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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
<insert the telephone number or website>."
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.
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
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.
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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,
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 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.
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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 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 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
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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.
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 pregnancyrelated services to provide specified notices to clients.
b) AB 1254 (Grove) of 2015, was substantially similar to AB 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
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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
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