NRL News

Both CDC and Guttmacher Show Chemical Abortions Way Up in 2020

by | Nov 30, 2022

NRLC Analysis of New Abortion Reports: Part Two

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

Perhaps nothing has altered America’s abortion landscape as much as chemical abortions, changing the public’s image and women’s perceptions of abortion, the way these are performed and delivered, and significantly, their widespread availability. Loosened government regulations on their distribution, coupled with the unexpected revolution in telemedicine or remote medical care brought on by COVID, made these abortions both easier to get and harder to track.

Exactly how and how much this impacted abortion counts for 2020 is difficult to say. But both the U.S. Centers for Disease Control (CDC) and the Guttmacher Institute, the research arm of the abortion industry, show enormous growth in the incidence of chemical (or “medication”) abortion since their last reports.

More than half of abortions now chemically induced.
Both Guttmacher and the CDC show the number of chemical abortions climbing, now accounting for more than half of all abortions performed in the United States. The percentages were fairly consistent, with the CDC saying that 53.4% of the abortions it recorded were chemical abortions, while Guttmacher reported 53% of them were.

Guttmacher recorded more than 200,000 more chemical abortions than did the CDC. Guttmacher’s overall numbers were much greater because Guttmacher reported data from all fifty states; the CDC was missing method data from Illinois, Louisiana, and Tennessee in addition to all data from California, New Hampshire, and Maryland.

No one is assuming that Guttmacher tracked each and every abortion, chemical or otherwise, but because Guttmacher contacted clinics and “providers” directly and has contacts and connections throughout the abortion industry, it is generally recognized that they uncover a lot more abortions than the CDC. The CDC relies on reports from state health departments, which generally rely on reports identified clinics file with the state.

Becoming more difficult to track
What qualified as an abortion clinic or even a private abortion-performing doctor’s office became somewhat murky with the advent of chemical abortion and even harder to identify once COVID hit and some suppliers began shipping pills directly to women’s homes.

When first approved by the government in September of 2000, chemical abortions with RU-486 (mifepristone) required a minimum of three office visits. On the first visit, women were counseled, given a physical exam, sometimes ultrasound to make sure they didn’t have an ectopic pregnancy, to verify that they were not past the gestational age where these pills were effective. They were then given the first set of mifepristone pills in their first visit.  

They came back a couple of days later to receive misoprostol, a prostaglandin to stimulate powerful uterine contraction to force the dead or dying baby out.  A third visit at two weeks sought to confirm the completion of the abortion.

The U.S. Food and Drug Administration (FDA) dropped all but the first required visit in 2016. Even before the pandemic hit, abortion advocates were experimenting with and calling for the elimination of all clinic visits, saying that appointments could be handled virtually and pills could be shipped by mail to women’s homes.

More than a dozen states participated in Gynuity’s “trials” of telemedical abortion between 2016 and 2021 (many other states banned or limited the practice during this same time frame), and international abortion activists like Aid Access began selling these to American women online at least as early as 2018.  But these remote abortions did not become legal until a federal judge temporarily suspended the FDA’s distribution rules in July of 2020. 

Ostensibly, this was a response to the pandemic, when medical authorities were urging that non-essential care be postponed or delivered virtually by webcam, but when the Biden administration took over, it made the suspension of the rule permanent.

When established clinics added chemical abortions to their offerings and reported them the way they did surgical ones to the state health department or to Guttmacher, this was somewhat easier to track.  Of course, there still exists the possibility that the woman changed her mind and did not take the abortion pills or that they did not work, but at least the clinic could relate to how many women it prescribed the pills.

But with 1) the industry actively promoting the online sale and shipping of foreign abortion pills from remote prescribers in other states or other countries, and 2) the possibility of physicians, nurses, or other generic “certified healthcare providers” who were unfamiliar with state reporting regulations adding chemical abortion to “services” offered by their practices, it is easy to see how many might fall through the cracks and not get reported.

Data on “contactless” chemical abortions
Given the new rules and practices, exactly how many practices added telemedical chemical abortions and how many women ordered these from these or online abortion pill providers is difficult to determine. One might guess that Guttmacher, an abortion industry insider, might have more and better access to this data than the CDC, which relies on reports from state health departments.

Guttmacher did ask and received responses from 625 facilities (they sent out 2,131 surveys) telling how COVID altered their abortion protocols. About a third (34%) of those told Guttmacher that they added a remote pre-abortion visit and 42% said they added a remote post-abortion visit. 

Sixteen percent indicated that they added “quick pick up” of mifepristone, and 5% said they began mailing abortifacients when the pandemic hit (about 3% had begun doing this before COVID).  

Most of these surveys were returned in 2021, giving Guttmacher the chance to determine how many of these clinics continued to do the remote visits once the pandemic waned. Significantly, 5% said then that they continued to mail abortion drugs. And 4% indicated they now utilize online pharmacies to get abortion pills to their patients, a protocol modification President Biden’s FDA pushed through later that year.

Again, with less than a third responding to Guttmacher’s surveys on this topic, it is difficult to tell how representative this sample might be. These might be responses from only the most enthusiastic chemical abortion advocates. But clearly, the industry has taken the opportunity of the COVID crisis to adapt its methods and the delivery of its services. We can expect more abortions to come from abortion pills ordered online and mailed to women’s homes.

Limited reporting of deaths and complications

The concern will be not only that these abortions will go unreported, but that failed chemical abortions, complications, and deaths prompted by these deadly drugs will not be recognized or reported as such. This will especially be the case if women or their partners do not reveal these to doctors at the Emergency Room when they seek treatment incomplete abortions, infections, for ruptured ectopic pregnancies, for uncontrolled bleeding.

Few people know it, but thousands of women have been injured and more than two dozen are known to have died after attempting chemical abortions.  One U.S. study (Upadhyay, 2015) put the complication rate for these at 5.1%.

The CDC does not specify deaths by particular abortion method, but has continued to report deaths from legal abortion every year since abortion first became legal in 1973 and every year since the “new and improved” chemical abortion method with mifepristone was approved in 2000. 

These, of course, are only those deaths officially identified and reported by the states as abortion-related. This leaves out those where a woman’s abortion or pregnancy status was not known, recorded, or revealed. Actual numbers are likely much higher, but their reporting at all is an admission that abortion, chemical or surgical, is not as safe as the abortion industry would have women believe.  

A growing concern
Whether you look to the Guttmacher Institute or the CDC, both of the nation’s primary sources of abortion data tell you the same thing – chemical abortions are on the rise, are putting a lot of women and their unborn children at risk, and are getting harder to track.

Tomorrow we’ll look at what these latest reports tell us about new abortion “providers” being added and what we can learn from their relative caseloads.