The U.S. Centers for Disease Control and Prevention (CDC) reported that chemical abortions represented 38.6 percent of all U.S. abortions in 2018, an increase of 120 percent from 2009. According to the Associated Press, abortion by pill rose to 54 percent of all abortions in America in 2020. The abortion industry has evidently found its path to circumventing the possible overturning of Roe v. Wade, and that avenue is the mailbox.

What is the Abortion Pill?
The chemical abortion is currently a combination of Mifeprex (generic mifepristone; aka, RU-486) plus misoprostol (Cytotec) to end pregnancies of 70 days gestation (10 weeks) or less. The U.S. Federal Drug Administration (FDA) website states the chemical abortion regimen since 2016 has been: “On Day One: 200 mg of Mifeprex taken by mouth[.] 24 to 48 hours after taking Mifeprex: 800 mcg of misoprostol taken buccally (in the cheek pouch), at a location appropriate for the patient[.] About seven to fourteen days after taking Mifeprex: follow-up with the healthcare provider[.]”

Contrary to the popular yet unsupported claim that abortion pills are as safe as Tylenol, the FDA site specifies these as expected side effects to the abortion protocol: “Cramping and vaginal bleeding are expected effects of the treatment regimen. In some cases very heavy vaginal bleeding will need to be stopped by a surgical procedure, which can often be performed in a healthcare provider’s office. Other common side effects of the treatment regimen include nausea, weakness, fever/chills, vomiting, headache, diarrhea, and dizziness in the first day or two after taking the two medicines.” The American Association of Pro-life Obstetricians & Gynecologists has well-researched information on Mifeprex abortions.

Study of Induced Abortions in Medicaid-eligible Women
2021 saw the publication of a “population-based longitudinal cohort study of 423,000 confirmed induced abortions and 121,283 subsequent ER visits occurring within 30 days of the procedure, in the years 1999-2015, to Medicaid-eligible women over 13 years of age with at least one pregnancy outcome, in the 17 states which provided public funding for abortion.” The study confirmed the rise of chemical abortions to 34 percent of total abortions in 2015, but also something else: “Similarly, ER visits following mifepristone abortion grew from 3.6% of all postabortion visits in 2002 to 33.9% of all postabortion visits in 2015.” That should get one’s attention. One-third of all ER visits for postabortion problems resulted from the chemical regimen, refuting the claim that mifeprex is as safe as Tylenol use.

The study authors further noted “Abortion studies in the United States consistently report lower postabortion complication rates than are documented in the international scientific literature.” Their analysis found two contributors to that discrepancy: “miscoding of abortion-related complications by the provider and the nondisclosure of prior abortion history by the patient.” Elaborating on the first, “Our study demonstrated ER visits misclassified or miscoded as spontaneous abortion grew for both types of induced abortion, reaching 39% of abortion-related visits following surgical abortion and 60.9% of visits following chemical abortion in 2015.” Thus over 60% of the chemical abortion complications are being erased by miscoding. As for the second causal factor, “…but some abortion advocates encourage women to withhold information if seeking treatment for an adverse event.” Two citations were offered as supporting evidence for this assertion,

“Safe2Choose. Will medical staff be able to notice that I am having an abortion?” and “Plan C. Abortion pills FAQ: Can I get in trouble for using abortion pills?”

ACOG Expectations of the Pre-abortion Visit
The American College of Obstetricians and Gynecologists clearly states the visit of the abortion-seeking patient with the healthcare professional must include certain essential screenings, among which are the following two:

1. Screening for Intimate Partner Violence: “Include reproductive and sexual coercion and IPV as part of the differential diagnosis when patients are seen for pregnancy or STI testing, emergency contraception, or with unintended pregnancies.” ACOG CO 554 Reproductive and Sexual Coercion, Feb 2013.
2. Unknown Rh status: “Rh D immune globulin should be given to Rh D- negative women who have pregnancy termination, either medical or surgical.” ACOG PB 181.

However, ACOG’s enthusiasm for telemed and do-it-yourself abortions has caused them to ignore their own published recommendations and advocate for this dangerous, unmonitored self-use of mifeprex.

Loosening Regulations Increases Risk
Common post-abortion-pill complications include retained tissue, infection and bleeding, among others. If an ectopic pregnancy is missed, the result is usually fatal.

The FDA’s Risk Evaluation and Mitigation Strategies (REMS) for abortion pills was relaxed in 2016 to only require the reporting of patient death, not serious adverse outcomes from their use. In July 2020, a federal judge suspended the requirement for in-person dispensing of abortion pills during COVID-19, but the U.S. Supreme Court overturned this decision in January 2021, so that women would again need in-person visits for chemical abortions. However, in April 2021, the FDA wrote ACOG that they would not be enforcing the in-person requirements, opting instead “to exercise enforcement discretion.” In December 2021, the FDA removed the requisite healthcare settings for dispensing of abortion pills. That FDA Commissioner letter to ACOG stated: “…that the small number of adverse events reported to FDA during the COVID-19 public health emergency (PHE) provide no indication that any program deviation or noncompliance with the Mifepristone REMS Program contributed to the reported adverse events.” Does one laugh or cry at the Commissioner’s statement, knowing the FDA dropped required Mifepristone adverse event reporting in 2016? It appears the FDA is willfully ignorant of harm to women caused by Mifepristone.

The elimination of a mandatory office visit for access to medical abortion means there will be no examination by a healthcare professional, no confirmation of gestational age, little assurance of adequately counseling the patient, difficulty with truly informed consent, no adequate assessment for intimate partner violence and human trafficking, no ultrasound to rule out ectopic pregnancy, no determination of Rh status and need for RhoGam and likely no chance of caring for complications. The abortion pills are sent, and the odds roulette gets played needlessly.

Abortion Pill Reversal and Abortion Pill Rescue Network (APRN)
A ray of hope exists in the midst of this medical, scientific and regulatory travesty. The Abortion Pill Rescue Network (APRN) provides the possibility of reversing the effects of Mifepristone for women who regret initiating the abortion pill regimen, if engaged promptly. Available around the clock at help@apr.life and 877-558-0333, APRN uses Progesterone to reverse the effects of Mifepristone.

Their website explains, “The abortion pill mifeprex is known to work by blocking progesterone receptors. The drug development literature also clearly shows that the blockade is reversible with natural progesterone. Natural progesterone has been used safely in pregnancy for over 50 years and is used routinely in the IVF industry.” Their track record demonstrates a 64 percent to 68 percent effectiveness “in appropriate patients,” with 2,500 babies saved as of 2022. For doctors who are interested in becoming APR providers, there is a website with FAQs and a link to sign up to the network.

Conclusion
Chemical abortion with the mifepristone and misoprostol pill combination now comprises 54 percent of all U.S. induced abortions. The FDA rescinding of the requirement for in-person pre-abortion patient evaluation with a medical professional decimates safeguards. The abortion pills are not Tylenol. A recent study discovered that one-third of all post-abortion ER visits in 2015 were after use of abortion pills. Patients may well withhold revealing the abortion-pill causality, and these incidents have been miscoded as miscarriages 60 percent of the time. So long as patient death does not occur, the FDA REMS declares nothing must be reported. How is this defensible?