New Study Claims, But Fails to Show, Physical Exams, Ultrasounds Unnecessary for “Safe” Chemical Abortions

By Randall K. O’Bannon, Ph.D., NRL Director of Education & Research

It seems like there’s a new study just about every week or so claiming that telemedical chemical abortions are “safe” and “effective.”  They take some aspect of telemedical protocol – the estimation of gestational age, the diagnosis of ectopic pregnancy, the side effects like pain and bleeding, the number of reported complications, etc. – and collect and publish data showing that, despite reasonable medical expectations and against all common sense, the number of “successes” is high, the number of complications is low, and the overwhelming majority of patients find the experience satisfactory.

The latest study by a few of chemical abortions biggest promoters – Ushma Upadhyay, Elizabeth Raymond, Beverly Winikoff, and others – is titled “Outcomes and Safety of History-Based Screening for Medication Abortion: A Retrospective Multicenter Cohort Study” and was published in the online version of JAMA Internal Medicine on March 21, 2022.  

The study looked at data from 3,779 women having chemical abortions associated with 14 clinics in the U.S. between February 1, 2020 and January 31, 2021.  Researchers in this study were specifically trying to determine whether women who were only asked to give their medical history (whether in person or over the phone or internet) to get the abortion pills fared as well as women having in person physical exams or ultrasounds as part of their screening for chemical abortion.

Not surprisingly, the abortion researchers, entrenched in the abortion industry, determined that just getting an oral medical history was sufficient. Women having these chemical abortions without physical exams or ultrasounds, they claim, found them about as “safe” and “effective” as those of women who did have those exams. This was supposed to be the case whether the women came in to pick up the pills in person or had them mailed to their homes.

But, as usual, this involves a certain sleight of hand with the data, where hundreds of women disappeared between the time of the initial interview, the dispensing of the pills, and the time when it came for researchers to tally the results.

Most of the women for whom they had data did abort successfully without serious complications. However, the researchers couldn’t honestly make that claim about the women who didn’t return their calls, those who, if they had problems, were the most likely to have had them treated elsewhere.

Problems with even basic claims

Before even getting into some of the bigger problems the study had patients lost to the study, it should be noted that even the study’s basic claims about safety and efficacy of a protocol without an in person exam reveal deficiencies with their proposed modifications.

The Kaiser Family Foundation, which bills itself as an independent and authoritative source of health care information (but also happens to be one of nation’s biggest promoters of chemical abortion), claims that mifepristone and misoprostol are 99.6% effective when used at nine weeks gestation or less. (The U.S. Food and Drug Administration says it should only be used up to 10 weeks after a woman’s last menstrual period.)

That said, researchers in this study claim only an overall 94.8% effectiveness rate. Though that might still sound high enough to casual observers, such a drop represents a considerable increase in the failure rate for women using the abortifacients.

If, as the Guttmacher Institute tells us, more than half of current abortions employ chemical means, then even this small percentage represents hundreds or thousands of women.  

According to Guttmacher’s most recent survey of abortionists, there were 862,320 abortions performed in the U.S. in 2017.  If exactly half of those were chemical abortions, that would mean 431,160 such abortions.

If these were the “successful” abortions, with the Kaiser efficacy rate—99.6%– that would mean just 1,732 failed chemical abortions for the whole country.

But the numbers of failed abortions jump to 22,420 if we take instead the efficacy rate –94.8%– “reported here by the researchers in this 2022 JAMA Internal Medicine study passing out or mailing abortion pills without a physical exam or ultrasound.

That’s a lot of women rushing to the emergency room with an incomplete abortion or scrambling to find a clinic which can surgically address the issue.

The authors of this study assert that it showed that “screening for medication abortion eligibility by history alone was safe and effective with either in-person dispensing or mailing of medications” and claimed further that they “obtained outcomes similar to published rates of models involving ultrasonography or pelvic examination.”

Even if their numbers are accurate, it does not appear that such a conclusion is warranted.  It seems a real stretch to call a method that fails more than twenty thousand patients and sends a number of them to the hospital “safe” or “effective.”

“Safe” means more than lost patients getting help elsewhere

It is almost never mentioned in the media and certainly never highlighted by the pill’s promoters, but one reason why advocates have been able to report the seemingly high efficacy and low complication rates is that these studies consistently lose track of high numbers of patients.  

Many women who receive the pills never get back to researchers to share their results, to confirm whether or not the pills worked, whether they had complications, whether they had surgery, or whether they might have changed their minds and sought abortion pill reversal.

This was true in this latest study as it has been in so many previous studies.

While researchers started with a pool of 3,779 patients or “eligible patient records” (already excluding some who had ultrasound, did not take both mifepristone and misoprostol, had files with invalid or incorrect medical data, etc.), their final analysis was based on just 2,397 with “known abortion outcome.”

This means that researches lost track of more than 36% of the patients who are supposed to have received the drugs.

Researchers simply leave these women out of the equation and calculate risks based on the records they have available. While normally this might seem to be a reasonable accommodation to the data at hand, in this case, it compromises the basic integrity of the study.  

One of the major concerns, a primary focus of this sort of study is to determine how well women fare without some of the procedural safeguards, how they do without standard exams and with less direct supervision. But if you end up losing track of more than a third of your patients, and particularly those patients most likely to seek help elsewhere, you really don’t know the answer to that question.

It isn’t just that this leaves off some women that randomly might have some issues, but that the women it loses track of are precisely those most likely to have experienced problems. Women for whom things go as planned have no real problem getting back with researchers and telling them how things went. 

But those who do have problems – who have copious bleeding, extreme pain, who do not see the baby pass and perhaps have a vague sense that something is wrong – seem much more likely to go their nearest Emergency Room, or even to their own private doctor rather than return to a clinic they may have visited only once, if at all (since many are getting their pills through the mail).

Missed Complications

In line with other similarly structured studies, the 2022 JAMA Internal Medicine study reports complication rates of only about 0.5%.  It recorded eight patients requiring blood transfusions, three needing major surgery for issues like ectopic pregnancy, and six who had to be admitted to hospitals.

But studies which checked hospital or emergency room records instead of relying on reports back to clinic staff or online abortion pill websites automatically found higher numbers of complications than what abortion pill advocates report here. In fact, in 2015, Upadhyay, one of the authors here, studied emergency department visits and found not a 0.5% complication rate, but a 5.1% complication rate for “medication abortion.”

Though considerably more than her latest study, even this may be a significant underestimate. Those who sell these abortion pills online routinely tell women that if they end up having to go the ER for bleeding of other issues, they need not inform the doctor that they have taken the abortion pills. They can simply say they are experiencing a miscarriage and that the doctor will not be able to tell the difference.

So there may be many complications and failed abortions not being reported as such.

Whatever the actual complication rate, it is clear that studies like this latest one do not and cannot give women any real confidence regarding the safety or efficacy of chemical abortions using these drugs – with or without medical exams – with such a high number of missing patients.

Abortion industry ready to risk women’s lives

What we have here, then, is not a study proving that physical exams and ultrasounds are not necessary for safe or effective chemical abortions. Instead, what we have is a study showing how anxious the abortion industry is to avoid any of the basic medical safeguards that will help ensure that women with ectopic pregnancies or pregnancies past the recommended gestation will not be given the pills.

“Effectiveness” of these drugs begins to fall off the farther a woman gets past the ten-week gestational limit of the FDA’s protocol. The pills do not work at all in the circumstances of ectopic pregnancy, which can be detected by an ultrasound but not nearly as well from a few interview questions.  

Even relying solely on self-disclosed patient medical history (which may have been erroneous if a woman misremembers or mistakes early pregnancy spotting for her last menstrual period), authors admitted that at least 62 were given pills past the FDA’s 70 day deadline.  All told, researchers also said they identified four ectopic pregnancies, including at least one that was only detected nine days after the patient had taken mifepristone. 

The problem with ectopic pregnancy is not only that the pills do not work in such circumstances but that the signs of a rupturing ectopic pregnancy – severe abdominal pain and bleeding – are exactly the symptoms expected and experienced during an ongoing chemical abortion.

Again, these are only the cases of ectopic pregnancy and post deadline gestations that researchers found among the women they were able to track. How many more suffered failed or incomplete abortions, or complications like hemorrhage or ectopic pregnancy among the patients lost to follow up is unknown.

Clearly, though, there are cases that slip through the cracks with the abortion industry’s “no-test” or “no physical exam or ultrasound” protocol, and there are women who suffer because of it.  

And just as clearly, the abortion industry is willing to accept that higher level of risk for those women so long as it enables them to sell more abortion pills.