Americans are divided on abortion, but even abortion supporters should want abortion to be safe — at least for the woman. Unfortunately, our new research shows that the chemical abortion drug mifepristone became significantly more dangerous to women after the Biden administration watered down safety rules in an effort to appease pro-abortion advocates.
We recently analyzed the data on mifepristone’s serious adverse events, looking before and after Biden’s Food and Drug Administration (FDA) removed a longstanding requirement for a woman to see a medical professional in person before chemical abortion could be prescribed or dispensed. What we found is not surprising: Removing a doctor from the process makes things worse for women. Indeed, the rate of serious adverse events was significantly higher after the FDA’s in-person dispensing requirement was removed, especially as mifepristone was inappropriately prescribed for women with an ectopic pregnancy, a life-threatening condition that can be diagnosed by a physician only through an in-person visit.
From the time the Clinton FDA approved mifepristone until just about five years ago, the FDA required that a woman see a medical professional in person before chemical abortion could be prescribed or dispensed. The in-person visit was essential to determine the age of the unborn child, rule out an ectopic pregnancy, and ensure the woman was not being coerced into the abortion.
Nevertheless, the Biden FDA used Covid as an excuse to eliminate the required in-person visit, and women have paid the price.
After all, without requiring an in-person doctor visit, anyone can go online and get mail-order abortion pills. There is no way to ensure the unborn baby hasn’t grown so large that chemical abortion is unsafe for the mother, no way to ensure the unborn baby isn’t implanted outside the uterus where using chemical abortion drugs could prove deadly to the mother, and no way to ensure it’s the mother who is voluntarily requesting the chemical abortion drugs and not a boyfriend seeking the pills to secretly and coercively poison her.
Tragically, since the in-person requirement was lifted, we have seen countless instances where women were coercively poisoned to kill their unborn babies by boyfriends who ordered chemical abortion drugs online and slipped them into their drinks. It has become an unregulated free-for-all where no woman is truly protected. But it’s not just coercion that has documented instances; now we can show that removing the in-person doctor visit requirement has increased general health risks, and the misuse of chemical abortion in the case of ectopic pregnancy in particular.
Our data shows that the rate of serious adverse events was 10.15 percent when the in-person visit requirement was in effect and that it jumped to 11.50 percent when the requirement was removed — a statistically significant difference of 1.35 percentage points.
Our data similarly shows that the rate of chemical abortion prescription during ectopic pregnancy was 0.27 percent before the Biden changes and 0.41 percent after. The abortion pill can be deadly if taken during an ectopic pregnancy (where the child is implanted in the fallopian tube, not the womb). But there’s no way to determine the location of the child via the internet, as that too requires an in-person doctor visit. So it is not at all surprising that after removing the in-person requirement, we saw this number rise by more than 50 percent.
This most recent analysis (with full details available here) builds on the largest-known study of the abortion pill that we coauthored and published at the Ethics and Public Policy Center. It found the abortion pill poses severe risks, with 10.93 percent of patients experiencing sepsis, infection, hemorrhaging, or some other serious adverse event (as classified by a team of doctors following an FDA definition and NIH methodology) within 45 days after taking their abortion prescription. This is more than 22 times the summary figure of “less than 0.5 percent” reported on the drug’s label.
Removing the in-person office visit requirement is likely significantly more dangerous than just the 1.35 percentage-point change the data would suggest. Critically, the effect of the change depends on the percentage of mifepristone prescriptions that were dispensed remotely once that became allowed. While no one has firm data on that percentage, we can consider estimates based on pro-abortion researchers’ own reported data, as we detail here.
“If remote dispensing of mifepristone accounted for 10% of all prescriptions” after the FDA changes, “this would imply a rate of serious adverse events of 23.65% for remote dispensing — 13.50 percentage points higher than for in-person dispensing,” we write in our new report. “Under this 10% scenario, the provision of mifepristone to a woman with an ectopic pregnancy would be more than six times as likely with remote dispensing as with in-person dispensing.”
Our report continues: “If remote dispensing of mifepristone accounted for 25% of all prescriptions … this would imply a rate of serious adverse events of 15.55% for remote dispensing — 5.40 percentage points higher than for in-person dispensing. … Under this 25% scenario, the provision of mifepristone to a woman with an ectopic pregnancy would be more than three times as likely with remote dispensing as with in-person dispensing.”
While we can’t quantify the precise additional risk that online, mail-order abortion pills pose to women, we do know that after the Biden FDA changes, things got significantly worse overall, which suggests that remotely dispensed chemical abortions were particularly dangerous to drive this change. As a result, everyone who claims to be concerned about women’s health and safety should favor a return to the earlier FDA safety regulations.
Voters overwhelmingly support common-sense safety protocols for abortion pills. A recent survey conducted by President Donald Trump’s most trusted pollster, McLaughlin and Associates, shows that 7 in 10 likely voters support requiring an in-person doctor visit for a mifepristone prescription, while nearly 9 in 10 support updating the drug label to warn of real-world safety risks.
The Trump administration is all about promises made, promises kept. And the president made three relevant promises here.
First, he promised to “Make America Healthy Again.” But you can’t make America healthy with a pill that causes 1 in 9 women who take it to experience a serious adverse event.
Second, he promised to undo all of the misguided policies the Biden administration enacted. Using Covid as an excuse to eliminate in-person visits was terribly misguided and needs to be rectified.
Third, he promised he’d leave abortion to the states, upsetting many pro-lifers. But you can’t leave abortion to the states when a citizen in Texas or Florida can get around their pro-life laws by going on the internet and getting abortion pills in the mail from California or New York. And anyone can get these deadly drugs online and in the mail, which allows for the coercive abortions we’ve already seen.
Requiring in-person doctor visits fulfills all three of President Trump’s promises.
But regardless of whether you’re MAGA or Never Trump, whether you’re pro-life or pro-abortion, we should at least be able to insist that abortion be safe for the woman, even as we continue to debate whether its manifest lethality to the child should be allowed to persist.
