The other pill

PAUL BUTLER, HOST: It’s Tuesday, the 18th day of April, 2023.

Glad to have you along for today’s edition of The World and Everything in It. Good morning, I’m Paul Butler.

NICK EICHER, HOST: And I’m Nick Eicher.

First up on The World and Everything in It: chemical abortions.

Now a quick word to parents, we will go into some detail that may not be suitable for younger listeners.

Back in the year 2000, the U.S. Food and Drug Administration approved the abortion drug mifepristone.

But two weeks ago, a federal district judge in Texas put a pause on that approval. Mifepristone is a drug that kills unborn babies by blocking a hormone that they need to grow in utero. That hormone is called progesterone.

BUTLER: On April 10th, the FDA appealed the Texas ruling, and the Supreme Court placed it on hold until it can consider the case more fully. If mif-e-pristone comes off the market, some pro-lifers are concerned about the abortion industry’s backup plan. Specifically shifting to a form of chemical abortions common in underdeveloped countries. WORLD’s life beat reporter Leah Savas spoke with an overseas doctor as well as a former U.S. abortion industry worker to get their perspectives.

LEAH SAVAS, REPORTER: The process for chemically aborting a baby in the US requires two drugs: mifepristone to kill the baby, and another one, called misoprostol, to expel the baby. But with the future of mifepristone uncertain, pro-abortion physicians in February published an article in the medical journal Contraception recommending a sample protocol for how to do abortions with just misoprostol.

This is already a common form of abortion in Africa, Asia, and Latin America, so I spoke to a pro-life doctor overseas who’s seen the after-effects of these abortions. Clarke McIntosh has been a medical missionary in South Sudan for the past 14 years. McIntosh was in the United States back in 2000, when the FDA approved mifepristone. He thought the FDA’s decision to push the drug through to approval was horrendous. But now that he’s overseas, he doesn’t really deal with that drug.

CLARKE MCINTOSH: I've never seen mifepristone in South Sudan. And whereas misoprostol, you know, we actually use fairly often in our hospital. We used it last night in a woman who was not progressing in her in her delivery, in her labor. We did it again for a woman who had a naturally occurring miscarriage as we would say in the United States the baby was gone, but there was tissue in there and it needed to come out and we used misoprostol in that situation, to open up the cervix so that we can take out that dead tissue, that tissue that would never result in a baby's life.

But it’s not just doctors who have access to misoprostol in countries like South Sudan. McIntosh says unlicensed pharmacies sometimes sell misoprostol stolen from hospitals, and he thinks that’s how women in communities access it to abort their babies.

A recent paper from the pro-life Charlotte Lozier Institute points to past studies that show misoprostol-only abortions are more likely to require surgical intervention. That’s because sometimes pieces of the baby stay inside the woman, something McIntosh has seen more than once.

MCINTOSH: Some of the young girls, particularly those who were in school, got pregnant, did not want to drop out of school, had found misoprostol and at least twice, I knew of young women who, who used misoprostol to induce an abortion. In both of those situations the abortion was incomplete. And so we ended up having to do a D&C on them to complete the abortions.

McIntosh says the biggest risks of incomplete chemical abortions are bleeding and infections. The dead remains of the baby attract bacteria, which can lead to sepsis, an infection of the bloodstream that can be deadly.

Women who have experienced chemical abortions have extremely personal reasons for being concerned about the shift to misoprostol.

KELLY LESTER: My name is Kelly Lester. I am the Outreach and government engagement coordinator for And Then There Were None and ProLove Ministries. I am a former abortion worker. I also am a woman who's had multiple abortions.

Lester has had four abortions. The third one was a chemical abortion. As an abortion facility worker, Lester had told women that the process would be more natural than a surgical abortion.

LESTER: You'll feel the contents of your uterus gently come out. It's basically like a period you know.

But when Lester went through the experience herself, it turned out to be nothing like a routine period.

LESTER: I was fully conscious. I took the pills myself. I had the abortion in my home and really had to return to the scene of the crime. So the bathroom where I saw my baby come out—I had to go back to that bathroom. And it was so traumatic, in fact that I actually moved out of my apartment because I didn't want to have to keep remembering that experience.

Even though Lester took both mifepristone and misoprostol for this abortion, she remembers the effects of the misoprostol being especially violent.

LESTER: It is labor. I mean, you are going into full labor. You are—the process forces your body to go from not being in labor to, throws it into extreme labor, so it was very very traumatic.

That experience makes her worried that the recommended protocol will increase the danger of chemical abortions for women, beyond the existing danger for the babies.

The current FDA chemical abortion regimen calls for 200 milligrams of mifepristone followed by 800 micrograms of misoprostol. But if mifepristone becomes unavailable, the Contraception journal article recommends women take three to four times as much misoprostol split between several doses.

LESTER: It is throwing women's bodies into labor super fast. The the risk for cer—for cervical rupture, for uterine rupture, for those kinds of things is a much higher risk with this new protocol.

And Lester has other concerns. One being that misoprostol-only abortions are not reversible. An increasing number of pregnancy centers offer Abortion Pill Reversal treatment–progesterone pills or injections that counteract the effects of the mifepristone. But by the time you take misoprostol, it’s too late to reverse. You can’t save the baby.

For this and related reasons, Lester is not thrilled about the attempts to take mifepristone off the market.

LESTER: I haven't understood why we were trying to push this as the pro-life movement. It it was, in my opinion, pretty short sighted for us to really go this route route, because . They're still gonna have a chemical abort—You know what I mean? I just don't see the win.

But to Dr. McIntosh, mifepristone is the more dangerous drug. In his mind, taking it off the market would be a significant win for the pro-life movement, and the medical industry more broadly.

MCINTOSH: Mifepristone has never been proven to be fay, safe, and then has some more and more not to be safe since it was released. And the FDA is has turned blind eyes to it. So I'm thrilled with this lawsuit and I certainly hope it goes through.

Regardless of the final ruling, the pro-life movement’s efforts to end chemical abortions won’t be over.

Reporting for WORLD, I’m Leah Savas.

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