It isn’t very often that we find ourselves saddened when a member of the Trump administration decides to resign. But when FDA Commissioner Scott Gottlieb leaves his position, it could spell disaster for progressives — especially those who support reproductive rights.
Unlike many of the government officials serving President Donald Trump, Gottlieb — while by no means a moderate — wasn’t totally unqualified for his job. And, even more importantly, he didn’t appear to be using his office to push forward the policies most important to zealous religious groups or letting his own personal dogma influence his work.
In a Department of Health and Human Services full of far-right social conservative bigwigs, Gottlieb was surprisingly more interested in public health than pushing Christian dominionist ideology.
Unfortunately, that means that with his departure, President Trump now has the opportunity to put another evangelical or Catholic die-hard in a key decision-making position — and that’s an alarming turn of events for those who want abortion, or even contraception, to be easily accessible in the United States.
The FDA is responsible for a number of contraceptive- and abortion-related decisions, ranging from how medication abortion is provided to whether hormonal birth control and emergency contraception should be available over the counter.
It was only in 2013 that the FDA first allowed Plan B One Step – an emergency contraceptive that would prevent ovulation if taken within 72 hours after having unprotected sex — to be obtained over the counter, without a prescription and with no age limit. At least one of the possible new FDA commissioner contenders opposed the idea — and depending on who takes over, there could be a push to reevaluate that decision.
In fact, the FDA has an overwhelming amount of influence when it comes to deciding what sort of drugs can be available — or even classified — for use as contraceptives and abortifacients. And it’s because of previous FDA rulings that the right still considers emergency contraception to be an abortion-causing drug.
When emergency contraception was introduced and made available for public consumption, it had not yet been fully vetted. Out of an abundance of caution, the FDA labels stated that the medication could potentially make the uterine lining inhospitable, preventing a fertilized egg from successfully implanting.
For the sliver of the population that believes life begins at conception — when sperm and egg meet, rather than the more scientifically embraced idea that a fertilized egg must implant before a pregnancy can technically begin — the bet-hedging language caused them to cling to the idea that it must be considered an “abortion” drug. These same “pro-lifers” hold a similar stance against any form of hormonal contraception or even IUDs.
Since the early release, more studies have proven conclusively that emergency contraception primarily stops ovulation from occurring — and in the rare cases it doesn’t, it’s far less likely for sperm to get to the egg from the beginning. Despite these findings, the FDA has refused to revise its labeling process.
An even more politicized far-right FDA could go way further than just blocking updated drug labeling efforts, too. The agency could actually roll back some of the recent medical advances in addressing unintended and unwanted pregnancies.
In 2016, the FDA agreed to update the protocol for RU-486, changing the official rules to meet medical best practices long used by doctors inducing early gestation abortions with the drugs. The changes allowed providers to use much less medication, to take it further into a pregnancy and to make fewer visits to a clinic while taking the drug. It also put to bed a number of state restrictions that forced doctors to use the outdated FDA protocol, or not offer any medication abortion whatsoever.
At best, a new ideologue in the FDA could bring any sort of advance in telemed abortion grinding to a halt. A new pilot program that’s allowing pregnant patients to get medications quickly online after a video consult is running successfully in four states – all with a waiver from the FDA.
A less progressive, religiously-bent department is unlikely to expand the waivers — and the agency could withdraw them all together, regardless of how safety and effectiveness of the fledgling trial. The FDA would almost definitely refuse to drop the REMS requirements currently in place on the medication — an unnecessary protocol that limits who can provide the medicine and keeps it mostly limited to abortion clinics, rather than family doctors or other health practitioners. The ACLU is in the process of suing the FDA to drop the REMS requirement all together.
Or, the department could move back to the original protocol for RU-486 — the more expensive, onerous and medically unnecessary one — and cause states to limit medication abortions again. Even more dire, the FDA could take up the social conservatives’ ongoing claims that medication abortion is highly dangerous – a talking point that the right continues to push. To put that in perspective, there have been less than two dozen deaths from patients using RU-486, despite the more than 2 million people who have used the drug.
The worst case scenario, however, would be not just a combination of the above, but a cooperative effort between the FDA and other Trump administration entities to find and prosecute people who obtain medication abortion drugs online — either for themselves or for others.
Currently the best known of these “offenders” in the U.S., AidAccess, is allegedly being investigated by the FDA for breaking the rules on providing medication inside the United States. The site’s owner claims that she’s found a loophole allowing her to provide the medicines without running afoul of the law. The FDA recently sent letters telling AidAccess and another medication sites to stop their offerings to the U.S. – and a zealous FDA commissioner intent on blocking all access to abortion could target them even further.
Anti-abortion activists in the Trump administration have already changed the rules on Title X, religious liberty, LGBTQ health care, environmental protections and more. The FDA may have been one of the last departments somewhat untainted by Trump’s religious right backers. And, now, we may finally be losing that one as well.