Redefining DIY abortion effectiveness to include a failure rate of 10%.

Abortion activists in the US are rushing to promote a new study that claims DIY medication abortion at home is safe and effective after 9 weeks gestational age, minimising or even ignoring the observed 10% failure rate and the recognised harm to women.

The study by Moseson et al. was published in Obstetrics & Gynecology on 06 July, 2023; it was an initiative of Ibis Reproductive Health and funded by The David and Lucile Packard Foundation. It was a small prospective study of 264 women in Argentina, Nigeria, and an unnamed country in SE Asia (where, according to this New York Times article, abortion is illegal). These women were sent the abortion pills after they contacted an abortion-accompaniment group and were subsequently called at least once in a follow-up over a three-week period.

The United States Food and Drug Administration (FDA) has approved the combination medication abortion treatment of mifepristone plus misoprostol for use up to 9w6d gestational age, measured from the first day of the woman’s last menstrual period (LMP). The WHO endorses self-managed medical abortion using the same drugs without medical supervision up to 12w LMP. Two-thirds of the candidates enrolled onto this study were beyond the GA limit of 9w6d set for US women.

The key finding from this study was that the medication abortion treatment failed in 10% of cases.

Follow-up calls discovered that 5% of women had needed a surgical intervention at a healthcare facility to address complications arising from a failed or incomplete abortion. A further 5% were still incomplete at the time of the last contact with the research team. It is essential that an incomplete abortion is treated to stop ongoing bleeding and to prevent the risk of infection.

We should ask why senior providers and activists would want to promote a DIY abortion medication treatment that has a known failure rate of at least 1-in-10, for use by women themselves at home? Speaking with the New York Times, Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, said:

“This paper adds to previous research indicating that self-managed abortion with medications is safe and effective, including after 12 weeks of pregnancy. As clinic-based abortion care becomes less available in many parts of the country due to state-level bans, self-managed abortion will become more common, as we are already seeing.”

Grossman clearly considers a failure rate of 10% to still be ‘effective’, and when we read the rest of his statement, we can see why he must adopt this position, he is promoting self-managed medical abortion after 12w across the US, especially in those states with legislation restricting the clinical provision of abortion. He and his collaborators welcome those who are providing online and telephone access to abortion pills to women across the US, whilst noting that delays in shipment often mean that women will be beyond the FDA limit of 9w6d when they start their medication abortion at home.

In a related article in Vox, Grossman said:

“People who are further in gestation have more pain associated with medication abortions. Because of the pain and the elevated complication risk, the standard of care in the US has been for medication abortions in the second trimester to take place in medical facilities.”

So, notwithstanding his acknowledgement of greater pain and increased complications rate, Grossman still promotes self-managed medication abortion in the second trimester by women on their own at home, as a means of circumventing state-wide legal restrictions.

But surely a failure rate of 10% is not good enough for DIY abortion at home. One-in-ten of women using medication abortion after 10w, will have to seek medical intervention at their local emergency department to address continued bleeding and an elevated risk of serious infection.

We must also consider the experiences for those women who have a ‘successful’ abortion, what this like for them?  Linda Prine, a family physician and co-founder of the Miscarriage and Abortion Hotline when interviewed for the Vox article, said:

The experience [second-trimester medication abortion] can also look different from a first-trimester abortion. Earlier procedures tend to produce fairly consistent cramping and bleeding over the course of several hours, while later medication abortions more often result in a big gush of fluid and then passage of the fetus and then some bleeding after that.

Sometimes patients call the hotline frightened, saying things like, “I just passed my pregnancy and it’s the size of my fist.” Others call because the umbilical cord is still connected, or because they haven’t passed the placenta yet and want to know what to do.

We know abortion providers will recommend to women that after taking the misoprostol, when they feel the urge to push, they should sit on the toilet, push the fetus and placenta out, and then flush before looking. From the many reports available online, sadly we know that many women do look, and what they see, their fully formed baby, inflicts so much trauma on them, causing many to suffer nightmares, flashbacks, post-traumatic stress, and grief. Live Action has collated many of these stories together in its “I Saw my Baby” online report.