Chemical abortion harms women. Supreme Court can’t ignore them

On Dec. 13, the U.S. Supreme Court announced that it would hear a case to challenge the FDA’s actions to remove commonsense safeguards for women and girls who take the chemical abortion drugs mifepristone and misoprostol. It was filed by my organization, three others and four doctors via our Alliance Defending Freedom attorneys. 
 
On Dec. 13, the U.S. Supreme Court announced that it would hear a case filed by my organization, three others, and four doctors via our Alliance Defending Freedom attorneys to challenge the FDA’s actions to remove commonsense safeguards for women and girls who take the chemical abortion drugs mifepristone and misoprostol. The court’s decision could be a significant move toward protecting women and girls across the country from the extreme dangers of these drugs — something the FDA failed to do over the last two decades. 
 
As an example of the harm that has already occurred, a friend and fellow OBGYN hospitalist recently shared the tragic experience of a patient he treated a few months ago. Giselle, let’s call her, became pregnant and opted to undergo a chemical abortion using mifepristone and misoprostol. Her clinic told her to expect a couple days of cramping, bleeding and passing the contents of her uterus in clots — nothing more. 

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Shortly after starting the abortion, a sharp pain took over her abdomen, but no bleeding or clots. After days of only worsening pain, Giselle called the clinic repeatedly. But the staff just told her that her symptoms were normal and, in an egregious act of neglect, denied her a follow-up examination. 

Giselle remained in agony for two weeks before her blood pressure dropped to dangerous levels, and she was rushed to the hospital. During her emergency abdominal surgery, my friend discovered the source of Giselle’s pain: a ruptured ectopic pregnancy. It had severely damaged her pelvis, which was filled with pus and scar tissue. She required two week-long hospitalizations and took much longer to recover emotionally. 
 
Given that ectopic rupture is a life-threatening emergency and something every well-trained OB physician knows how to recognize, it’s puzzling that Giselle’s abortionist didn’t do more to prevent this near-deadly complication. Unfortunately, outcomes like hers are foreseeable. 
 
Safeguards around chemical abortion drugs were minimal to begin with but are now nearly nonexistent. For example, the FDA has never required abortionists to perform an ultrasound before starting a patient’s chemical abortion. Today, it allows these drugs to be obtained online and delivered in the mail, without a woman even interacting in person with a medical professional. 
 
Ultrasound is the only way to confirm gestational age and definitively rule out ectopic pregnancy, which occurs in one in 50 pregnancies and which abortion drugs cannot treat. A patient with an undiagnosed ectopic will believe that her symptoms are normal side effects of her chemical abortion and will be less likely to seek help promptly. That’s the scenario Giselle found herself in — one that has killed women before. 

Nevertheless, the FDA is intent on eroding the safeguards that could prevent many complications like this. During a May hearing in the lawsuit now before the Supreme Court, the FDA’s legal counsel was asked how women were being screened for ectopic pregnancy when they obtain these drugs online. She replied that the women are asked questions, such as ‘whether they have shoulder pain.’  

As a physician who has cared for hundreds of women with ectopic pregnancies, I was shocked at this response. Shoulder pain in a woman with an ectopic pregnancy means that she has an abdomen so full of blood it is causing irritation of her diaphragm and referred pain into her shoulder. At that point, she would be close to death. Women in this country — my patients, your daughters — deserve far more than this shoddy level of care. 

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Misidentifying an ectopic rupture is not the only possible complication of chemical abortion. One in five women who undergo a chemical abortion will experience complications such as hemorrhage and infection — not an insignificant number when you consider that, today, more than 50% of the nearly 900,000 abortions in the U.S. every year occur via these drugs. 
 
The removal of in-person visits for women both before and after taking chemical abortion drugs is malpractice, and emergency physicians are seeing the consequences.  

Given that ectopic rupture is a life-threatening emergency and something every well-trained OB physician knows how to recognize, it’s puzzling that Giselle’s abortionist didn’t do more to prevent this near-deadly complication. Unfortunately, outcomes like hers are foreseeable. 

Giselle’s physician, who serves less than 10% of the total volume of women in his hospital’s emergency department, recounts managing no fewer than 11 women experiencing significant complications after chemical abortion in the past year alone — women who were traumatized and even rendered infertile by these drugs. My colleagues and I have served patients who suffered sepsis, hemorrhage, acute kidney injury and more.