(Un)happy birthday, chemical abortion: profit first, patient health and safety second

In this second installment of Americans United for Life’s lookback on twenty years of legal chemical abortion, we take a closer look at the charge that opposition to chemical abortion is only political and anti-woman. Has the practice of providing RU-486/chemical abortion in the last two decades reflected a commitment to women’s health and safety or an ideological servitude to pro-abortion politics? 

We know that the vast majority of doctors, including obstetricians-gynecologists (OB-Gyns), do not want to do abortions of any kind, surgical or chemical. A nationwide study found that although 97% of OB-Gyns had encountered a patient seeking abortion at some point in their practice, just 14% do abortions.  

In order to increase supply for abortion, providers seek to push the envelope for chemical abortion and increase its market share. Planned Parenthood freely admits that clinics provide the abortion pill up to 11 weeks gestation, well beyond the 7 weeks the FDA originally approved for Mifepristone and beyond the 10 weeks the FDA approved several years ago under an amended order. Planned Parenthood also directs patients to take the second pill, misoprostol, “either right away or up to 48 hours later.” This is in direct conflict with FDA guidance; the REMS indicate a woman only may take the second pill, misoprostol, 24-48 hours after taking the first pill, mifepristone.  

Other abortion clinics also ignore FDA guidelines. For example, the Orlando Women’s Center (Tampa Bay location) is particularly concerning in how it openly breaks the REMS. Orlando Women’s Center advertises outpatient chemical abortions for up to 14 weeks into gestation. Moreover, the same abortion clinic advertises in-patient chemical abortion up to 28 weeks gestation using RU-486. These advertisements encourage abortions weeks after the FDA’s 10-week limit. Orlando Women’s Center also indicates that women take Mifepristone and Misoprostol simultaneously during a chemical abortion. Again, as the FDA warned an international abortion group, Aid Access, in an official reprimand letter, FDA guidelines state that women should only take misoprostol 24-48 hours after taking mifepristone. 

Abortion activists increasingly demand abortion without limitation, delay, or oversight. Two decades after the approval of chemical abortion, and against the backdrop of the COVID-19 pandemic, abortion activists pushed for a loosening up of chemical abortion regulations so they could send abortion pills through the mail using telemedicine technology. Planned Parenthood’s Acting CEO Alexis McGill-Johnson called it the “silver lining” of the COVID pandemic, saying “Planned Parenthood and many other health providers have actually been able to really lean into telehealth infrastructure and provide service.” Abortion activists claim that existing FDA regulations are antiquated and at-home abortion solves the problems of travel and utilizing scarce medical resources like personal protective equipment (PPE). Under their system, a woman would video chat with a doctor who would either mail the pills to her home (their preferred method) or call them into a pharmacy near her home to be picked up. Gynuity Health has developed what it calls “a sample protocol for providing medication abortion without any routine facility-based tests either before or after treatment.”  

But support for unrestricted at-home abortion is rooted in ideology, not medicine. Under the guise of an FDA-approved trial, Gynuity has already opened abortion by mail locations. According to Dr. Donna Harrison, Executive Director of the American Association of Pro-life Obstetricians and Gynecologists (AAPLOG), a study evaluating Gynuity’s at-home abortion pilot program determined that around 27,000 American women find themselves in the ER suffering from chemical abortion-related complications each year.  

According to most current protocols, for either an in-clinic or telemedicine abortion, a woman must consult with a doctor in person. Medical institutions are in agreement about this; according to the world-renowned University of California-San Francisco Health Center, “a medical abortion involves at least two visits to a doctor’s office or clinic.” Before the abortion, a healthcare provider must first confirm she is a medically appropriate candidate for chemical abortion. In most states, this consultation is with a physician, although in a few states, like California, it can be done by a midlevel provider, such as a nurse practitioner, certified nurse-midwife, or physician assistant. A number of medical conditions make a women ineligible to take the chemical abortion pill, including having a potentially dangerous ectopic pregnancy (a pregnancy outside of the uterus). Chemical abortion cannot terminate an ectopic pregnancy and should not be used after the first 70 days of pregnancy due to heightened risk to the woman’s health. 

Though follow up visits are increasingly done over the phone or video, Gynuity’s FAQs say: “After you take the pills, you will have some additional tests as directed by the abortion provider to verify that the abortion is complete. These tests may consist of an ultrasound, pelvic exam, blood tests and/or urine pregnancy tests,” suggesting that best practices would necessitate an in-person follow up appointment. The world-renowned Mayo Clinic goes further, stating, “Medical abortion isn’t an option if you…can’t make follow-up visits to your doctor or don’t have access to emergency care.” 

Pushing the FDA-imposed gestational limits for chemical abortion and the time limit for taking the RU-486 dosages, even though abortionists know doing so raises the danger level for women; disregarding the danger of refusing to properly screen for ectopic pregnancies; failing to take into account whether a patient has access to emergency care, are all par for the course for an abortion industry that seemingly cares more about its bottom line than about patient safety.