ACOG’s Practice Bulletin 143 states, “The introduction of medical abortion into widespread clinical practice has required continued emphasis on follow-up because failure rates for medical abortion are higher than those for surgical techniques.” It continues, “Clinicians who wish to provide medical abortion services either should be trained in surgical abortion or should be able to refer to a clinician trained in surgical abortion.”

Virginia’s only identified medication-only abortion facility agrees. Their facility’s procedures for medication abortions require patients to agree to have a surgical abortion in the facility if the medication abortion was unsuccessful. The policy stated, “During the abortion pill (medication abortion) visit, you must agree — before you start — that you will have an in clinic abortion if the abortion pill does not work.”

If America's medical community and Virginia’s only medication-only abortion facility both agree that medication-only abortion facilities should be prepared to provide surgical abortions, why are we separating medication and surgical abortion facility building codes and standards?

PB143 also states, “The FDA-approved regimen for medical abortion has an efficacy rate of 92%.” The efficacy rates, however, are greatly impacted based on a women’s gestation and the medication protocol followed. If medication is used outside the approved regimen, efficacy rates can drop to “85%” per ACOG. That’s 15 out of every 100 women who could need follow-up surgical abortions in a facility that is not prepared to handle surgical abortions. It is not the Commissioner, VDH or the BOH’s job to prescribe the effective medical abortion protocol. However it is their job to provide for safe access to abortion no matter the protocol used.

The Commissioner, VDH and BOH are limiting women’s access to health and safety by removing necessary building codes and standards when a woman receives a medical abortion.

I recommend removing the distinction of medication-only abortion and surgical abortion, retaining the current regulations which provide one building code standard for abortion facilities.