The Abortion Industry’s ‘War’ on Rural Women

by Mailee Smith
Women without access to a doctor face real dangers when they take RU-486.

Abortion is not the “safe, legal, and rare” procedure activists claim they are fighting for – and if they have their way, chemical abortion is about to become less safe,  more suspect, and  more rampant.

In fact, what was alleged by abortion supporters to be a “safer” alternative to surgical abortion is proving to be anything but. As reported in a New York Times article this weekend, abortion advocates eager to get these drugs into the hands of women without physician oversight. The article raises red flags in detailing how abortion advocates are pushing these drugs, and the reporter leaves out facts proving that chemical abortion is indeed dangerous and must be regulated in order to protect women’s lives.

Chemical abortion (widely referred to as RU-486) actually consists of two different drugs: mifepristone (brand name Mifeprex) and misoprostol. The FDA approved the RU-486 regimen in the United States in 2000, restricting use to up to 49 days gestation and requiring, among other things, that women ingest mifepristone on Day 1 and return to the clinic on Day 3 (48 hours later) to ingest misoprostol.

The facts reported in the New York Times should raise significant concerns. Framing the article around a “general-practice physician and activist” who has devoted her life to getting abortion drugs to women around the world, the reporter presents a picture that should send chills through the reader — if the reader cares anything about maternal health, that is.

From a small office in Amsterdam, this “physician and activist” — who formerly worked on a Greenpeace vessel — receives Internet requests for the drugs. A small team of associates, the location of which she would not reveal (as if that is not suspicious), reviews requests and writes prescriptions for the drugs — without ever communicating with (much less examining) the women receiving the drugs. The drugs are then sent from an “exporter” in India.

When women face complications, the “help desk” in Amsterdam is trained to “send a standardized list of warning signs but not to weigh in about the severity of anyone’s particular symptoms.” Instead, women are told to go to a doctor. But considering that most women who are “importing” these drugs are doing so from countries where abortion is illegal, and that they are therefore in the middle of undertaking an illegal procedure, it’s likely that they are just a tad bit nervous about consulting a physician.

Of course, with no real physician-patient relationship and no follow-up care, there is no data on whether the women “helped” by this Amsterdam activist ever go to a doctor or survive their complications.

So we have a former-Greenpeace-activist-physician who exports drugs from India to women without any accurate data on the physical heath of the women, and no follow-up protocol. Back alley, anyone?

The reporter also fails to relate facts proving that chemical abortion can indeed be dangerous for women. The U.S. mifepristone drug label itself states that “nearly all of the women who receive Mifeprex and misoprostol will report adverse reactions, and many can be expected to report more than one such reaction.” These risks include, but are not limited to, uterine hemorrhage, viral infections, and pelvic inflammatory disease. Because of the risks of serious complication, the RU-486 regimen is contraindicated for women who do not have immediate access to emergency care, including medical facilities equipped to provide emergency treatment of incomplete abortion, blood transfusions, and emergency resuscitation (i.e., “rural women” and likely most of the women at the crux of the Times article).

In July 2011, the FDA reported 2,207 adverse events in the U.S. after women used mifepristone for the termination of pregnancy. Among those were 14 deaths, 612 hospitalizations (excluding deaths), 339 blood transfusions, and 256 infections (including 48 “severe infections”). Eight of the deaths were caused by severe bacterial infections, and two were caused by ruptured (i.e., undetected) ectopic pregnancy. While some of the complications arising after use of the RU-486 regimen have been within the range expected, the U.S. Government Accountability Office has reported that the number of women dying from fatal infection is not within the expected range.

Moreover, studies have shown that surgical abortion is actually safer than chemical abortion. One peer-reviewed study found that the overall incidence of immediate adverse events is fourfold higher for chemical abortions than for surgical abortions. In particular, hemorrhage and incomplete abortion are more common after chemical abortions. Researchers found that the incidence of hemorrhage is 15.6 percent following chemical abortions, compared with 5.6 percent for surgical abortions. Further, 6.7 percent of chemical abortions result in incomplete abortion (thus necessitating a second chemical abortion or a surgical abortion, further compounding the risks), compared with 1.6 percent of surgical abortions. Another study found that chemical abortion failed in 18.3 percent of patients and that surgical abortion failed in only 4.7 percent of patients.

The unauthorized, dangerous use of abortion drugs is not just something that happens in other countries. The activist described in the article receives 40 to 60 requests a month from women in the United States (although it does not ship to women where abortion is legal).

Moreover, the dangerous protocol portrayed in the article is not dissimilar from the protocol advocated by Planned Parenthood here in the United States. Fortunately, earlier this month a state trial court in Iowa upheld an Iowa Board of Medicine rule halting Planned Parenthood’s experimental “telemed abortion” procedure, in which a physician communicates via teleconferencing with a woman and never examines the woman before approving chemical-abortion drugs for her.

Notably, the rule prohibiting this practice was approved by a medical board — consisting mostly of physicians — in an 8–2 vote (with the two dissents focused not on the merits of the rule itself, but instead on the speed of the rule-making process). This group of physicians acknowledged that chemical abortion is dangerous and poses unique risks — risks that require the physical presence of a physician and the establishment of a physician-patient relationship. The Iowa trial court noted repeatedly that the board was acting to protect maternal health and that women in “rural” areas are entitled to the same standard of medical care as women in more urban areas.

All women deserve the best medical care. And that care must come from physicians — not exported from nameless, faceless entities overseas (who cannot be held accountable) and not from abortion providers who aren’t willing to have a doctor examine women physically before sending them away with life-ending (certainly for the baby and potentially for the mother) drugs.

Mailee Smith is staff counsel for Americans United for Life.

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