Prior to Roe v Wade, perhaps the most popular argument for legalising abortion was that women’s safety demanded avoiding the dreaded “back alley abortion”. In untrained hands, the unregulated procedure was just too dangerous for women.
Now, as non-surgical, chemical abortion becomes more common, abortion rights activists hunger for a future where women and girls self-administer and self-manage their own abortions – without any medical assistance or oversight.
In their rush to sweep away every obstacle between a pregnant woman and a termination, Planned Parenthood and the pro-abortion lobby now seek to do away with the safety regulations of the Food and Drug Administration (FDA), which would open the door to online black-market pill networks that operate illegally but with near impunity. Their new goal? In the words of a recent New York Times opinion piece, “Abortion Pills Should Be Everywhere”.
Is the pro-abortion side correct? Are medical abortions so safe and easy that they can and should be done without medical supervision? The answer is an emphatic no, especially when using illegal online marketplaces.
A chemical abortion, approved for pregnancies of up to 10 weeks, consists of two drugs. One (Mifeprex) interferes with progesterone, the hormone of pregnancy. The other induces uterine contractions.
The FDA keeps Mifeprex under a safety system called REMS (Risk Evaluation and Mitigation Strategy), used to manage medicines with dangerous side effects. Only a few dozen drugs require this kind of oversight. One of them is thalidomide, which is used to treat certain cancers but is best known for causing severe birth defects. Under REMS, only certified healthcare providers can dispense Mifeprex – and only in a clinic or hospital setting under the provider’s direct supervision.
The FDA’s website explains in great detail the reason for all these restrictions. Since the year 2000, 24 women have died as a result of supervised use of Mifeprex in the US. Several died from severe infection, two from ruptured ectopic pregnancy, and others from haemorrhage, toxic shock and overdose. Hundreds more women have been hospitalised with similar complications but survived.
In order to avoid severe adverse effects, responsible medical practitioners who perform medical abortions begin by making sure that the baby is no more than eight weeks old and located within the uterus. They use ultrasound to avoid the danger of inducing an abortion after 10 weeks or causing the deadly rupture of an ectopic pregnancy. (One to two per cent of pregnancies are ectopic.) They also take a detailed medical history – in person – to ensure that the mother is free of medical conditions like a bleeding disorder or lung disease, is not taking certain medications and is able to receive follow up care if she needs it. The doctors are also available for close follow-up so that early signs of infection (which can turn into fatal sepsis) are not missed by women and girls who are enduring a painful and distressing process that can take up to two weeks.
Those who want to eliminate REMS for Mifeprex – and the rogue pill distributors on the internet – believe that women and girls can navigate this dangerous terrain all on their own.
A significant portion of my practice as a physician consists of dating and localising pregnancies through ultrasound, since it is very common for a pregnant woman to be unsure of the date of her last menstrual period. As a physician, I also know that getting a good medical history requires knowing how to ask the questions in a way that will elicit valid and crucial information. This is especially difficult with younger patients. This kind of clinical care cannot be safely outsourced to an online questionnaire. Even more egregious is the blithe support of abortion activists for obtaining black-market or non-FDA approved drugs through illegal websites. Buying pills willy-nilly online is always a bad idea. A full 62 per cent of drugs purchased online are fake or substandard, and some have been found to contain fillers like drywall and rat poison. In fact, the World Health Organisation estimates that 100,000 to a million people die each year from counterfeit medicines.
One activist website lists several online distributors where women and girls can purchase Mifeprex. The National Association of Boards of Pharmacy has evaluated every one of these sites and found that they were operating dangerously and illegally.
It’s important to remember that the 24 young women who have died from medical abortions were all receiving supervised care from a qualified practitioner – and they still died. Are these rare incidents? Yes. But Mifeprex is hedged with extra safety precautions precisely because women and girls deserve more than a roll of the dice and the hope that they won’t be one of the outliers on the risk curve.
In their rush to make abortion ubiquitous and routine, Planned Parenthood and other activists are well on the way to making abortion as dangerous as in the days of the “back alley”.
Grazie Pozo Christie MD is a policy adviser for The Catholic Association (thecatholicassociation.org)