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Ob-gyn hopes high court sees medication abortion’s dangers

Pills and ultrasound images of baby

Sofiia.P | Shutterstock

John Burger - published on 12/16/23

Supreme Court takes on case challenging FDA's approval of mifepristone.

The past president of the Catholic Medical Association hopes the US Supreme Court will listen to medical considerations when it weighs a case involving a very common abortion procedure.

The court announced this week that it will consider a challenge to the Food and Drug Administration’s relaxed regulations on mifepristone, which according to reports is now a leading procedure to terminate pregnancies.

Last year, the pro-life Alliance for Hippocratic Medicine brought a case in an Amarillo, Texas, federal court against the FDA’s original approval of mifepristone in 2000. The group of doctors and medical organizations also challenged more recent regulations easing the original requirements that women seeking an abortion pick up the drug in person – it could not be mailed – and visit their doctor three times during the process. Originally, the drug could be prescribed only by a physician. 

In COVID-era 2021, however, the Biden administration allowed the drug to be prescribed after a “telemedicine” visit.

Meanwhile, the Supreme Court’s 2022 Dobbs decision, overturning Roe v. Wade, opened the way for states to ban abortion. Because some states have done just that, apparently there is a greater demand for the abortion pill, which would allow women to terminate early pregnancies in their homes.

Safe as aspirin?

In April, U.S. District Judge Matthew Kacsmaryk, a Trump appointee, ruled that the FDA’s initial approval of mifepristone, as well as the more recent regulations, were invalid. The Biden administration appealed that ruling. In turn, the Fifth U.S. Circuit Court of Appeals, in New Orleans, reinstated the FDA’s approval but invalidated the more recent FDA rules.

Reacting to the news that the high court will hear the case and possibly restore the lax rules, a White House spokesperson made a statement referring to mifepristone as “safe and effective medication abortion.”

But Dr. Kathleen Raviele, past president of the Catholic Medical Association and a retired OB/GYN, disagrees.

“The pro-abortion [side] says that taking mifepristone is as safe as taking Tylenol,” Raviele told Aleteia

She said there is no central reporting agency to collect data on complications. “There’s no way to really track the complications,” she said. “We have to look to other countries for their statistics. … The data in Finland shows that women with a chemical abortion have four times the complication rate of even surgical abortion.”

Various dangers

One danger is the possibility that a woman trying to do a medication abortion could have an ectopic pregnancy, where an embryo lodges in a fallopian tube. Undetected, it eventually could rupture and cause massive bleeding. A telehealth visit will not be able to detect an ectopic pregnancy – an exam and an ultrasound are needed – and a medical abortion will not end such an abnormal pregnancy. A woman with an ectopic pregnancy might think that the bleeding and pain are from the medical abortion and won’t seek medical care, perhaps, until it’s too late.

Abortion providers and advocates maintain that the risk of an ectopic pregnancy is too small to insist on a thorough examination before prescribing mifepristone, Raviele said, “but they haven’t looked at the statistics on ectopic pregnancies since 1992 or so.” 

The physician also contends that the lax regulations allow for abuse. “It’s been approved up to 10 weeks of pregnancy, but most women, if they’re having a miscarriage at nine or 10 weeks, they’re much more likely to have complications,” Raviele said.

“The only way you can accurately date a pregnancy that early is by having an ultrasound,” Dr. Donna Harrison, then-CEO of the American Association of Pro-Life Obstetricians and Gynecologists, told Aleteia in 2022, and that’s not something that can be done through a telemedicine session. 

Dr. Raviele said the risk of a failed medication abortion, necessitating a surgical abortion to complete the job, rises from about 8% to about 38.5% in the second trimester. 

The lack of a requirement for proper supervision also feeds into human trafficking and sex trafficking, Raviele contended. The medical professional at one end of a telehealth call might see only a woman seeking an abortion – not a trafficker who is forcing her to get rid of a “baby that comes as a result of the woman being trafficked.”

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