A chemical abortion is a two-pill regimen that ends the life of the baby and poses health risks to the mother. The deaths of 24 women have been “associated with the abortion pill,” Melanie Israel, a research associate in The Heritage Foundation’s DeVos Center for Religion and Civil Society, says. The Daily Signal is the news outlet of The Heritage Foundation.  

Israel joins the “Problematic Women” podcast to discuss her recent research paper, “Chemical Abortion: A Review,” which provides extensive information on the history and risks of chemical abortions. 

Also on today’s show, we talk about a new petition to force a House vote on a bill to require medical care for babies who survive an abortion procedure. Plus, we break down what you need to know about the controversy over singer Taylor Swift’s new album “Fearless (Taylor’s Version).” And as always, we’ll crown our Problematic Woman of the Week.

Listen to the podcast below or read the lightly edited transcript.

Virginia Allen: I am so pleased to be joined by Melanie Israel, a research associate in the DeVos Center for Religion and Civil Society at The Heritage Foundation. Melanie, thank you so much for being here.

Melanie Israel:
Thank you for having me. Glad to be here.

Allen: You have just published an in-depth paper on the topic of chemical abortions. You cover a really broad spectrum in this paper, from how they operate, the potential harms to women, the FDA’s involvement. But I want to begin by just asking you to explain what a chemical abortion is.

Sure, sure. And to be clear, the pro-abortion side prefers to call it medication abortion to give it more of a veneer of respectability, I guess you could say. But ultimately, what it is, chemical abortion, the abortion pill regimen, is when a woman typically takes two different types of medication. The first one is the actual abortion pill. It’s called mifepristone, it’s brand name Mifeprex. Some people might also know it by its trade name, RU486. That is the pill that a woman takes, and it essentially cuts off nutrients to her developing child. And then, after that has happened, about a day, two days later, a woman takes a second pill, which is misoprostol, brand name Cytotec, to actually cause her to have that cramping that then expels the pregnancy.

To be clear, Cytotec, that second pill in the abortion regimen, was not ever meant to be part of the abortion pill regimen. That is actually a medication for a completely different indication that had nothing to do with abortion. Just over the years, people found out that one of its side effects is uterine cramping. And so, some women might also remember taking Cytotec when they’re being induced to go into labor, or if they’re managing a miscarriage for a pregnancy that has already ended on its own, spontaneously.

But in those other circumstances where this medication is being used off-label, you’re in the hospital for an induction, that is under the supervision of multiple medical professionals. It’s contraindicated if you’ve had things like previous uterine surgeries, like C-sections; they have to monitor you to make sure that you don’t have any kinds of complications.

And so, it’s really, really interesting to see this disparity between how we treat the off-label use of this drug in one circumstance compared to chemical abortion, when a woman is just sent home, do it on your own at home, maybe call if you have any problems, see you later. It’s just such a really, really different experience.

Allen: So essentially, the first pill that the woman takes ends the life of the child. And then the second pill is what actually causes her body to go into labor, to expel the baby.

Right. And this abortion pill regimen, the abortion pill, it is approved through the FDA [Food and Drug Administration] to be used through about 10 weeks [of] gestation, though of course we know that some providers don’t actually follow that limit. And in fact, there’s studies taking place in other places, overseas, to have chemical abortion pills being used for second-trimester abortions as well.

And it’s worth noting that the farther along a woman is in her pregnancy, the more likely she is to experience complications. We know that with chemical abortion, the complication rates are four times higher than they are for surgical abortion. Which is crazy to think about because the abortion lobby says that chemical abortion, it’s so easy. It’s like having a heavy period. You can do it at home. It’s no big deal.

They really downplay the risks and offer it as being this great alternative to surgical abortion. And when you actually look at the complication rates, a four-times-higher complication rate is not great.

Allen: And when you say complications, what exactly does that mean? Are these long term, is this just a lot of heavy bleeding and pain?

So just because of the nature of what we’re talking about, we’re talking about an abortion, basically any woman who’s going through this regimen is going to experience a lot of cramping, a lot of bleeding. That’s unavoidable really, given what this actual process is doing. There’s also things like nausea, vomiting. Those are things that you expect.

But then, some of the more serious complications that you can get into: A woman can get an infection if the abortion is incomplete. If she has an ectopic pregnancy, where the pregnancy was located outside of the uterus and a provider did not adequately screen her for that, or determine the location of the pregnancy, that can be a fatal complication if that ectopic pregnancy ruptures. There’s also sepsis.

We know of 24 deaths that have been associated with the abortion pill, things like hemorrhaging, which of course is extreme blood loss. A good percentage of women, I think it’s around 10%—I’d have to go back and double-check in my paper—are going to have an incomplete abortion. And they’re going to end up having to have a surgical abortion anyway to complete the process.

And so, the FDA is aware of thousands of adverse events. And unfortunately, when we talk about that tracking process, this all has to come with a caveat for several reasons. First of all, abortion reporting in general in the United States is not really streamlined. We don’t have a great system. A lot of the numbers that the CDC [Centers for Disease Control and Prevention] reports can be a couple of years out of date; not every state submits data, different states have different ways that they collect data and present that data. It can be a little bit hard to make those apples-to-apples comparisons. And so, the whole system of abortion reporting in the United States leaves much to be desired, in general.

But beyond that, in 2016, the Obama administration weakened the FDA requirements about reporting complications for the abortion pill. One of the stipulations for the maker of the abortion pill and anyone who prescribes these pills originally was that they needed to report all adverse events that they’re aware of to the drug sponsor, so that the drug sponsor can periodically collect those and report those to the FDA.

In 2016, the Obama administration weakened that requirement and said that only deaths have to be reported. And so, of course you can see now, it’s easy for the abortion lobby to say, “Oh, there’s a low rate of complications, no big deal, nothing to worry about.” Well, you’re going to have lower reported rates if that reporting is not mandatory. It’s voluntary now. And so, people do still report. We do still have these thousands of adverse events coming in, but it’s not mandatory [reporting].

And often, a woman who is experiencing these kinds of complications, like extreme blood loss, running fever days on end, bleeding for over a month afterward, she’s probably going to be reporting to an emergency room, not the same abortion doctor who gave her these pills because, of course, they are abortionists. You typically don’t go to a family practitioner or your regular OB-GYN for these kinds of abortion pills, because most of those doctors have no interest in prescribing those pills.

So if a woman is going to be showing up to an emergency room with these complications, they may not even know to report that adverse event. A woman might feel ashamed to even say that she’s there because of complications for an abortion, or it might be characterized as a spontaneous miscarriage. There’s just so many different ways that we know we’re not capturing the full scope of all of these different complications that women do experience on a large scale from these dangerous abortion pills.

Allen: And how long have these pills been on the market?

The FDA approved the abortion pill for the U.S. market in September 2000. So it’s been on the market here for just over two decades. It originally went onto the market in France in the late ’80s. And it took a very, very long time for anybody to actually bring it to the United States, because so many pharmaceutical companies here wanted nothing to do with manufacturing abortion pills. And, in fact, the group that eventually did bring it to market in the United States, they had to go overseas to even find a manufacturer willing to make these pills for them.

And they landed on a manufacturer in China, which of course has its own loaded implications. These pills were being manufactured in a country with, at the time, a very draconian one-child policy. Now, of course, [China has] a two-child policy, but still very inhumane family planning practices, family planning practices, forced sterilization, forced abortions. And so, it’s really adding, I guess, insult to injury that they couldn’t get it manufactured in the United States for so many different reasons, and so they had to go to China of all places to be able to have it done.

Allen: If the risks are known, why did the FDA, all of a sudden, say, OK, yeah, we’ll approve this. We’ll allow women to take these pills, take them home, and essentially, have an abortion on their own?

It’s so interesting to go and look back at the whole approval process. And it’s something I get into a lot more in-depth in the paper, but essentially, you had a presidential administration that wanted to make this happen. Within the first days of his presidency in 1993, President Bill Clinton told the Department of HHS [Health and Human Services] and his HHS secretary that “We need to make this happen. We need to bring the abortion pill to the United States.” And he actually had people from the highest levels of the United States government petitioning to the French maker of the abortion pill and working relentlessly behind the scenes to do what they could to bring this pill to the United States market.

They ended up working with the Population Council, which was this organization solely devoted to bringing the abortion pill to the U.S. market and working with the abortion lobby, like Planned Parenthood and other organizations. And the Clinton administration really worked behind the scenes to connect the Population Council with European counterparts to bring the drug to the U.S. market.

And so it took multiple rounds of review through the FDA. They ended up deciding that there would be these various restrictions on the abortion pill in order to let it be marketed in the United States. They eventually did give that approval in 2000, but some of these restrictions have to do with things like you have to be a qualified prescriber. So a person, a doctor, has to affirmatively seek out through the maker of the abortion pill to be able to prescribe these pills.

Any doctor in America is not a qualified prescriber. You can’t just go to anybody and ask for a prescription for an abortion pill. And of course, with that kind of self-selection dynamic going on, it really is pretty limited to specifically abortion providers in large part, your Planned Parenthoods and other kinds of abortion clinics.

There’s restricted dispensing requirements. It has to be directly dispensed by that person doing the prescribing. So you can’t just go to Walgreens and pick up a prescription for an abortion pill. It’s really being done directly through that prescriber. And so, there’s these various restrictions, like we talked about, the mandatory reporting of deaths. So we do have these restrictions in place, but the abortion lobby is actively seeking to do away with those restrictions.

Allen: And who now is making these pills? Are they still coming from manufacturers in China?

That’s one of the really interesting dynamics here. The FDA has never publicly actually said who this manufacturer is. At the time, I believe it was because the manufacturer in China volunteered that information and said that they were the ones making it. In the United States, the FDA and Danco [Inc.], the company that sponsors the drug, they didn’t want that information to be public. That information was redacted from documents and court documents. They wanted to keep it a secret.

And the justification is really dubious. They said they didn’t want to subject the manufacturer to things like protests and threats of violence from those terrible pro-lifers. And it’s really strange to think about, because this manufacturer, it’s in China. They don’t allow you to protest in China. And so, just a really dubious justification there.

And even today, we don’t actually know for sure where these pills are being manufactured. They might still be manufactured in China, but we don’t know that for sure, because the FDA does not make that information public.

Allen: You talk a bit in your paper about where women can get these pills. We’ve chatted about, of course, they can walk into a Planned Parenthood or another abortion clinic and receive those, but there’s also a way for women to purchase them online, correct?

That’s right. And the U.S. government, the FDA, they warn women not to purchase these pills from online pharmacies, from overseas sources. But, of course, people do. Sometimes those drugs are seized when they’re coming into the United States, but very often, they’re not. And in fact, there are multiple organizations that are dedicated to getting women those illegal, foreign-sourced abortion pills, which of course has so many horrifying implications.

One of the studies that I talk about in the paper is where some pro-abortion [researchers]—this is coming from the pro-abortion side, which is probably a little bit more astounding given their conclusion, which I’ll get to—but in their study, they ordered dozens and dozens of abortion pills from pharmacies overseas, places like China, India, other places. And then, once they took possession of those pills, they ran tests to see if they even had the advertised amount of these different medications, mifepristone, the abortion pill, and misoprostol, the pill that you take to do the cramping, to complete the abortion.

And what they found is many of these packages, they didn’t come with the advertised amount of medication. None of them came with any kind of instruction guide of even how many pills to take, what potential side effects could be, what complications you could experience. No information, just the pills. Some of the packaging had been tampered with, partially opened. And again, some of the pills didn’t even contain the advertised amount of the chemical composition of what it was advertised to contain.

And yet, these pro-abortion researchers concluded, really, just a mealy-mouthed conclusion. They said that this was a suboptimal buying experience, that they could see how many women would think this is a rational choice.

Allen: Wow. So from the perspective of the pro-choice side, I think a lot of individuals that support abortion might say, well, we need to keep chemical abortions legal and very accessible at Planned Parenthoods, and so on and so forth, because if that ends, then what we’ll see is all these women will just go online and they’ll buy these pills. And there’s not as many controls or, like you said, we don’t even really know what’s in them. So what would be your response to individuals saying, “No, no, no, it’s actually much better to keep these pills legal in the United States so that there’s not this increase in the black market”?

I think it’s one of those questions where there’s so many different answers. But one of the things I think we have to keep coming back to is that even these pills that people are getting at Planned Parenthood and other places through the currently allowed protocol, they’re still very, very dangerous to women. And so, essentially, what the proposition is, is Dangerous Choice A or Dangerous Choice B.

And of course, for a pro-life person like myself who works in this policy space, I don’t think we need to choose either one of these. I think we need to educate people on the dangers of the abortion pill, no matter where you’re getting it from, whether it’s Planned Parenthood or a sketchy pharmacy overseas. Regardless, it’s dangerous to women’s health and safety. It’s obviously dangerous to the life of their unborn child.

And we also need to do more to let people know that there is the possibility of abortion pill reversal. [There are] doctors who, if you contact them soon enough, can get a woman access to progesterone, which is the hormone that can basically counteract the effect of that first round of the abortion pill regimen. And in fact, there are hundreds and hundreds of children who are with us today because their mothers chose to take that abortion pill reversal regimen. They changed their minds halfway through.

And so, so much of it has to do with education, but also just more broadly in culture, making sure we’re doing everything we can to welcome life so that women don’t feel like they have to have this choice of having an abortion. I’ll also note [that] for so many women, it’s not actually a choice. It’s something that they feel pressured into, something that they’re being coerced into.

And I would just caution people … especially if the abortion lobby has their way and abortion pills are available through telemedicine, getting it through mail order, available in retail pharmacies, or even over the counter. That’s what some abortion advocates want, just abortion pills over the counter, no prescription required, no questions asked. Imagine what that would mean in the hands of an abusive partner, a coercive partner, a trafficker.

There would be such a profound human cost. And so, for as much as the abortion lobby talks about choice, I think we also need to remember that for so many women, it’s not actually a choice.

Allen: And just this week, we saw that the FDA took measures to allow for continuing to have even easier access to these pills. Could you talk a little bit about that?

Tuesday morning, [we were] waking up to the news the FDA has announced that they are not going to be enforcing the in-person dispensing requirements for the abortion pill. And so, that opens the door in many states for women to be receiving these pills through the mail, allows for a much looser telemedicine model. And I will note that in, I believe it’s 19 states right now, that sort of telemedicine abortion by mail scheme is not allowed. So even with the FDA taking this action, there are still some protections in certain states, but not all.

And this is really not a surprising action. This is something that the abortion lobby has been agitating for, for the duration of the pandemic. They’re not going to let a crisis go to waste. And what this is actually about is laying the groundwork for them to permanently do away with that in-person dispensing requirement and really do away with most, if not all, of those various restrictions that the FDA has in place. Because again, the ultimate vision of the abortion lobby is for chemical abortion pills to be available to anyone, anytime, anywhere.

Allen: You tell the story of a woman named Holly Patterson in your paper. Could you share a little bit about Holly?

Yes, yes. Thank you so much for asking about that, because I think it’s so, so important that we really humanize this conversation. Because [in] throwing out statistics, 24 deaths, 4,000 adverse events, I think it’s really helpful for us to think about the individual people behind those statistics.

So Holly Patterson was an 18-year-old woman in California. She was seven weeks pregnant and she went to Planned Parenthood to receive the chemical abortion pill regimen. And unfortunately, a week after starting that chemical abortion process, she went into septic shock from a very rare infection, and that infection killed her. She was the first person in the United States known to have died in this way. This happened in 2003 and the abortion pill, of course, had been approved just a couple of years earlier. But unfortunately, she was not the last person to die in this manner.

And so, again, when we talk about these complications, these serious complications, including the fatal complications, I think it’s worth keeping in mind that these are real women here. These are our neighbors, our friends, sisters, daughters, wives. And when the abortion lobby downplays the risks of dangerous abortion pills, I think we need to take a step back and really remember the human cost of getting this question wrong.

Allen: What are the steps forward? What should policymakers at the state and federal level be doing to protect women from the risks of chemical abortions?

It’s going to be a huge lift. Right now, obviously, the Biden administration, they are really letting the abortion lobby call the shots. They are beholden to the abortion lobby. And so, in my paper, I outline some of the things that they could be doing at the federal level that would be strengthening these restrictions, that would be increasing transparency and taking decisive action. But of course, we don’t expect the Biden administration to do any of that.

And so, where that leaves us is really looking to the states. State legislators who want to protect women from these dangerous pills can act. They can do things like add those additional restrictions to do things like banning telemedicine, abortion, to increasing their informed consent requirements and other reporting standards, making sure that people really know the risks, know that we’re tracking the risks, all kinds of things that they can be doing at the state level in the absence of that federal action.

And one of the dangers, I think, that many people at the state level might not realize is that these restrictions that are in place for the abortion pill can be done away with by agency action. And unfortunately, many state laws that are in place right now are there in reference to those FDA restrictions that could be wiped away at any moment by the Biden administration.

And so, a state might have restrictions in place right now and think that, OK, everything is good, we’re safe, but actually that’s not the case. If they are relying purely on the FDA’s advisories and those then go away, then a state is going to have a problem. That’s why it’s so important that individual states take a look at what their laws specifically say right now, and really look for areas that they can improve the situation to protect women and to protect women’s unborn children.

Allen: Melanie, thank you so much for your time. Thank you for the work that you’re doing on this issue. We will link your paper in the show notes [for] anyone who wants to read it and go through it; it’s incredibly helpful, filled with so much wonderful information.

Thank you so much for having me. It’s such an important conversation.

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