By Randall K. O’Bannon, Ph.D., NRL Director of Education & Research
You might have expected the abortion industry to celebrate when the Food and Drug Administration (FDA) approved the abortion pill mifepristone (“RU-486”) for sale in the U.S. in September of 2000. Chemical abortions were high, high on their list of objectives. But they complained. Too many pills, too many visits, too much red tape, they groused.
When the FDA acceded to many of their demands in March of 2016 — reducing doses, fewer office visits, widening the prescriber pool, extending the gestational cutoff date–they still weren’t happy. Why should women have to come to the clinic at all? Why couldn’t the abortionists just mail the drugs to women after a short video consult?
They tried getting around the regulations with webcam abortions in Iowa in July of 2008. Rather than meet in person with the abortionist, women were “prescribed” their abortion pills via video call and pills were dispensed at lightly staffed satellite office. A group called Gynuity launched a multi-state “study” in 2016 with the video consult where the pills were shipped by overnight mail.
When the pandemic hit in 2020, activists argued that they temporarily needed a “contactless” abortion. Earlier this month they penned a magazine commentary saying women should be able to pick up these deadly drugs at their local pharmacy (Ms. Magazine, 4/6/21).
If it wasn’t clear at the beginning, it has become increasingly obvious in recent years that the abortion industry is anxious to move abortion out of the clinic and into women’s homes. Here are just some of the reasons why.
Rebranding an Increasingly Unpopular Product
Considered simply as a product, abortion has not been “selling” well. Over the past thirty years, the number of abortions has fallen from 1.6 million a year to just over 860, 000, a drop of 45%.
When the FDA first received the application for mifepristone in 1992, abortion was no longer glamorous, trendy, empowering, or defiant. After years of experience, women were disenchanted with abortion, surgical abortion in particular, concerned about the cutting, the scraping, and the bleeding. Many found their encounters with the abortion industry intimidating, impersonal, mechanical, and abrupt.
Like any company facing a sales slump, the abortion industry looked a fresh product, a “new and improved” model to increase sales.
It wasn’t long before the industry began marketing mifepristone as an easy, safe, and simple alternative to surgical abortion. That the reality was far different was of no matter to the abortion pill marketing machine.
Today, despite nearly two dozen deaths among women taking mifepristone and thousands other women suffering serious complications such as hemorrhage, infection, and ruptured ectopic pregnancies, the industry has continued to push these pills as convenient, safe, and easily manageable. They flatly dismiss these “adverse events” as “rare” when they don’t pretty much ignore them altogether.
That advertising campaign has been somewhat successful. After a slow start (doctors being courted to become abortionists weren’t so sure about the pill’s cost, safety, and demands on their offices), use of the abortion pill picked up. By 2017 (the most recent national figure available), chemical abortions accounted for 39% of all abortions performed in the U.S.
While overall abortions thankfully continued their drop, as did the number of “providers” offering abortion, the increase in chemical abortions temporarily slowed the rate of decline. And when new facilities added chemical abortion, it kept the number of “providers” from sinking even further.
True or not (and, of course, it isn’t), the very idea that women might have “easy, safe, and simple” abortions conveniently “in the privacy of their own homes” adds another attractive sales feature to women who may not know what dangers and horrors these pills actually entail.
Home use of the drugs also makes these an easier sale to potential new abortionists who may have been put off by having to schedule multiple visits for every woman wanting to take these pills.
Using At-Home Chemical Abortions to Circumvent the Political Process
Though Roe is still in force and abortion is still legal in all fifty states, the pro-abortion movement has suffered many setbacks since the court declared abortion on demand the law of the land in 1973.
With the Hyde Amendment cutting off virtually all federal funding of abortion, at least two million lives were saved. Many states passed informed consent or some form of parental notification during Roe’s first decades. Since that time, the federal government has banned partial-birth abortions and multiple states have blocked abortions on pain-capable unborn children, while several states have put limits on the prescription of abortifacients. In addition, many states have passed basic clinic safety regulations.
Where they could, abortion advocates have challenged these in courts and fought to have states overturn these common sense regulations. They were also always ready to do their best to elect politicians like Joe Biden and Kamala Harris they could count on to do their bidding.
But one thing they clearly hope to accomplish by getting government authorization of at-home chemical abortion is to essentially bypass many of these legal hurdles. Is there any realistic way for a prescriber to know whether the person ordering the abortion pills is a minor or not? Or even that the person ordering the pills is the one on whom they will be used?
How will they guarantee that a woman won’t attempt to use these to abort an unborn child of twenty weeks gestation or more, when science says that child can feel pain? An abortionist would not even have to have a clinic, much less a clean one, if the woman is aborting herself at home.
If the whole process were essentially deregulated and managed by the activists from the abortion industry, monitoring who sent the pills, their quality, who received the pills, who used them, how well she was screened or counseled on their use, or how she fared (whether the abortion was complete or she suffered serious complications) would be well nigh impossible.
This is precisely what many of these advocates have in mind, using self-managed chemical abortions to finally get around those pesky laws passed by pro-lifers (and typically supported by the general public).
At-Home Chemical Abortions Address the Shortage of Clinics and Abortionists
When the number of abortions dropped in the U.S., so did the number of abortion clinics or “providers.” Many have closed when state funding dried up or when bringing decrepit, unsanitary facilities up to code proved too expensive.
The abortion industry has responded by building many giant new regional megaclinics. However, many of the old clinics that closed have not been replaced, and the abortion industry decries that there are many “abortion deserts” in America, vast areas of the country with no identified abortion “provider.”
The industry has tried to recruit and train as many new abortionists as it can, but the truth is that few want to go where they know they are not wanted.
Abortion pills prescribed over the internet and shipped by overnight mail give the industry a way to bring abortion into every small town in America, no matter how isolated or remote, without having to build a single new clinic or send out a single new abortionist.
And if those pills don’t work, or those women end up in the Emergency Room with a ruptured ectopic pregnancy, uncontrollable bleeding, or a virulent infection, well, that’s somebody else’s problem.
At-Home Chemical abortions make Things Easier (and More Profitable) for Abortionists
One reason that the abortion pills took a while to catch on was that abortion providers didn’t want to deal with scheduling women for multiple visits. They considered it a waste of their time and skills to have to come into the office to do screening, counseling and go through a lot of paperwork with the woman just to pass out a few pills.
They didn’t relish the idea of having to spend an inordinate amount of time monitoring one patient. Abortionists didn’t and don’t want to have to deal with having to respond to late night phone calls from women undergoing acute pain or experiencing excessive pain or worried the pills “weren’t working.” Worse yet, they did not want to have to treat a woman who showed up back at the office with any of these problems, maybe creating a scene for other patients in the waiting or recovery rooms.
Eliminating the FDA regulations on distribution (requiring in person delivery, limiting distribution to certified prescribers, documentation of patient’s informed consent, etc.), doing their screening and counseling online, allowing delivery of these drugs by mail solves a lot of these problems for would be prescribers. The “health care provider” never needs to even meet, much less physically examine the patient. As long as there is a national hotline where a woman can call if she has problems (where operators may only send her to her local ER where she can just say she is having a miscarriage), the doctor and the clinic are off the hook.
If the doctor is no longer responsible for handling complications like hemorrhage or offering surgical backup for failed or incomplete abortions, then the clinic need not hire someone with surgical training. And if all is required is screening, counseling, and passing out (or mailing) pills, anyone with only modest medical training can prescribe the pills.
Allow video consults and abortion pills to be shipped by overnight mail, and all a “clinic” needs is a single staffer and a computer with internet access. Reduced regulations make staffing a clinic much easier, much cheaper, and thus more profitable.
It also enables the local clinic to expand its sales territory. With women no longer needing to visit to pick up their pills or return for follow-ups, the clinic can market its deadly product to women who are not within realistic driving distance of the clinic. They could be several counties over, or even on the other side of the state.
If the pills are delivered by mail, they don’t have to be able to drive or have access to any form of transportation at all, opening up markets even further.
None of these changes would make this drug safer for women; if anything, their risk will increase because of reduced screening and monitoring. But it would make things easier – and more profitable – for the abortion industry. And that’s the real aim here.