to provide services. ![]() Other than laws requiring an extra visit to the clinic, demand-side restrictions appear to have minimal effect on the overall abortion rate. Initially these laws focused on the “demand” side of abortion and aimed to discourage women from seeking abortion by mandating parental involvement for minors, biased counseling or waiting periods. ![]() Recent years have seen a surge in state laws restricting abortion services.
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