By Randall K. O’Bannon, Ph.D., NRL Director of Education & Research
Clinics have been closing, abortions have been dropping, and the abortion industry is having difficulty enlisting a new generation of abortionists to replace those that have retired or exited in scandal. Should we expect them to abandon the cause? Hardly.
What they’re doing is trying to come up with ways to do abortions without clinics, without hiring new doctors, to sell and deliver abortions to communities where abortion was never a serious option.
The latest project? Taking the use of chemical and webcam abortions a step further: have women do an online interview from their home computer and then have abortion pills shipped to them by overnight mail.
Currently, the “abortion by mail” option is being made available in four states – Washington, Oregon, Hawaii, and New York – as part of a “study” by Gynuity Health Projects. The New York Times calls it a “nonprofit research group focused on reproductive health services that seeks to improve women’s access to medical abortions” (11/10/16).
The idea is that eventually a couple of online abortion consultants and a shipping department can handle hundreds or thousands of orders from all over the United States. No need to buy property, get zoning, build a clinic, train and hire an abortionist and staff, or court controversy in a community where you aren’t welcome. The abortionist and the clinic are as near as your computer and your mailbox.
Gynuity is headed by Beverly Winikoff, formerly of the Population Council, where she was instrumental in bringing the abortion pill, RU-486 (mifepristone) to the United States.
In what Gynuity has dubbed the “TelAbortion” study, a woman somehow (via a story on the news, a computer search, word of mouth?) hears about the study and contacts Gynuity. If she is interested in the abortion by mail option, after a short “Video Evaluation” in which some basic medical questions are asked, the “provider” will help the woman find places near her where she can get the tests (an ultrasound or pelvic exam, possible blood tests) she needs to qualify.
Once a consent form is electronically signed, the tests performed and the results sent back to the “study provider,” a package with mifepristone, misoprostol, ibuprofen and a medication guide is overnighted to the address given by the patient, if the abortionist determines the woman to be eligible.
These pills are to be taken by the pregnant woman according to the instructions at a time and place of her choosing.
The abortion by mail method is an obvious extension of the web cam abortion process pioneered by Planned Parenthood in Iowa a decade earlier. We have written about webcam abortions on many, many occasions.
Here, again, is the video consult with the abortionist back in some metropolitan hub. Only this time, she does the consult on her own computer and the drugs are mailed to her home rather than unlocked from a desk drawer at the local clinic where she has gone for her video interview.
Like the abortion industry in general, Gynuity tends not to dwell on the difficult and painful part of the chemical abortion process. It does admit that “Side effects of medical abortion are common; they include vaginal bleeding and abdominal cramping, nausea, vomiting, diarrhea, fatigue, and mild fever.”
They do not talk about how much bleeding these involve (more than a standard first trimester surgical abortion and it may last for days, or even weeks) or how that the pain and cramping may be intense. Instead they reassure patients, “These side effects usually last a short time and can be treated with over-the-counter medications.”
Gynuity tells women that serious risks such as heavy bleeding and infection are rare. Not mentioned is that more than a dozen women in the U.S. are known to have died after having chemical abortions with these pills.
Though promoted as a method that allows women to avoid going to the abortion clinic, it is not clear they will be able to do so with the study. Their video consult is with one of Gynuity’s three participating abortion clinics. (We know from the TelAbortion website that these are The Choices Women’s Medical Center in Queens, NY, the Hawaii Women’s Health Research Center, in Honolulu, and the Oregon Health & Science University in Portland.) They must have certain tests performed before their abortions to qualify and tests after their abortions to determine if the abortion process is complete.
We don’t know if a woman’s choices for her testing are limited to doctor’s offices or clinics selected by Gynuity, but those locations do have to cooperate with Gynuity for Gynuity to get the woman’s medical records and evaluation and process her results for the study. Local abortion clinics working with Gynuity are the obvious choice here, although it is clear that Gynuity has in mind that these tasks can be carried out by any doctor or clinic.
For its part, Gynuity does not promise that the woman’s case will be handled by a doctor, but only the “abortion provider.” According to the New York Times, that could be a doctor “or other clinician such as a nurse practitioner.”
In truth, with the new protocol from the U.S. Food and Drug Administration (FDA), the only requirement is that the whole process is somehow under the supervision of some “certified healthcare provider.” That could be anything from a trained surgeon to a certified medical assistant with only a few health classes from a local community college.
Who will be responsible in her local area if a woman having a mail order abortion begins to hemorrhage or contracts a deadly infection or has a ruptured ectopic pregnancy is also unclear.
Does she return to the site where she had her ultrasound or blood tests? Would they necessarily be prepared to handle a hemorrhage or a ruptured uterus? Or will that become a problem for the local ER to figure out and solve?
All such details will probably be carefully monitored for now while the study is in process. And in a few months, barring no unforeseen publicly disclosed disasters, one can expect to see a report of the study published claiming that everything went swimmingly, that women were “satisfied” with their experiences (a not entirely unexpected result, given that their abortions were paid for, even if they had a surgical abortion after the “medication” failed), with a recommendation that the method could be safely duplicated anywhere in the country.
If all goes as planned, abortion, while not easier or safer, will become more widely available.
Abortion by mail will open a whole new market for the abortion industry, giving them access to whole new populations of women in communities where there is no abortion clinic anywhere nearby.
But it’s worth noting that while abortion will become more widely available for such women, it won’t necessarily become any easier or safer. In fact, it will likely make things much more dangerous.
And it certainly won’t be of any benefit to the unborn child.