Increased Ectopic-Pregnancy-Related Deaths Show Why FDA Must Reinstate Abortion Pill Safeguards

ProPublica recently attempted to trick the public with a misleading article titled “Ectopic Pregnancy Deaths Have Nearly Doubled. It’s Worse in States With Abortion Bans.” Michael New here correctly pointed out various flaws in the authors’ arguments and observed that “the CDC does not publicly release data on ectopic pregnancy deaths.” I accessed the CDC WONDER database, subject to standard confidentiality requirements, and was generally able to replicate the calculations in the article. And the data revealed important details that ProPublica failed to mention.

In the 21 years from 1999 to 2021, the United States averaged 4.2 ectopic-pregnancy-related deaths per million live births. Suddenly, in 2021, this figure surged to a peak of 9.8. It has averaged 7.8 over the past five years, which are five of the seven worst years for ectopic-pregnancy-related deaths since 1999.

Critically, both the pro-life states that would ban abortion post-Dobbs and the pro-choice states that would not have done so experienced far higher rates of ectopic-pregnancy-related deaths since the removal of the in-person safeguards for abortion pills.

The FDA-approved mifepristone drug label warns that it “is contraindicated in patients with a confirmed or suspected ectopic pregnancy,” a life-threatening condition that can only be diagnosed with an in-person doctor visit. I have previously calculated that the incidence of mifepristone being inappropriately prescribed to a woman with an ectopic pregnancy increased by more than 50 percent when the FDA stopped enforcing the in-person dispensing requirement. My calculation relied on an insurance-claims database, which overwhelmingly includes only legal abortions. In pro-life states, where nearly all abortions are now procured illegally using pills shipped through the mail without an in-person doctor visit, the increase was surely much greater. This is why ectopic-pregnancy-related deaths surged in both groups of states, but even more in states with abortion bans.

The primary explanation for the nationwide increase in ectopic-pregnancy-related deaths beginning in 2021 logically cannot be state-level pro-life policies that took effect in 2022. The evidence is more consistent with the real problem being increased inappropriate provision of mifepristone to women with ectopic pregnancies. The FDA should reinstate in-person safeguards to protect women from the harms of the abortion pill.