Do chemical abortions cause increased trauma?

A client walked into the Heartbeat of Miami pregnancy clinic in Hialeah, Fla., in December—holding her aborted baby in her hand.

She had visited the center nine days earlier, and the staff had seen the baby’s image on the ultrasound screen. Heartbeat of Miami president Martha Avila said the mother was almost eight weeks pregnant at the time of the ultrasound. But after she left, she took an abortion drug.

Avila was one of the staff members present when the woman returned. Although Avila said the infant’s body was clean and she saw no blood, the incident was hard on her and other staff members. “We were—you know, very distraught about it,” she said, adding she never found out why the woman came back with the baby’s body.

Olga Rodriguez, a sonographer at a sister clinic in Flagler, had a similar client interaction in 2021. In this case, the woman opened a napkin and showed a roughly 10-week-old preborn baby to Rodriguez. She remembers the tiny eyes, hands, and fingers. Rodriguez said the woman caressed and hugged the baby and started crying—“because she felt guilty,” Rodriguez recalled. “That’s the word that she used. She said, ‘I feel guilty, what I did with my baby.’”

Avila recalls these incidents as she notes the increase in chemical abortions since the COVID-19 pandemic started in 2020. Today, the abortion pill accounts for more than half of all abortions. All abortions are devastating to the unborn babies they kill, but the rise in chemical abortions introduces new difficulties for the women undergoing abortions and for the staff at pro-life pregnancy centers who help them in the aftermath. The shift towards the abortion pill raises the question: Do chemical abortions have a greater psychological toll on women than surgical abortions? Limited scientific research provides no ready answer.

Anecdotally, staff at pregnancy help organizations say the psychological toll often begins during the abortion as many women try to navigate the process and related symptoms on their own. Savannah Marten is executive director for the Bella Vita Network, a pro-life organization that operates a pregnancy center, a college ministry, and an abortion-recovery program in Toledo, Ohio. She said her organization has observed an increase not only in chemical abortions but also in women hesitant to go to “brick and mortar” abortion facilities to obtain the pills. They’re opting instead to order them online. The result is that women are aborting without direct guidance from a medical professional and don’t realize what a serious medical procedure a chemical abortion is. Some women have compared the process to giving birth

“We’re getting lots of calls after women have taken the chemical abortion or right before,” Marten said, adding that these calls have increased “drastically” just in the last few months. “And because there’s no medical professional there to walk them through, they’re calling us—they have questions.”

Heidi Inlow, case manager for the pro-life Support After Abortion, said the national support line hears from women who are in the process of picking up their pills or who have just taken them and don’t know what to expect. “They’re not planning well for it. … They think it’s just going to be a one- or two-day thing. We get questions about, ‘How long should I be bleeding for?’”

Many abortion pill websites warn women that they will have heavy cramping and bleeding after taking the pills, some noting that it’s normal to have blood clots “the size of lemons.” A few add that the women may see white or gray “pregnancy tissue” with at least one instructing women to flush it down the toilet.

The FAQ page of one website asks, “What am I supposed to look for?” The answer reads, “You aren’t. An early medication abortion looks and feels like a heavy period.”

But Inlow and Marten have heard from women who looked anyway and were distraught by what they saw. “We’ve had people say, ‘I couldn’t flush it,’” Inlow said. “We’ve had people share with us that it’s under their bed. I mean, they just—they have no idea what they’re supposed to do because they weren’t prepared.”

Avila remembers seeing her own baby after her natural miscarriage decades ago. She still weeps thinking about the loss and about how she flushed the baby down the toilet because she didn’t know what else to do. “If that happened to me without me doing anything to cause it, I can’t imagine … what these women go through,” she said of women who see their aborted babies. She noted that women who have chemical abortions “cannot really blame a doctor. … It was her by herself, alone.”

Her words echoed those of a French abortionist who commented in a 1999 interview that the “difference between a surgical and a medical abortion is the difference between experiencing and submitting. With a medical abortion, the woman … participates, whereas with a surgical abortion it’s over in two minutes and she has done nothing but submit to the physician.”

Avila and Inlow speculated that the increased agency and awareness women have in chemical abortions as opposed to surgical abortions is driving them to seek help sooner after their abortions.

Marten said that 10 years ago, Bella Vita’s after-abortion program saw mostly pro-life Christians who had aborted a baby decades ago. She estimated that just two years ago, they would never have seen women who were less than a decade out from their abortions. But, within the past year, Bella Vita has started seeing an increasing number of women come for help within weeks of their abortions—sometimes even days. And it’s no longer just pro-life Christian women.

The increase in chemical abortions could partially explain that change. Marten noted that women who have had surgical abortions are often medicated or under anesthetics during the procedure and sometimes don’t remember too many specifics about the process. Meanwhile, women taking the abortion pill are aware and often alone during the process, “actively participating step-by-step in their abortion,” said Marten, which she said leads to “a varied level of isolation and trauma.”

Marten acknowledged the program could be seeing women sooner because younger generations value mental health counseling more than previous generations. Also, Bella Vita’s after-abortion program moved next door to an abortion facility in 2017, meaning that post-abortive women are simply more aware that the program exists.

Meanwhile, scientific data illustrating the unique effects of chemical abortions are lacking. “We know from a large body of research that abortion of any type has psychological trauma for women,” said David Reardon, associate scholar with the Charlotte Lozier Institute. He has authored peer-reviewed articles about the effects of abortion on women, some that have linked abortion with increased rates of mental health issues such as depression, bipolar disorder, substance abuse, and suicide.

But when it comes to differentiating between chemical abortions and surgical abortions—“I’m not sure that the psychological effects are that different,” Reardon said. He pointed to a handful of studies that have attempted to distinguish the two types of abortion, but they’ve had conflicting outcomes. Some associate chemical abortions with more negative mental effects—one noting that in chemical abortions, “Seeing the fetus was associated with more intrusive events (nightmares, flashbacks, unwanted thoughts related to the experience).” But others found that surgical abortions were harder on women.

“I think if anything, the difference is more in the short-term reactions,” Reardon said. Based on conversations with post-abortive women, he speculated that a woman who has a chemical abortion is “probably more likely to have a higher rate of recognized distress immediately in the short term.”

Reardon said getting good data on this is difficult because pro-abortion groups have little interest in the psychological consequences of abortion. And any pro-lifers who want to study this simply don’t have the access they need because abortion providers are unlikely to allow someone critical of abortion to survey their patients.

“There’s a few studies, and then there’s no more,” Reardon said. “That kind of speaks volumes, because those few studies showed that there’s psychological impact, yet nobody wanted to know anymore.”

Regardless of why women are reaching out to pregnancy help organizations sooner—some even during a chemical abortion—Marten sees it as an open door for pregnancy centers. “Some of the medical community at large is failing these women. They’re turning to pregnancy centers for help, and we have the ability to step in,” she said.

To Avila, it’s a frontline battle. “I always tell anyone that comes to volunteer … ‘Unless you have a personal relationship with Jesus Christ, and you are a woman of prayer, you cannot do this job.’ Because this job is a spiritual warfare,” she said. “We pierce the darkness every day.”