Evidence-Based Decisions About Abortion


On the surface, a business decision by Google doesn’t have much in common with a pending court case involving women’s health. But both involve abortion, and both just might show a way to break out of the morass that the national debate has fallen into. When it comes to abortion, it’s far too easy to let emotion and assumptions take precedence. But here more than ever, it pays to take a step back and give the same respect to the evidence and facts as less sensitive subjects receive.

Google decided this week to ban the majority” of advertising on its site from crisis pregnancy centers, or CPCs. Hundreds of these clinics exist in the U.S., and most operate with the goal of dissuading pregnant women from choosing abortion. The tactics begin with the names and locations of many clinics, which are often deliberately near comprehensive women’s health clinics and have similar names; and often falsely claim to employ medical professionals, provide discredited information about abortion and birth control, and violate a woman’s privacy by telling her family that she’s pregnant and considering abortion.

Try and think of one other branch of medicine where opponents of the procedure go to such length to dissuade people from having that procedure. There are no fake plastic surgery clinics where, when you sit down to talk about your nose job, the doctor tries to pray to persuade you not to get one. And say what you will about faith healers and homeopaths, but at least when you walk in the door you know what they’re about.

All of which makes Google’s recent decision to ban crisis pregnancy centers, or CPCs, from AdWords so welcome. Following an investigation by NARAL Pro-Choice America, the company concluded that the ads violated their advertising policy. That policy holds that ads must be “factually supportable” and bans “misleading, inaccurate and deceitful ads.” According to NARAL, 79 percent of CPCs that advertised on the site used false or misleading language in their ads.

This decision is also refreshing because it appears to have been made simply on the basis of facts: that the content of the ads went against the company policy. That shouldn’t even be worth remarking on, except that when it comes to abortion, decision-makers have a funny way of letting assumptions, stigma, and emotion cloud their judgment. Witness the opinion of the Fifth Circuit Court of Appeals earlier this year, where Judge Edith Jones derided the idea that making women drive 300 miles round trip to access abortion care was a burden.

But perhaps the judges on the Ninth Circuit Court of Appeals will be more inclined to look at the facts and expert judgment on a high-profile case that will be argued before the court next week. In 2012, Arizona Gov. Jan Brewer (R) signed into law regulations that require doctors to use an outdated FDA protocol when offering medication abortion and to not offer the procedure after the seventh week of pregnancy.

Just how outdated is the FDA protocol? Well, it’s based on a regimen developed in the late 1980s. Newer medical evidence, research, and protocols all indicate that medication abortion can be used safely into the ninth week of pregnancy; and that the procedure can be effectively performed by using lower doses of medication.

Allowing doctors to use evidence-based medicine, not prescribing unnecessarily high doses of medication, and ensuring that patients have the widest possible range of health care options to choose from all seem to be good developments for women’s health. For that matter, they seem to be good developments for health care in general. It’s hard to imagine that politicians in Arizona, or any one of the other states seeking to restrict medication abortion, would get so fired up about doctors using the most current, reputable research and regimens to treat heart disease, erectile dysfunction, and migraine headaches, especially if their alternative was relying on information that was over 25 years old.

Indeed, two leading medical organizations have spoken out against the restrictions. The American College of Obstetricians and Gynecologists and the American Medical Association have filed an amicus curiae brief in support of the challenge. The brief says, in part, “The Arizona law jeopardizes women’s health by requiring that physicians deny women the benefit of the most current, well-researched, safe, evidence-based, and proven protocols for the provision of medical abortion and, instead, prescribe a regimen that is outdated and less safe. By imposing a regimen that does not serve the best interests of patients, the law also requires that physicians depart from their ethical obligation to provide the best possible care for their patients using their sound medical judgment—insisting, rather, that physicians substitute the judgment of the Arizona legislature for their own.”

So here’s hoping that the Ninth Circuit follows in the footsteps of Google and allows evidence and facts, unclouded by politics and emotion, to carry the day. Not just for the sake of women and families in Arizona, but for the sake of doctors that want to do their job free from unnecessary government interference. Because, as the AMA and ACOG succinctly put it, “the law is bad medicine.”

Sarah Erdreich is the author of Generation Roe: Inside the Future of the Pro-Choice Movement. She lives in Washington, D.C. with her family.