The abortion pill’s significant complications must not be buried or ignored

The abortion pill’s significant complications must not be buried or ignored ( Danilo Alvesd/Unsplash)

(Live Action) Chemical abortions (via the abortion pill) are increasing rapidly in the United States. Among the states that have released chemical abortion data for 2019, chemical abortions jumped almost 12 percent from 2018. That trend is unlikely to slow, with the U.S. Food and Drug Administration (FDA) suspending an important element of its safety regulations on the abortion pill mifepristone to permit its distribution through the mail. Despite the dangers that mifepristone can pose to women, the drug is now widely available with almost no medical oversight. 

Complications are significantly underreported

As chemical abortions in the U.S. increase, complications will likely increase as well, but abortion complication data in the United States is spotty.

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Since 2016, the FDA no longer requires distributors of mifepristone to report any adverse events other than death. Just over half the states collect information from abortion providers on complications resulting from abortion, and only a quarter of all the states require other healthcare providers to report abortion complications they treat. Of these, states enforce their reporting requirements to varying extents, and many complications are never reported.

However, what little information there is shows that chemical abortions lead to more complications than other abortion methods. A recent analysis of adverse event reports from the years that the FDA required wide-ranging reporting showed that chemical abortion has led to multiple known deaths and hundreds of hospitalizations, even though these adverse events were significantly underreported. 

Higher rate of complications for those that are reported

Of the states that have reported complications resulting from different types of abortion procedures in recent years, most reported a higher rate of chemical than surgical complications.

In Arkansas, chemical abortions accounted for 89 percent of abortion complications, while chemical abortions made up just 55 percent of all abortions reported in the state. In Pennsylvania, chemical abortions composed 45 percent of the abortions but 60 percent of the complications. Chemical abortions in Idaho were 48 percent of abortions causing complications and 42 percent of total abortions. In Missouri, more reports of chemical abortion complications were received (53) than the total number of chemical abortions occurring in the state (15), suggesting that some women who obtained chemical abortions in other states suffered complications that were treated in Missouri. Only Michigan reported that chemical abortions made up a smaller share of complications (41 percent of 75 reported abortions with complications) than total abortions (52 percent).

Ohio is unique among the states with a special adverse event reporting system for chemical abortions. Any doctor who administers abortion drugs must report any complications that occur to the Ohio State Medical Board. Ohio received 90 adverse event reports for chemical abortions performed in 2018, or 1.5 percent of all chemical abortions reported in the state that year.

Complication data from other states helps to fill in the picture. While Texas does not report the type of abortion procedure that results in each complication, its new complication reporting law has led to improved reporting in the state, with 229 complication reports submitted by healthcare facilities in 2019. Almost half (111 complications) were incomplete abortions – a common complication of chemical abortion.

Similarly, Wisconsin reported an enormous jump in “retained products” or incomplete abortions, with 621 cases in 2019, up from 73 the previous year. Separately, 35 of Wisconsin’s abortion reporting forms in 2019 indicated that the procedure was a surgical abortion following an incomplete or failed chemical abortion, an increase from the year before. Both Texas and Wisconsin have reported large increases in chemical abortions in recent years. 

Large-scale studies reinforce state data showing increased risk of complications

While complication data is underreported for some states and completely missing for others, large-scale studies show the same pattern. An analysis of Medicaid data from California found that chemical abortions had a complication rate four times that of first-trimester surgical abortions. Even though visits back to the abortion center or to a different provider were not included, over five percent of the chemical abortions resulted in trips to the emergency room. 

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One of the strongest studies on chemical abortion complications examined data from Finland, where the complete medical history of each woman undergoing abortion is available. Similar to the California analysis, the Finnish study found that chemical abortions had four times the complication rate of surgical abortions, but recorded much higher complication rates overall. A full 20 percent of the more than 22,000 chemical abortions performed in Finland between 2000 and 2006 resulted in complications, with hemorrhage occurring in nearly 16 percent of chemical abortions and incomplete abortion in almost seven percent.

These high complication rates in a country with complete reporting indicate that abortion complications in the United States are probably significantly undercounted. 

As mifepristone is transmitted via the mail, and proposals increase to provide it later in pregnancy and to women unsure of the length of their pregnancy, complications are likely to increase and reporting to get worse. Fortunately, some states have taken the initiative to implement their own safety protections and improve abortion complication reporting. As the FDA slackens its oversight of what has proven to be a dangerous drug, it will be up to the states to stand in the gap and ensure that safety standards are enforced.

Editor's note: Tessa Longbons is a research associate with the Charlotte Lozier Institute (CLI), based in Arlington, VA. Her research focuses on abortion statistics at the state and national levels and tracks U.S. abortion trends. CLI's State Abortion Reporting map is available HERE. This article was published by Live Action News and is reprinted with permission. Heartbeat International manages the Abortion Pill Rescue® Network (APRN) and Pregnancy Help News.

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