Chemical Abortion: Coming to a Pharmacy Near You?
The United States Food and Drug Administration (FDA) first approved the Abortion Pill (Mifeprex) for use in the United States in 2000. Since then, it has been gradually liberalizing its availability, despite evidence that the medical risks to the women who take the abortion pill have increased with every relaxation of regulatory controls.
Just a short time ago, on January 3, 2023, the FDA approved its most recent expansion of the abortion pill availability. It passed a rule that makes the distribution of the abortion pill even easier: corner drugstore pharmacies like Walgreens and CVS will be allowed to dispense the drug following a certification procedure. Before this, the abortion pill could only be dispensed by a limited number of pharmacies certified by the drug manufacturers or by specially certified doctors or clinics.
This expansion of the availability of the abortion pill and relaxation of how and where it can be dispensed cast into doubt whether the FDA is fulfilling its core mission, which is to make sure that drugs are not just effective but safe. Part of the safety aspect requires putting sufficient measures in place to ensure that drugs will be used as intended and that patients taking the drug are not put at risk of harm in the way it is administered. In the case of the abortion pill, however, the FDA seems to have revised its rules not with an eye toward safety but to achieve the specific policy goal of making abortions more readily available.
Given the Supreme Court’s decision in Dobbs last year, it seems just a little too convenient that the FDA finds that it is “safe” to expand the distribution of the abortion pill at a time when many states have implemented restrictions on abortion. As noted by the New Yorker Magazine: “[Abortion pills]m are safe, effective, and can be mailed or passed around, making them relatively difficult for authorities to trace.” In short, the FDA’s new rule makes it much easier for people to evade state laws restricting abortion.
The Looser the Regulations, the Higher the Risk of Injury
Prior to this newest rule, the FDA had loosened other restrictions on the distribution of abortion pill. During the COVID lockdowns, the FDA, in early 2021, loosened its rules to permit the abortion pill to be prescribed by telemedicine appointments – in other words, prescribed by healthcare providers who do not conduct any in-person examinations of the patient. Later that same year, the FDA no longer required that the pills be distributed in person and allowed them, instead, to be distributed by specified mail-order pharmacies. The FDA has now made those rules permanent, even though there is little evidence that this system adequately protects women, who are now “self-medicating” in their own homes or apartments, with minimal screening and no medical supervision.
Interestingly, toward the end of 2021, several doctors in India published a paper that cautioned about the dangers of inadequate medical oversight in taking the abortion pill or “medical termination of pregnancy” (MTP) pills. Their findings:
Results: The major complaint at presentation was excessive bleeding (78%). Out of 100 patients, 66% of cases were diagnosed as incomplete abortion, 6% as missed abortion, and 6% as unaffected pregnancy. Ectopic pregnancy was detected in 12% of cases. Sixty patients of incomplete abortion were managed with suction and evacuation and six were supplemented with misoprostol. All patients with ectopic pregnancies were managed surgically.
Conclusion: The majority of the pregnant women who took MTP pills presented with serious complications in the form of bleeding, incomplete/missed abortion, and ectopic pregnancy. Restriction of the over-the-counter dispensation of abortion pills needs to be strictly implemented and knowledge of women regarding the unfavourable [sic] outcome of MTP pill intake without proper consultation needs to be improved.
In sum: women who take the abortion pill without adequate medical supervision are likely to suffer medical complications requiring hospital intervention up to and including surgery.
What Other Dangers Lie Ahead?
Sadly, the eagerness to embrace the abortion pill as an end-run around abortion restrictions is likely to lead to serious harm. One wonders whether CVS and Walgreens are ready to step into the breach that will exacerbate these harms.
For example, according to the same New Yorker article noted above, proponents now suggest that abortion pills should be provided before getting pregnant. In other words, distributing the pills without being pregnant and without seeing a doctor, getting a prescription, and waiting for the prescription to be filled:
Other providers propose advance provision of abortion pills: getting them to people as a precautionary measure so that if an unwanted pregnancy occurs, the pills will be on hand. (The pills have a shelf life of around two years.)
These advocates are utterly oblivious to – or do not care about – the obvious dangers implicated by this kind of thinking. It seems a sensible precaution that young women who end up pregnant – or assume they are pregnant – when they don’t want a baby should not be allowed unfettered access to medication as potent as the abortion pill without some medical oversight. Are we to believe that young girls will truly have informed consent when this pill is just lying around and ingested without supervision? Abusive men or guardians would never induce a pregnant girl to take the abortion pill against her will, would they? After all, no other girls have ever been coerced into getting an abortion at an abortion facility, right? Yet advocates are eager to allow this to happen in a private setting with no safeguards at all.
This latest move by the FDA is almost certainly not the last expansion it will push regarding using the abortion pill in its quest to normalize abortion. They seem to regard terminating a pregnancy with a pill as something that should be as easy as taking a pain reliever for a headache. Women with adverse health consequences are collateral damage they are willing to accept.
The abortion pill now accounts for over half of all abortions performed in the United States, and that proportion is likely to grow as the pill’s availability expands. Thankfully, at ProLifeDoc, we see some women change their minds and choose life. On several occasions, we have been instrumental in helping young women who take the abortion pill reverse the effects of this drug and save their babies. I am honored to be a part of these stories and to see women find redemption and love through giving birth to new and precious lives.