ACCESS TO REPRODUCTIVE HEALTH SERVICES

To recognize that reproductive healthcare includes access to and safe use of medications; further,

To recognize that reproductive health services include pre-conception, conception, post-conception, and termination of pregnancies; further,

To advocate for access to safe, comprehensive reproductive healthcare for all patients, including historically underserved patient groups such as patients of color, those with limited means, and those living in rural areas; further,

To advocate that medications related to reproductive health not be reclassified as controlled substances and that dispensing of those medications not be required to be reported to prescription drug monitoring programs; further,

To affirm that healthcare workers should be able to provide reproductive healthcare per their clinical judgment and their conscience without fear of legal consequence, workplace sanctions, social stigmatization, harassment, or harm.

Rationale

Reproductive health has been defined as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes," and reproductive healthcare has been defined as "the constellation of methods, techniques and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems." (International Conference on Population and Development Programme of Action, Twentieth Anniversary Edition, United Nations Population Fund, Sep 2014). In the U.S., the term "reproductive health services" is defined in 18 USC § 248(e)(5) as "medical, surgical, counselling or referral services relating to the human reproductive system, including services relating to pregnancy or the termination of a pregnancy." Reproductive health services include pre-conception, conception, post-conception care, including termination of pregnancies, and reproductive healthcare includes access to and safe use of medications.  

ASHP advocates for access to safe, comprehensive reproductive healthcare for all patients, including historically underserved patient groups.

The reproductive health medications misoprostol and mifepristone have been reclassified as Schedule IV controlled substances in Louisiana, effective October 1, 2024 (Louisiana Act 246, 2024). The classification of controlled substance is typically reserved for medications with potential for abuse that may lead to physical or psychological dependence and safety liability. There is no evidence suggesting that misoprostol and mifepristone have a likelihood for abuse or physiological dependence, despite decades of approved use in the U.S. The improper classification of reproductive health medications burdens providers and patients and can lead to a dangerous stigma for patients prescribed the medications for purposes other than abortion, such as mifepristone for managing the effects of miscarriage or misoprostol for treating or preventing stomach ulcers. Prescription drug monitoring programs require  reporting of dispensed controlled substances, often across state lines, which could increase risks of prosecution for both providers and patients who seek or provide these medications.

On June 24, 2022, the Supreme Court of the United States overturned Roe v. Wade, freeing states to restrict or outlaw abortion. Thirteen states had implemented trigger laws that would outlaw abortion almost immediately, and 26 states were expected to ban or severely restrict access to abortion. These state laws are likely to impact patient access to necessary treatments, including medications, and the practice of pharmacy, in the following ways:

• Access to necessary treatments: Pharmacists are involved in treating patients with ectopic pregnancy or pregnant patients with cancer diagnoses. These laws could limit patient access to lifesaving treatments because of the risk of legal liability for providers. Pharmacists have a role in providing medications for these treatments as well as supporting patients’ mental health and well-being related to reproductive health.
• Access to medications: A number of companies have formed that provide telehealth access to medications used to induce abortion. There are likely to be challenges to interstate mail order of these medications. In addition, some overseas companies also provide these medications, which raises questions about foreign importation of medications. ASHP opposes wholesale importation of medications from other countries due to supply chain security concerns but does not object to patients ordering from legitimate foreign pharmacies for their personal needs. Further, medications (e.g., misoprostol) that are used off-label as abortifacients but have other clinical uses may become harder for patients to access because providers fear the legal liability for prescribing or dispensing these medications. Finally, access to medications is a national security issue. For examples, the Department of Defense is required by law to make contraceptive services available to all female active-duty servicemembers.
• Clinician judgment: Restrictions on medication abortion function as limitations on clinicians’ professional judgment. As noted above, because some medications can be used off-label as abortifacients, it is possible that there will be increased scrutiny of the prescribing and dispensing of certain medications. Further, some states are pursuing laws that would allow citizens a private right of action against a clinician who assists in an abortion (i.e., “bounty laws”). These laws could create civil and/or criminal liability against clinicians who prescribe or dispense abortion medications.

In addition to these concerns, other procedures that are not abortion but might result in destruction of an embryo (e.g., in vitro fertilization therapy) could fall into an uncertain legal zone. Medications used to induce labor to protect a pregnant patient could be restricted. Because the decision in Roe v. Wade was based on a constitutional right to privacy, other privacy-related rulings are now in question, including Griswold v. Connecticut, which allowed access to contraception.

The decision to terminate a pregnancy is a complicated, difficult, and often extremely emotional choice for patients and healthcare providers, and it often involves weighing the risks to the pregnant patient. Under some state laws, pregnant patients could be prosecuted for seeking lifesaving treatment, and healthcare providers involved in these difficult decisions and providing necessary treatments could be subject to unjust criminal prosecution. ASHP believes that healthcare workers should be able to provide reproductive healthcare per their clinical judgment and their conscience without fear of legal consequence, workplace sanctions, social stigmatization, harassment, or harm.