Are Abortion Pills Safe? Here’s the Evidence.

It’s not just about ‘safety’ – the abortion pill (mifepristone and misoprostol) is medically safe for the woman; serious complications from medical abortion including hospitalisation, blood transfusion, major surgery, or death are rare. Arguing for changes to the legal and regulatory control of medical abortion solely based on safety is a very weak argument. Now that most abortions in the UK are self-managed by women at home, we need to turn our attention towards ‘efficacy’.

The New York Times recently published a piece summarising the findings from 101 studies covering 124,000 first trimester abortions performed in 26 countries over the last 30 years. The reporters state: “All [of these studies] conclude that the pills are a safe method for terminating a pregnancy.” They also state:

“And while the pills are about 95 percent effective, about 3 to 5 percent of patients need an additional procedure to remove remaining tissue or terminate the pregnancy. Providers say these are not typically dangerous situations.”

95% effective means that in one case in every twenty this treatment fails, and a subsequent medical intervention is required. Abortion Providers have always known this and in the past it didn’t really matter because it could be ‘fixed’ before the woman left the clinic. However, as noted on the GOV.UK website, from the start of 2019, women in England have been able to self-administer misoprostol at home (June 2018 for Wales), and since the COVID-19 changes they have been self-administering both mifepristone and misoprostol at home. The official data show that in 2021 across England and Wales 149,993 women self-administered both or the second part(s) of this abortion treatment at home.

Providers are not able to predict for which women the medical abortion treatment will fail, but they can be sure that this will be the outcome for at least 1-in-20. This implies that as many as 7,500 women across England and Wales experienced an abortion treatment failure in 2021, resulting in an average of 21 women needing an emergency medical intervention every day, usually at the Accident and Emergency department of their local hospital.

We need to clarify the guidance given to women to make sure that they understand the risk of medical abortion treatment failure and what to do if this happens.

BPAS notes on its website the following:

Significant unavoidable or frequently occurring risks

• Retained products of conception – where the pregnancy is no longer growing but some of the pregnancy tissue is left behind in the womb (2 in 100)
• Continuing pregnancy (less than 1 in 100)

Combined this suggests a treatment failure rate of less than 3 in 100, which is not quite right and somewhat minimises the 5% risk, but at least BPAS uses the words ‘significant’ and ‘frequently’.

MSI Reproductive Choices says the possible complications and risks of medical abortion include:

• Incomplete abortion – uncommon (affects 3 in 100 people)
• Treatment failure (continuing pregnancy) – uncommon (affects 1 in 100 people)

So, a treatment failure rate of 4 in 100, which is less than the 5% reported by Marie Stopes Australia in 2020. They are also misleading women by stating that these failure rates are ‘uncommon’; NICE, the UK National Institute for Health and Care Excellence shows that these are in fact ‘common’ risks.

A woman can only really give her informed consent to a self-managed medical abortion at home if she is told that abortion treatment failure is common, occurring in at least 1-in-20 cases, and that such failure will require her to seek medical attention at her local hospital or to return to the abortion provider’s facility.

You can read more about the potential risk and impact of medical abortion treatment failure in this report: FOI Investigation into Medical Abortion Treatment Failure.