25,000 Reasons Why 95% is Not Good Enough.

Research shows that the abortion pill fails in 5% of cases – that’s the findings from a New York Times review of 101 studies covering 124,000 first trimester abortions performed in 26 countries over the last 30 years.

Some of the 101 studies in the New York Times review

Non-negligible risk of failure.

It is well-known that medical abortion will sometimes fail, resulting in either a continuing pregnancy or in retained products of conception.

Ranbaxy (UK), the manufacturer of Medabon, the mifepristone/misoprostol combination treatment provided by BPAS to its clients, warns in its SmPC (summaries of product characteristics) that there is a non-negligible risk of treatment failure, occurring in 4.5 to 7.8% of cases.

Linepharma, the manufacture of the mifepristone used by MSI Reproductive Choices, includes a similar warning in its SmPC, ‘…non-negligible risk of failure, which occurs in up to 7.6% of the cases’.

Marie Stopes Australia’s published 2020 report indicates that the medical abortions performed by its teams fail 5.48% of the time, resulting in 4.95% incomplete abortion and 0.53% continuing pregnancy.

You will find further details about the above and links to source documents in this report: FOI Investigation into Medical Abortion Treatment Failure.

Medical intervention required.

The New York Times reported from its review of the research that about 3 to 5 percent of patients need an additional procedure to remove remaining tissue or terminate the pregnancy. This additional procedure is essentially a surgical abortion, most likely performed using aspiration. The attending medical team might alternatively choose expectant management in which they adopt a wait-and-see approach, or the administration of an additional dose of misoprostol.

Ranbaxy and Linepharma both recognise that medical abortion treatment failure will often require a surgical procedure to completely remove products of conception. Ranbaxy states clearly:

“Because it is important to have access to appropriate medical care if an emergency develops, the [medical abortion] treatment procedure should only be performed where the patient has access to medical facilities equipped to provide surgical treatment for incomplete abortion”

25,000 reasons why this matters.

Since the start of 2019, women in England and Wales have been permitted to self-administer misoprostol at home, and from April 2020 both mifepristone and misoprostol. Official UK Government data for 2019 – 2021 show that 319,766 women self-managed their medical abortion at home. (see here for a link to the specific 2021 data file)

If we make the reasonable assumption that this trend has continued into 2022 and up to the end of March 2023, it is very likely that across England and Wales 500,000 women have self-managed their abortion at home using abortion pills provided by the NHS and its contracted providers.

Given these numbers, we must reconsider if a 95% effective rate is good enough; it is likely that as many as 25,000 women have by now suffered the complication of an incomplete or ineffective medical abortion and needed to seek medical intervention.

Before the approval for use of misoprostol at home and then the approval for both pills at home, these 25,000 women may not have needed emergency medical treatment. They would have had their abortion in a provider facility and most likely not have been discharged by the abortion provider before being assessed as complete.

Since January 2019, across England and Wales, 500,000 women have self-managed their abortion at home. As many as 25,000 women have by now suffered the complication of an incomplete or ineffective medical abortion and needed to seek medical intervention.

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