Alaska Superior Court finds state law restrictiing medication abortion acess is likely unconstitutional | News

Alaska Superior Court finds state law restrictiing medication abortion acess is likely unconstitutional | News

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Last week, a Superior Court in Alaska’s Third Judicial District ruled in favor of Planned Parenthood Great Northwest, Hawai’i, Alaska, Indiana, and Kentucky, in the group’s suit against the State of Alaska. The order granting temporary injunction, authored by Judge Josie Garton, will temporarily prohibit enforcement of a state law requiring that only physicians licensed by the State Medical Board can legally perform medication abortions. 

Medication abortions most often come in the form of two drugs: mifepristone and misoprostol, and it is a much different procedure than induced (commonly known as “aspiration”) abortions. Mifepristone blocks the creation of progesterone, the hormone required for a pregnancy to grow. Patients take the second drug, misoprostol, within two days subsequent to mifepristone. “This medicine causes cramping and bleeding to empty your uterus,” Planned Parenthood explains on their website. The procedure is safe and, as the Mayo Clinic notes, “doesn’t require surgery or anesthesia and can be started either in a medical office or at home with follow-up visits to your doctor. It’s safer and most effective during the first trimester of pregnancy.”

Alaska spans nearly 665,000 square miles – more than twice the size of Texas. To get to much of it,  needless to say, requires a bit more effort than calling a Lyft. The 732,000 residents who call the state home are served by precisely four Planned Parenthood locations in Anchorage, Fairbanks, Juneau, and Soldotna. The limited amount of locations has been compounded by a deficit in their ability to recruit and retain full-time physicians, forcing clinics to hire physicians to perform abortions on a contract basis as a stop-gap measure. These realities, and the restrictions written into law, have translated to real-life consequences for those seeking access to the reproductive health care Planned Parenthood provides.

“As a result of the physician requirement… Planned Parenthood can only offer medication abortion approximately once per week at each of its four locations in the state,” Judge Garton wrote in the order granting the injunction. She added that the requirement frequently made access either very difficult or outright unattainable for patients with “inflexible work schedules, limited access to transportation, and child care needs,” and for patients who can “only reach a clinic by boat or air.”

“In 2020, the average time between the date an appointment for an abortion was made and the date of the appointment ranged from 3.13 days (in Soldotna) to 8.73 days (in Juneau),” Garton found, noting that this duration did not take into account the time between the initial contact a patient makes with a clinic and the appointment being scheduled. “Planned Parenthood’s patients have faced delays of up to several weeks in accessing medication abortion.”

Medication abortions generally are limited to pregnancies up to 12 weeks’ gestation, according to the World Health Organization. In Alaska, this has translated to patients becoming “ineligible for a medication abortion,” Garton wrote. If a patient is unable to schedule a medication abortion procedure within the time frame necessitated by the efficacy of the drugs, that patient must then undergo an aspiration abortion – often plagued by even more cumbersome wait times, and replete with additional emotional burdens and medical risks.

Aspiration abortions can be performed just once a week in Anchorage; once a month in Fairbanks and Juneau; and not at all in Soldotna. This, too, can conflict with patients who may have medical conditions that preclude the aspiration abortion entirely. Garton concluded: “Due to the difficulty of accessing abortion care in Alaska, some patients have been unable to end their pregnancies.”

Planned Parenthood contends that law should be amended to expand who can perform medication abortions to include advanced practice clinicians (APCs) – a category that includes nurse practitioners, physicians assistants, and certified nurse midwives. According to the Abortion Provider Toolkit, nearly one-third of U.S. states currently afford APCs this ability, to varying degrees. Alaska State law also already permits APCs the ability to prescribe the exact same medications to patients under different contexts: mifepristone is used to treat hyperglycemia caused by Cushing’s Syndrome and misoprostol is prescribed to prevent ulcers in patients who take specific arthritis or pain medications.

The court found that the State failed to provide a compelling interest warranting the access gaps created by the physician requirement. Planned Parenthood “has shown that it is likely to succeed on the merits of its claim that prohibiting advanced practice clinicians from providing medication abortion violates patients’ right to privacy under the Alaska Constitution by significantly restricting the availability of abortions in this state without sufficient justification,” Garton opined. 

The Superior Court judge quoted the Alaska Supreme Court’s finding in State Department of Health & Social Services v. Planned Parenthood of Alaska, Inc. (2001), which found that if abortion services are to be provided in the state, those services must be distributed equally. Otherwise, laws that produced unequal outcomes pertaining to health care access (dependent on disparate income levels or accessibility of clinics able to perform the service) violated the Equal Protection Clause of the Alaska State Constitution (Article 1, Section 1). The physician requirement, according to Garton, lacked in proving the “means [the State] has chosen to advance [it’s] goals are well-fitted to the ends.”

“Today’s ruling is a critical victory that will increase much-needed abortion access across Alaska for everyone who needs it,” Alexis McGill Johnson, president and CEO of Planned Parenthood Federation of America, wrote in a press release. “Medication abortion services performed by nurse practitioners and certified nurse midwives are safe, effective, and necessary. The removal of this medically-unnecessary restriction on qualified health care providers’ ability to deliver essential care will help eliminate delays in accessing abortion as well as emotional and financial harm to pregnant Alaskans.”

The injunction will allow APCs to perform medication abortions between now and July of 2022, when the matter will proceed to trial. Planned Parenthood hopes the Court will then void the prohibition altogether and allow APCs to perform medical abortions on a permanent basis.

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