“Data released in 2018 by the FDA shows thousands of adverse events caused by abortion pills,” Heartbeat International’s Medical Impact Director Christa Brown, BSN, RN, said in her workshop “DIY and Chemical Abortion” at Heartbeat's 2023 Annual Conference in Louisville, Ky.
Brown's workshop covered the critical issue of chemical abortion, which is on the rise, currently comprising more than half of all abortions committed in the U.S. Chemical abortion is expected to continue to increase in frequency as abortion states and providers in the U.S. look for ways to protect access after the Dobbs ruling pushed abortion regulation back to the states. The fate of the chemical abortion pill is being closely watched as its FDA approval from the year 2000 is facing a legal challenge.
These thousands of adverse events include 768 hospitalizations and 24 deaths since 2000, Brown said. “A study revealed severe side effects including heavy bleeding, intense pain, and death.”
On average, she said, five to eight percent of women undergoing chemical abortion will need emergency room visits for complications.
In fact, said Brown, “These abortion pills have four times the risk of complications as compared with surgical abortion. And that's saying something, because surgical abortion is a blind procedure with a sharp instrument.”
Yet abortion providers have been pushing the boundaries of chemical abortion into later trimesters of pregnancy, when those statistics turn even more dismal. In the United Kingdom, chemical abortions after the first trimester (12 weeks of pregnancy) have a terrible adverse event rate.
“One in 30 [women] experiences heavy or prolonged bleeding or pain requiring an extra medical appointment or treatment,” Brown said. “One in 400 develops an infection during or after the abortion and requires treatment with antibiotics. One in 60 requires further surgery for a retained placenta.”
“One in 200 bleeds heavily and requires extra treatment (which may include extra medicine or an operation or even a blood transfusion),” she said. “And then one in a thousand requires a hysterectomy, which is absolutely tragic and should never be a part of women's healthcare.”
Means of chemical abortion
Brown mentioned lesser used means of do-it-yourself abortion that included “home remedies” and other practices traditional to certain cultures. Because dosing would vary with each woman, users of these methods face risks of uncontrolled bleeding, liver and kidney damage, and allergic reactions.
Methotrexate, a chemotherapy drug used to stop the rapid growth of cancer cells, is administered by injection. At this time, it is rarely used for abortion.
Brown focused most attention on the so-called “abortion pill,” a term referring to a multiple-pill regimen of mifepristone (RU486) followed by misoprostol six to 72 hours later.
“Mifepristone is a synthetic anti-progesterone steroid that works by blocking progesterone,” she said.
Progesterone, a hormone that pregnant women naturally produce, develops the placenta and endometrial lining, inhibits contractions, and keeps the cervix closed, creating a nurturing environment for the baby.
When mifepristone blocks that, “the embryo survival rate after mifepristone is extremely low—only five to seven percent,” Brown said.
Then, to empty the uterus, misoprostol is used to cause contractions and bleeding, usually beginning about one to four hours after that drug is taken.
“It is normal to see large blood clots up to the size of a lemon when a woman takes misoprostol, and clumps of tissue or the baby may be seen,” depending on the gestational age and where she completes the abortion, Brown said.
Abortion with the mifepristone-misoprostol combination has a reported effectiveness in early pregnancy ranging from 52-95 percent. If used later in pregnancy, the drugs must often be used in conjunction with laminaria and digoxin injected into the baby’s heart to end the pregnancy.
“One thing to keep in mind with this type of abortion is that the pregnancy at the start is thriving,” Brown said. “You have a live baby, a thriving pregnancy, it can take a lot of doses to end that pregnancy.
“At the abortion pill reversal hotline, we have had women who have been prescribed [misoprostol alone], who have taken more than eight doses before their pregnancy actually ended,” she said. Since the drug causes uterine cramping, nausea, vomiting, fever, chills, and diarrhea, “That is a miserable process for that woman.”
The reversal hotline is manned by the Abortion Pill Rescue Network, a network pf more than 1,300 rescue providers and centers that administers abortion pill reversal that is managed by Heartbeat International.
Brown drew attention to a sample protocol for misoprostol-only abortion that stated there is limited data on the timing and duration of patient symptoms or the effectiveness of more than three doses to end a viable pregnancy.
“In the very next paragraph they say patients should be reassured that misoprostol-only is a well-studied and recommended regimen for abortion,” she said. “It makes no sense, and it never would hold up in any other kind of healthcare or any other kind of medicine.”
Pushing abortion access multiplies women’s risks
As abortion proponents push to get chemical abortion drugs to more women—especially those they deem “underserved” or who live where abortion is illegal—they are changing the entire face of abortion.
While it could look like a pharmacy or an over-the-border market, it could also look like telemedicine or one of about 70 websites marketing the drugs. And it could be a friend or family member or a pimp buying the drugs to potentially coerce a woman into abortion.
“They sell these drugs to women without any sort of proof that they are pregnant,” Brown said. “So, it could be a man, it could be anyone buying these drugs.”
Without knowing the gestational age, whether the pregnancy is inside or outside the uterus, or whether Rh-negative incompatibility might be an issue, these providers place women’s lives and mental health at risk while providing virtually no follow-up care.
“The woman is typically alone,” Brown said. “She's typically in her bedroom, her bathroom, or her dorm room. She's somewhere by herself in what she considers to be a safe place, and she is dealing with all of the symptoms on her own.
“She is left to determine when too much is too much, and when she needs to seek medical assistance,” said Brown. “And she is left alone in her pain: her physical pain, her psychological pain, her emotional pain, her spiritual pain. She is left there to deal with it all by herself.”
Brown noted several of the very real stressors that drive women to consider abortion.
“It isn't so much that they want to end the life of their child as much as they want to solve a problem and alleviate the stresses,” she said.
“Women are looking for solutions, a plan, support, and hope, but they are being promised ‘just a pill,’ no needle, no touch, an at-home abortion,” Brown said. Far too often, these promises are broken, and women need the kind of medical intervention they wanted to avoid in the first place.
Tweet This: Women are looking for solutions, and with chemical abortion they are promised ‘just a pill,’ but far too often this promise is broken.
Pregnancy centers keep promises, empower women
Showing several photos from among the more than 4,500 children saved through the Abortion Pill Rescue® Network to her roomful of pregnancy help workers, Brown said, “There is much good news and much of that comes from the work that you are doing. And much of it comes from the women we are helping.”
“They are strong, and we know that they are resourceful, they are intelligent beyond their years, emotionally strong, courageous,” she said. “And they're able to parent their children when given the chance.”
“The fact that you offer hope will bring the women back to you,” Brown said. “You have honest answers, information, support, medical services, real options, and hope for the future.”
At pregnancy help organizations, Brown said, “our support doesn't end when she walks out the door. That first visit is just the beginning. This is what ultimately makes abortion unwanted and unthinkable: the exact work that you do every single day.”
Editor's note: Heartbeat International manages the Abortion Pill Rescue® Network (APRN) and Pregnancy Help News. Heartbeat Conference workshop recordings can be purchased HERE.