By Randall K. O’Bannon, Ph.D., NRL Director of Education & Research
Editor’s note. In Part One, Dr. O’Bannon provided the background to the very unfortunate reality that Doctors Without Borders is involved with a new website giving women instructions on how to use abortion drugs. It is called howtouseabortionpill.org.
Doctors Without Borders (the acronym in French is MSF) says they have “teamed up” with HowToUseAbortionPill.org “to create a free, open-source, evidence based online course on medication abortion, or abortion with pills” by means of “five animated videos.” Dr. O’Bannon analyzed the first video in Part One.
VIDEO #2: Amateur Abortion Screening & Counseling
The second video, “Before the Abortion,” tries to instruct humanitarian personnel with no formal medical training on how to screen women as potential chemical abortion patients. The potential for problems is as profound as it is obvious.
There are certain conditions which may make taking the drug (or drugs) dangerous, or even deadly, for some women. Verifying the age and location of the unborn child are essential. The “effectiveness” of the abortion drugs diminishes as the baby grows and mifepristone and misoprostol do not work in situations of ectopic pregnancy (when the child implants outside the uterus).
While an ultrasound offers the clearest and most accurate way to date and locate a pregnancy, the MSF video says “ultrasound is not required.” Moreover, they claim it “does not necessarily increase safety or improve results.”
This, despite the documented fact that women undergoing chemical abortions have died from undetected ectopic pregnancies. Ultrasounds enable abortionists to determine whether or not the baby is properly implanted in the uterus.
As for dating pregnancy, the video claims that the drugs are “safe and effective over a range of gestational ages” so that “small differences of one or two weeks do not significantly affect clinical effectiveness.”
How “significant” this altered “effectiveness” depends on the source. Figures from the U.S. Food & Drug Administration (FDA) show effectiveness drops from 98.1% to 92.7% in just two weeks time, even the abortion is completed within the prescribed first ten week time period. Two weeks matter, and an ultrasound can make it clear whether the gestational age is eight weeks, ten weeks, or twelve weeks
If the abortion is performed later, commonsense tells you the “effectiveness” will diminish even more. This may not be clinically “significant” to promoters of the abortion pill, but it is a potentially huge issue to women without ready access to medical care.
So, given this, why try to justify amateurs using an inferior method for dating the pregnancy or locating the baby? Promoters realize that an ultrasound requirement would put chemical abortions out of reach of more women who either could not afford the additional cost or might not have access to an ultrasound machine.
This is also why they want to expand the pool of abortion pill providers in some of these areas by using lesser trained medical professionals. Though they grant that “trained health care workers” can estimate gestational age by a physical examination, they argue that it may be “accurate and acceptable “ to simply trust a woman’s memory of when her last menstrual period was.
What about determining whether a woman has any medical conditions that would make use of these drugs dangerous for her? MSF thinks that this can be addressed by having the woman answer a few basic health questions.
For example, ask about whether she has inherited porphyria, chronic renal failure, severe uncontrolled asthma, bleeding disorders, severe anemia, or signs of ectopic pregnancy. Multiple past Cesarean deliveries could also be a problem because a high dose of misoprostol could cause the uterus to rupture.
While a woman would obviously recall if she had had a previous Cesarean delivery, it borders on the ludicrous to expect her to have full knowledge of and understanding of her medical condition/ history when she may have rarely, if ever, visited a doctor.
The remainder of the video says that the woman should have a plan in place about when and where she intends to have the abortion, who will be with her, and how she would get to the nearest medical facility if she should have problems. Though good advice, there is no indication that this will be confirmed in any way or that she will be denied the abortion pills if she does not have an adequate emergency plan in place.
Nevertheless, if she encounters an emergency and does have to go to the doctor, they advise her that “she does not have to say she used pills to cause an abortion. She can simply say she is having a miscarriage, and she should receive the appropriate care. The symptoms of medication abortion are very similar to a miscarriage and there is no way to tell the difference.”
Why? She might want to conceal this information, either out of personal embarrassment, or to avoid implicating herself (or whomever supplied her with the drugs) in performing an illegal abortion. How fortunate for the organization providing her such drugs for her not to admit taking the abortifacient or tell whom it was who gave it to her. When the cause trumps personal safety, it reveals the organization’s real agenda in promoting them.
Even ignoring how such knowledge of the cause of her symptoms might legitimately help a physician better understand and treat the woman, concealing this information serves to corrupt (or may already have corrupted) any analysis of abortion safety. This could easily lead the physician to attribute her complications to her pregnancy when it ought to be attributed to chemical abortion.
Part Three on Friday.