Randall O’Bannon Ph.D
Advocates have diligently argued that chemical abortions are so simple and safe that women can do them on their own (the rhetoric). But simultaneously many have also insisted that women “denied” access to abortion would be in danger if they tried to self-abort (the reality).
What do abortionists who have encountered such women in their clinics—as opposed to activists and academicians–say?
Safety concerns about chemical self-abortion stand out in a study published April 16, 2019 in the journal Contraception. It is titled “Abortion Providers’ experiences and views on self-managed medication abortion, an exploratory study” (abstract at www.contraceptionjournal.org/article/S0010-7824(19)30143-X/pdf )
Between July and September of 2017, researchers from the University of Iowa did an online survey of the memberships of the Society of Family Planning, the Association of Reproductive Health Care Providers and the Abortion Care Network. They inquired about their experiences with and opinions of “self-managed abortion.”
Of the 650 respondents, just over half (359, or 55.1%) were abortionists. Results?
More than two thirds (230) of the abortionists reported having experience with women trying to abort on their own. More than three quarters (153) of those with such experience indicated those women were using mifepristone (RU-486) and/or misoprostol, the abortion drugs currently sold in the U.S., but legally available only through an abortionist who meets certain conditions laid down by the Food and Drug Administration (FDA). *
Women have been known to pick up misoprostol – which can be used alone to abort, though not as successfully – on the black market at places like border town flea markets  and have been able to order packets of foreign manufactured mifepristone and misoprostol from the internet .
Certain abortion researchers and advocacy groups (e.g., Aid Access, Women on Web  have been promoting the idea of self-managed abortion with pills bought over the internet. One, Gynuity, has been conducting trials in several states where abortion drugs can be mailed to women after an online consult 
In the University of Iowa survey, though, barely half (53.3%, or 171 of 321 abortionists**) said they thought the use of misoprostol/mifepristone for the self management of abortion was safe. That means that nearly half of those who did abortions were not satisfied that it was safe for women to use drugs to perform their own abortions.
More than a third (34.9% or 117 of 335 abortionists**) said they had witnessed complications from self-abortion. The most common complication was an incomplete abortion, but also reported were hemorrhage, sepsis (infection), and uterine rupture.
What the study tells us
Several results are very much worth noting.
One obvious thing is that “incomplete abortion” was mentioned so frequently as a complication in the study that failure is clearly a far bigger issue than advocates would have us believe. These results fly in the face of assurances by promoters that these drugs have proven to be “highly effective” (Aid Access at http://aidaccess.org/en/page/427/what-is-a-medical-abortion, accessed 4/25/19 ).
If official statistics from Danco, the U.S. distributor of mifepristone are accurate (claiming 93-98% effectiveness), this still means that perhaps one of every 20 patients may require surgery to either stop the bleeding or to complete the abortion. This would actually be a lot of cases for a drug we are told is used by hundreds of thousands of American women a year.
Promoters of the abortion pill have tried to soft-pedal complications
The University of California-San Francisco’s ANSIRH (Advancing New Standards in Reproductive Health) compiled an August 2016 Issue Brief on the “Safety and effectiveness of first-trimester medication abortion in the United States.” The Issue Brief claimed that there are serious complications with mifepristone and misoprostol in less than 0.5% [one half of one percent] of patients.
Women on Web, major promoters of online-facilitated abortions, appear willing to concede a greater incidence of complications. They said that between 2-3% of women having a “medical” (chemical) abortion “have to go to a doctor, first aid center or hospital to receive further medical care” (www.womenonweb.org/en/page/485/in-collection/6907/how-do-you-know-if-you-have-complications-and-what-should-you-do  , accessed 4/24/19 ).
These admissions seem at odds with the experiences of abortionists who participated in the University of Iowa survey.
From the figures given, we don’t know the percentage of self- aborting patients that had problems. But we do know that they were frequent enough that at least a third of the abortionists in the survey encountered them–and that some were quite serious, serious enough that almost half the abortionists were unwilling to tell researchers they considered it safe.
The latest FDA postmarketing report on mifepristone (www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM603000.pdf ) indicates that, since approval in 2000, there have been over four thousand cases where there has been a reported a significant “adverse event.”
The FDA reported that 24 patients are known to have died in the U.S. during that time, at least a third from rare bacterial infections. (Some of the 11 mifepristone patients who died in other countries also died of these infections.)
The over 4,000 figure includes over a thousand hospitalizations, more than 500 patients requiring transfusions, and more than 400 “severe infections.”
No matter how many thousands managed to endure the drugs’ grueling, painful process without any obvious immediate or enduring damage, if such a number of women have died or faced serious complications, it is a clear indication that the drugs are potentially quite dangerous.
And note this: most of these deaths and complications are associated with standard clinical use of the drugs, before studies of mail order abortions were launched and before webcam abortions became available in very many states. And there is nothing about the webcam or mail order abortions that would make complications like incomplete abortion, ruptured ectopic pregnancies, or deadly infections any less likely. It just might make medically qualified, timely help less likely–something that would concern any good doctor.
Abortionists at odd with Activists and Academicians
Perhaps the most significant finding in the University of Iowa study is that many of the rank-and-file abortionists do not appear to be on the same page as the academics and advocates who are pushing hard for at-home chemical abortions.
Those advocates are doing their own studies. They then tell the public that women can order these abortifacient drugs on line or pick them up at their local pharmacy and “manage” their abortions themselves with little or no supervision.
Daniel Grossman, popular abortion researcher, chemical abortion “expert,” and advocate, raved about self-abortion in an interview with National Public Radio [3/11/15]: “It would really be quite easy for women to actually use this [mifepristone/misoprostol] on their own…. It could almost be eligible for the kind of medication that could be available over the counter.”
In February of 2013, Grossman told Contraception that “Women can use misoprostol on their own and with accurate information; they do not necessarily need a health care provider to use it safely and effectively.”
He told CNN on November 5, 2018 that “When it comes to self-managing abortion, research shows that when people have accurate information and high-quality medication, they can use the abortion pill safely and effectively on their own.” (Emphasis added.)
Beverly Winikoff, of Gynuity, is currently in the middle of the “TelAbortion Study” using telemedicine (webcams) to counsel and screen patients and then mailing them the mifepristone and misoprostol to use at home. Winikoff claims that there had been no problems with the 200 women who had enrolled in the study as of November of 2018. (CNN, 11/18/18.)
Women, she said, were satisfied. “The results are equivalent to what’s happening in the clinics.”
The World Health Organization said “There is no evidence that home-based medical abortion is less effective, safe or acceptable than clinic-based medical abortion” (Vox 10/22/18).
Yet nearly half of the abortionists who answered the University of Iowa survey seem to think otherwise. Many of those who deal with aborting women at their clinics on a regular basis, who have practical, clinical experience versus the detachment of a university researcher or an activist, won’t call it safe. They don’t seem willing to consider self-managed abortion a good idea.
Winikoff and her Gynuity pals are likely to come out soon with a study of their own, claiming to have proven that mail order abortion drugs taken at home after an online consult are “safe” and “effective,” along with an assurance that women found them “satisfactory.” When they do, remember this University of Iowa study and the abortionists with the real life experience that led them to a far different conclusion.
*The FDA approved mifepristone, used in conjunction with misoprostol, for abortion in September of 2000. However it has limited its distribution to “certified healthcare providers” who 1) have the ability to date pregnancy accurately & diagnose ectopic pregnancy; who 2) provide (or have made arrangements for) surgical intervention in cases of incomplete abortion or severe bleeding ; and who 3) indicate they have read and understood the prescribing information (which contains warnings about possible “serious and sometimes fatal infections or bleeding”).
** We did not have full numerical tables when it came time to post. But apparently different numbers of abortionists responded to different survey questions.