The last year saw a new trend in abortion advocacy: Promoting DIY abortions. Several women’s (and fashion!) magazines hyped illegal black-market chemical abortions—a dangerous fad, as I have detailed.
Regardless, abortion experts also took up the mantle, with one of the leaders in the field, Dr. Grossman, co-authoring an article in the British Journal of Obstetrics and Gynaecology laying out a research agenda to move the sale of abortion pills (Mifeprex and misoprostol) over-the-counter. In an op-ed for The Guardian, Grossman explained his research explores “Whether the drugs used in medication abortion meet the criteria of the US Food and Drug Administration (FDA) for over-the-counter sale?” His conclusion? “The answer is a qualified yes, although more research is needed.”
In promoting DIY abortions, both the fashionistas and the physicians stress the supposed safety of chemical abortions and the presumption that “women are smart, sentient beings who can follow directions, take medication as prescribed, and seek care when needed.” Of course, the first assumption—that a chemical abortion is safe—ignores the life-destroying impact of the drugs on the baby in utero. But now a just-published study in the journal Obstetrics & Gynecology refutes, albeit inadvertently, the second proposition, establishing instead that nearly 20 percent of women undergoing a chemical abortion ignore the explicit directions their abortion provider gave.
I say “inadvertently” because that was neither the objective nor the intent of the research study. Rather, authors Ushama D. Upadhyay and Karen R. Meckstroth sought to examine the relationship between the distance traveled for an abortion and whether women who sought follow-up care returned to the original abortion provider or to an emergency room.
Many Women Don’t Follow Doctor’s Orders
In this study, the team culled California Medicaid records and discovered that of the women who sought medical treatment following an abortion, those who traveled 100 miles or more for an abortion had higher odds of seeking follow-up care at an emergency room than women who lived within 25 miles of the abortion provider. The authors also determined that the median cost for follow-up treatment at an emergency room exceeded the median cost of treatment at the original clinic by $405.
Leftist outlets, such as HuffPost, seized on this research to bemoan the lack of abortion providers, warning: “When Abortion Clinics Close, Healthcare Costs Go Up.” No doubt it is cheaper for California (which pays for elective abortions for poor women through its state-funded Medicaid program, Medi-Cal) if abortion clinics are plentiful. It is also less expensive for the state to pay abortionists to kill the babies in utero than to pay doctors to deliver the babies and for medical care for the next 18 years. Yet, given that only 3 percent of the women in the study sought follow-up care in emergency rooms, and some of those women may have had true emergencies, the total savings would seem minimal.
But this study is nonetheless informative for a different reason. The data underlying its research exposed a reality denied (or downplayed) by DIY abortion proponents: Women undergoing a chemical abortion do not follow directions, even when given by a physician, and even when the patient promised to do so in a signed “patient agreement.” The authors sidestepped these details, though, and those unfamiliar with the protocol for chemical abortion might not have noticed this important discovery, so here are the facts.
The 14-Day Post-Procedure Appointment
The study reviewed data from Medicaid claims of women in the Medi-Cal program for the years 2011 and 2012. That data, and specifically the coding, allowed the authors to determine the number of women who underwent a chemical abortion and whether they later returned to their abortion provider or an emergency room for follow-up treatment. Significantly, during 2011 and 2012, the label for Mifeprex provided:
Patients should be fully advised of the treatment procedure and its effects. Patients should be given a copy of the Medication Guide and the PATIENT AGREEMENT. (Additional copies of the Medication Guide and the PATIENT AGREEMENT are available by contacting Danco Laboratories at 1-877-4 Early Option) (1-877-432-7596). Patients should be advised to review both the Medication Guide and the PATIENT AGREEMENT, and should be given the opportunity to discuss them and obtain answers to any questions they may have. Each patient must understand:
– the necessity of completing the treatment schedule, including a follow-up visit approximately 14 days after taking
The FDA-approved label reiterated this point a second time: “Day 14: Post-Treatment Examination. Patients will return for a follow-up visit approximately 14 days after the administration of Mifeprex. This visit is very important to confirm by clinical examination or ultrasonographic scan that a complete termination of pregnancy has occurred.”
The medication guide the FDA required to be given to and reviewed with the patient likewise stated: “About Day 14 at your provider’s office: This follow-up visit is very important. You must return to the provider about 14 days after you have taken Mifeprex to be sure you are well and that you are not pregnant.”
The FDA also mandated that doctors require patients to sign a patient agreement form, in which patients committed to returning for a follow-up visit in 14 days. Specifically, the form stated: “I must return to my provider’s office in about 2 weeks (about Day 14) after I take Mifeprex to be sure that my pregnancy has ended and that I am well.” A second time, the form reiterated the patient’s commitment to “do the following – return to my provider’s office about 14 days after beginning treatment to be sure that my pregnancy has ended and that I am well.”
Yet even with these clear and repetitive directives, only 81 percent of women undergoing chemical abortions followed through with their commitment to attend the “very important” follow-up visit. That means one in five women did not.
Here’s the data from the study: Among all abortions, 4 percent of chemical abortions were followed by an emergency room visit and 77 percent were followed by a visit to the original abortion site. As the study’s authors noted, this data is solid: “a strength of the study is that it used data from a complete system with virtually no loss to follow-up, and thus we can reasonably expect that all follow-up visits, regardless of source of care, were captured.”
Nonetheless, nowhere in their article did the authors highlight the fact that nearly 20 percent of women undergoing a chemical abortion ignored the label instructions, their doctor’s directive, and their own commitment in the signed patient agreement to return for a follow-up appointment. Instead, the authors merely stated in passing that “[p]atients having a medication abortion are routinely advised to return for follow-up to rule out continuing pregnancies.” And “[a]s of March 2016, the label for medication abortion no longer recommends a follow-up visit.” These two fleeting references downplay the explicit directions given to women to return for a “very important” follow-up visit in about two weeks.
If nearly one in five women ignore such explicit “very important” directions given by their doctor, it is foolhardy to imagine all or even nearly all will follow the directions accompanying DIY abortions. These results should thus give pause to those promoting illegal DIY abortions and over-the-counter availability of Mifeprex. That is, if they want to avoid sending more girls and young women to the emergency room—or worse, the morgue.