In the Abortion Industry, ‘Access’ Now Matters More Than Care

‘T ried to get some reassurance from ChatGPT about the volume of blood coming out of my body . . .”

“Woke up at 5 a.m. with the severe cramps again. Had this ever happened to anyone? Is it someone [sic] normal part of the process?”

These anecdotes, posted on Reddit, aren’t rare, and they reflect a troubling trend: Mail-order abortion drugs have transferred the burden of monitoring pain, bleeding, and potential infection from experienced physicians to the women themselves. For the abortion industry, “access” now trumps standard medical care, and women have become collateral damage.

As an obstetrician-gynecologist with more than 30 years of experience, I am distressed by the effects these malevolent actions have on women. Quality medicine typically seeks to avoid producing heavy bleeding, significant abdominal pain, or other adverse symptoms, but with mail-order abortions, these experiences have become normalized as “treatment.”

This isn’t an accident; it’s by design.

The two-drug abortion regimen approved by the Food and Drug Administration (FDA) for DIY abortion first uses mifepristone to block critical hormonal support, disrupting blood flow and killing the unborn baby. Then, it uses misoprostol to induce contractions that expel the baby and pregnancy tissue.

Drug-induced abortions, which account for two-thirds of abortions in the U.S., are a terrible experience for most women. The average woman will bleed heavily for up to two weeks, and nearly half describe severe, labor-like pain as part of the process. Sadly, many will see the aborted child, triggering intense traumatic emotions that can linger.

Women may choose this method when they are incorrectly told that it is “safer than Tylenol” and incorrectly conclude it is a “benign” and “natural” way to end a pregnancy. However, complications from abortion drugs are at least four times more frequent than complications from surgical aspiration abortion. Abortion drugs, in fact, cause approximately one in 25 women who take them to require emergency room care.

In 2021, the FDA removed the in-person-dispensing requirement for abortion drugs. This opened the door to rampant mail-order abortion, where there is often no ultrasound to confirm the gestational age of the unborn baby or rule out a potentially deadly ectopic pregnancy. There is no blood work to determine Rh status, so some women may not obtain RhoGAM to prevent future pregnancy complications. Labs are also necessary to rule out severe anemia and diagnose sexually transmitted infections which may lead to future infertility. The FDA also no longer requires a follow-up visit or reporting of complications, apparently assuming that “no news is good news.”

In no other area of medicine are patients deliberately given drugs whose expected effects include significant pain and heavy bleeding — as well as other frequent complications — and then left to manage those effects without medical oversight. This intentional downgrading of medical care contrasts dramatically with the care provided to women in other pregnancy emergencies.

Ob-gyns readily provide grieving women who are experiencing natural pregnancy loss with precautions on when and whom to call if they should suspect they are experiencing a complication. An ultrasound to confirm pregnancy loss and in-person counseling are standard. Conversely, because many women order abortion drugs from out of state or even outside of the country, there may be no one to contact in an emergency. A woman may be forced to guess how much bleeding is too much, potentially increasing her risk if she should delay necessary care. I have cared for women experiencing such complications who have not been offered a follow-up visit when they contacted the abortion provider but were merely told “rub your tummy” or “take more misoprostol” in hopes of decreasing the bleeding.

Further exacerbating the problem, the abortion lobby encourages women to withhold information about a drug-induced abortion if they seek emergency care for complications, falsely assuring them that disclosure is unnecessary. Consequently, 84 percent of emergency room visits after abortion drug use were miscoded as resulting from miscarriages. This undoubtedly affects the quality of care when physicians are uninformed or mislead about a patient’s circumstances.

Following pregnancy loss, ob-gyns recommend in-person follow-up for reassurance that no physical complications have occurred and to screen for adverse mental health effects. Women who suffer mental health complications following abortion generally do so alone and undetected. Although abortion advocates falsely reassure the public that anxiety, depression, and other mental health issues are rare following abortion, European studies have documented that “deaths of despair” — including suicide, accidents due to high-risk activities, substance abuse, and overdose — occur six times as frequently in the year following an abortion compared with the birth of a child.

What the abortion industry has normalized with mail-order abortion drugs would be considered medical abandonment in any other situation.

Good medicine prioritizes patient safety and informed consent, but mail-order abortion drugs normalize isolation, uncertainty, patient dumping, and delayed care. As physicians, we cannot abandon commonsense medical standards for more “access” to dangerous abortion drugs.