Philippa Taylor

Abortion pills outside medical supervision? That’s just the start

Philippa Taylor was Head of Public Policy at CMF until September 2019 and now works with CARE. She has an MA in Bioethics from St Mary’s University College and a background in policy work on bioethics and family issues.
The views expressed do not necessarily reflect those of CMF.

The current campaign to remove the administration of the abortion pill, misoprostol, from medical supervision and oversight is part of a long-term goal for abortion activists. Their goal is to bypass medical professionals in the process of medical abortion and remove as many legal restrictions on abortion as possible.

This will be achieved step by step. Incremental extension is the name of the game.

A recent BMJ comment piece, celebrating the progress abortion providers believe that they have made towards full decriminalisation and easier access to abortion in the last few years, comments that: ‘A permissive legal framework is not sufficient to ensure access to abortion; skilled, willing providers are [also] essential…’ 

Interestingly, it seems that doctors may be increasingly reticent to be involved in carrying out abortions, thus leaving a potential gap in provision. So a goal for abortion activists is to increase the ‘abortion workforce’ by encouraging and training more doctors in abortion provision and by enabling nurses and midwives to become more involved in abortions, to fill the opening gap.

But that is not all. When more doctors refuse to be involved in aborting their unborn patients, what else is a pro-abortion industry to do?  One answer is direct to patient marketing:

  1. Encourage more self-administration of medical abortions at home
  2. Expand use of medical abortions at home, initially to the first trimester, (not just the first nine weeks), and then beyond
  3. Encourage the two abortion pills (mifepristone and misoprostol) to be given simultaneously, not 24 hours apart.
  4. Greater involvement of nurses and pharmacists in prescribing and providing pills (and doing abortions?), removing doctors from the process.
  5. Encourage women to obtain pills off the internet and to bypass legal restrictions
  6. Encourage women to lie if they cannot get hold of pills from a medical professional or pharmacist (more details below)
  7. Carry out post abortion check-ups simply by using mobile phone apps
  8. Get rid of as many legal restrictions as possible (see here too).


  1. Medical abortions are not as safe as usually implied, especially when self-administered (ie. do-it-yourself). There is limited data on the outcomes of self-administering abortion pills but one peer reviewed study found that 78% of participants had excessive bleeding, 13% had severe anaemia and 5% shock. 63% had incomplete abortion and 23% had failed abortion. They also found that surgical evacuation had to be performed in 68% of the patients, 13% with a blood transfusion. The authors’ conclusion? ‘Unsupervised medical abortion can lead to increased maternal morbidity and mortality.’ If they are so safe, why do medication guides for these pills warn they may cause a number of very serious side effects? And why are they only available in the USA through a restricted medical program (REMS) and only in certain healthcare settings? Furthermore, the medication guides note that there is no research on any possible link to cancer, while a package leaflet for the two pills admits there is only limited data on their use by adolescents.Even one of Ireland’s most vociferous campaigners for abortion, obstetrician Peter Bolyan, recently admitted that: ‘there are serious dangers when women take [abortion pills] without supervision. We have knowledge of women who have taken them in excessive dosage and that can result in catastrophe for a woman such as a rupture of the uterus with very significant haemorrhage…And if that happens in the privacy of a woman’s home or perhaps in an apartment somewhere, that can have very, very serious consequences for women. So, it’s really important that these tablets are…dealt with in a supervised way…’

  2. The later in gestation that medical abortions take place, the less effective and the more dangerous they are. Ten weeks is the maximum gestation recommended. Because of increasing uterine sensitivity to misoprostol with advancing gestational age, regimens for medical termination change in the late first trimester and second trimester to repeated, lower doses of misoprostol. The woman’s experience will also be more painful later in gestation, with an exponentially increasing rate of haemorrhage and complications after just seven weeks gestation. Abortion advocates realise that ‘…Gestational age assessment before undergoing medical pregnancy termination is necessary to ensure women take the recommended dose and regimen of medications, and in the appropriate setting’ and yet even they report large variances in self-calculated gestational age. They found that one‐third of women who were followed up after receiving ‘treatment’ had pregnancies of ten weeks gestation or more, when checked by ultrasound. Some even had pregnancies of 18-28 weeks, far off the recommended maximum of ten weeks.
  3. Taking both medicines at the same time causes more side effects and is less effective than when they are taken at least one day apart – the recommended protocol. One study (by authors who are pro-abortion) found that for women under 49 days’ gestation, the failure rate was 27% if they took the misoprostol immediately after mifepristone. For women between 50-56 days’ gestation, the failure rate was 31%.  The authors of this study strongly recommended that buccal misoprostol not be taken immediately after mifepristone because of the high abortion failure rate. Another study also concluded that a six hour gap ‘…is not as effective at achieving a complete abortion compared with the 36- to 48-hour protocol.’
  1. As noted in a previous blog, self-administration of abortion pills removes any control over who takes the pills, where they are taken, whether they are taken, when in the process they are taken or if an adult is present. It also removes an opportunity to ascertain if abuse or coercion is involved. Little data is available however we know that coercion can take many forms and come from different sources. As well as direct pressure to abort (often from a parent or partner), it can include receiving false information from others, withholding of support from one’s family or emotional blackmail. Several news stories have described abortions forced on a woman by a partner who has given her a drug in food or drink without her knowledge.
  1. Internet abortion providers deliberately encourage women to lie to get hold of abortion pills! One well-known provider states openly on its website: ‘To obtain one of these medicines, one could, for example, say that your grandmother has rheumatoid arthritis so severely she cannot go to the pharmacy herself, and that you do not have money to pay for a doctor to get the prescriptions for the tablets.’ And: ‘In many countries the pharmacy will ask for a prescription from a doctor, but sometimes you can get it without prescription if you are persistent and say it is for an ulcer (Cytotec), or for your grandmother’s arthritis…Don’t stop after the first “no”!’  Women on Waves also ‘helpfully’ shares that Mifeprex can also be bought on the black market from ‘places where you can also buy Marijuana‘.Women on Waves suggests: ‘If there are problems getting the medicines in one pharmacy, try another pharmacy, or a male friend or partner might have fewer problems obtaining them.’ While Women on Web say that while Mifepristone is not registered in all countries … this should not be a problem because the medicines are for personal use only. Mifepristone can also be used as a morning-after pill, for the cure of depression, to treat breast cancer etc.’
  2. Follow up using mobile phone apps is highly irresponsible, since complications from medical abortions are common, not rare. I cite above an example of the high rates of haemorrhage after medical abortion and the significant numbers of women requiring surgical follow up. Abortion pill provider, Women on Web, also found from their own surveys that 12–21% of women subsequently needed a surgical intervention and almost half of women who were over twelve weeks gestation (45%), required a surgical intervention. Information about abortion history becomes particularly and critically important when evaluating a woman for infection after abortion and yet, knowing this, Women on Web and Women help Women tell women that they can lie to their doctor, and claim they are ‘having a miscarriage’.

In order to increase access to abortions, it seems that abortion-rights advocates have gone from warning of back-street abortions to promoting do-it-yourself black-market ones. So much for the well-worn phrase, ‘Let’s make abortion safe, legal and rare’.

Not only does all this encourage illegal and dangerous practices (including the ability for abusers and pimps to get hold of pills, which can be discounted for packs of ten or more), with no medical professional involved there will be no objective gestational age dating, no guarantee that women read and follow the instructions, no objective screening for the medical and psychological contraindications (more common than for surgical abortion), no medical follow up with scans or visit, no access to emergency services.  And also….no potential malpractice issues to deal with.



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