I will never forget the patient I met in the emergency department who was pale, trembling, and in tears, her family in distress at her side in the trauma bay. She was suffering complications after taking medication to end her pregnancy. While such side effects can occur with medical abortions, they are markedly more likely when patients are forced to use misoprostol alone, a reality in states that restrict access to mifepristone. The experience of the rare, but serious and severe side effects, is becoming more common throughout the U.S. through the uninformed decision-making of lawmakers in a misguided attempt to “protect” women.
During that time, I was a medical scribe, just beginning my journey into medicine. At that point, I believed the field of medicine was purely objective, and I trusted that the reasoning behind which medications are given to patients was grounded in the best science available. As I’ve continued throughout medical school, I have come to the realization that politics can often pollute the field, especially when it comes to marginalized groups. Few areas illustrate this more starkly than the politicization of women’s reproductive health.
The gold standard versus the forced alternative
The most effective and safest medical regimen for terminating a pregnancy in the first trimester is a combination of two medications: mifepristone and misoprostol. Together, they can induce a complete abortion with minimal complications in 95 percent to 98 percent of pregnancies.
Currently, medical abortions are completely banned in 14 states, and despite evidence of the safety of the dual-drug regimen, access to mifepristone is restricted in an additional 10 states. This raises the critical question: What is the alternative to mifepristone for medically inducing an abortion in those 10 states that still allow abortions?
The answer is a higher dose of misoprostol, ranging from three to four times the amount used in dual therapy. This alternative is not only less effective; it is also more dangerous. Patients on misoprostol monotherapy are more likely to experience incomplete terminations, severe cramping, and prolonged bleeding. A recent study published in JAMA analyzed 31,977 patients who experienced an early pregnancy loss on either the dual therapy or misoprostol alone; in the misoprostol-only therapy, there was both a higher rate of subsequent uterine aspiration (14 percent versus 10.5 percent) and a higher rate of emergency department visits (7.9 percent compared to 3.5 percent).
A more than doubling in the rate of emergency department visits means there will be more patients like the woman I met who was writhing in pain, confused, terrified, and in tears. It is a harrowing experience: physically painful, emotionally distressing, and psychologically traumatic. What makes this even more troubling is knowing half of these cases could be avoided. Safer, more effective medications exist, yet access is withheld because of political agendas.
Politics masquerading as protection
Despite clear evidence of the increased safety profile of dual therapy, many legislators continue to justify the restrictions. In one of the states banning mifepristone but allowing a misoprostol-only therapy, Florida Attorney General James Uthmeier proclaims that the ban on mifepristone prevents “harms that women and young girls are experiencing” from unsupervised medication use in his challenge against the FDA’s approval of the drug. Ohio Attorney General Dave Yost declared his state’s ban “reflect not only our commitment to protecting the lives and dignity of children, but also of women.”
It’s one thing for these attorneys general to think they are promoting safety through restrictions, but the FDA has repeatedly affirmed mifepristone has serious complications in less than 0.5 percent of cases. And when looking at the alternative medical therapy, misoprostol monotherapy, it is clear they have just enacted a law that causes harm rather than prevents it.
Understandably, many patients seek a medical abortion to avoid an invasive procedure, but in states that don’t allow mifepristone, legislators decide to “protect” women who do not want a surgical alternative by forcing them to endure a less effective and more painful medical treatment. This is clearly no longer protection so much as it is coercion.
Don’t believe that you are isolated from the effect of these policies; they reach into the lives of the people you love: your mother, sister, wife, partner, or friend. These restrictions don’t reduce harm; they enhance it. Let’s be clear: These bans are not protection; it’s a mandate for more suffering, not less. Ultimately, these policies aim to subject women to increased amounts of pain and trauma for no other reason than to hurt them for the sin of wanting a choice.
If a state still allows patients to receive an abortion, it should also allow the best available medical care. Anything less than this is not only bad policy; it is a betrayal of the people these laws claim to protect. It is the responsibility of the public and especially medical professionals to demand evidence-based care for those we care about and to hold lawmakers accountable for policies that harm rather than heal.
John Finnie-Maloney is a medical student.
