DEVELOPMENTS IN GREAT BRITIAN, which approved its pandemic-era “pills by post program” in late March, may show what the United States has in store as access to abortion pills expands. In May, leaked internal emails from the National Health Service suggested that the new system isn’t safe for women. Among the 13 incidents described: Severe bleeding from ectopic pregnancies. Delivery of infants whose mothers had attempted to abort using the pill, even though they were past the legal 10-week limit. Two dead women. Police investigated the alleged murder of one 28-week infant reportedly born alive after the mother self-administered the pill.
The new regime has its critics. Kevin Duffy spent six years in Africa and Asia as a director and consultant with MSI Reproductive Choices (formerly Marie Stopes International). He saw what self-managed abortions look like. MSI distributed pills over the counter at local pharmacies, and no one assessed women to make sure they were eligible for a chemically induced abortion. Duffy saw more and more women with incomplete abortions needing emergency treatments for infections or severe bleeding.
Duffy sent a dozen volunteers in Tanzania to buy abortion pills in local drug shops. He discovered stores weren’t giving women the full dosage: To have a complete abortion they needed 12 misoprostol tablets, but the drug shops only sold them six. No one checked how far along the women were in their pregnancies.
In April, Duffy contacted pro-life organizations in Great Britain and proposed a survey of Great Britain’s “do it yourself” abortion protocols. With sponsorship from Christian Concern, Duffy and a volunteer recruited a team of women to spend six weeks calling the three primary abortion pill providers: MSI, the British Pregnancy Advisory Service (BPAS), and the National Unplanned Pregnancy Advisory Service (NUPAS).
Each pill order required two to three calls with the provider. The first conversation was usually with call center staffers, who took the caller’s general information and the date of her last period. Follow-up calls with a nurse or health adviser usually involved a flurry of yes-or-no questions about the woman’s health history and a quick overview of what to expect during the chemically induced abortion.
The volunteers adopted fake personas and gave false dates of their last menstrual periods during the calls. One volunteer intentionally switched the date of her last menstrual period between the initial calls and the follow-up calls, saying she had remembered incorrectly the first time. Providers accepted the new date and sent her pills, even though the first date she provided would have put her past the legal limit for chemical abortions.
For each persona, volunteers prepared responses to the question of why they wanted an abortion, starting with common reasons: the timing was bad, or money was tight. The call operators asked so they could check a box on the patient’s form: A patient’s reason for obtaining the abortion had to fit within the law. Usually they shoehorned the answers into the broad category of “unable to cope emotionally,” which meant the pregnancy posed a risk to the woman’s mental health.
Some of Duffy’s volunteers tried daring scenarios. When asked for the reason for her abortion, one volunteer told the midwife on the phone that she had just booked a holiday to the beach and didn’t want to look pregnant. The midwife said that was fine, but she had to fit it within a legal category: “I don’t want to put words in your mouth. … Any reason other than the sex of the baby is a valid reason to us, but to attach it to a legal reason, it sounds like emotionally it’s not the right time.”
The staff showed little concern for the emotional effects of expelling a dead baby in the bathroom at home. When the volunteer callers sounded worried, staff members told them they could expect to see “blood clots.” One MSI nurse told a volunteer to “sit on the toilet seat, and let everything just fall in to the toilet … rather than you having that in your pad” to make it more “pleasant.” The nurse told the caller the bleeding could last up to two or three weeks, that there was a 1 percent chance of “complications or failure,” and that the chance of “tissue” remaining in the uterus was more than 3 in 100.
Duffy’s team successfully obtained pills 26 times. The life-ending drugs arrived at volunteers’ homes in unassuming paper or cardboard packages with instructions and phone numbers to call in case of emergency. Christian Concern used the NHS emails and Duffy’s findings in a legal challenge against the health secretary’s decision to allow at-home abortions, but the judge dismissed the evidence. Christian Concern appealed the decision to the U.K. Supreme Court and is awaiting an outcome.
Meanwhile, the British government is moving forward with plans to make at-home abortions permanently available. Politicians expect that the law will change before the temporary pandemic measure expires at the end of its allotted two years. The Biden administration will be watching.
The pill’s history
Pro-life and pro-abortion groups have fought over chemical abortions since a French pharmaceutical company first invented RU-486 in the 1980s. Also known as mifepristone, the abortive drug received approval from the French government in 1988. Early studies found that mifepristone combined with a second drug, misoprostol, was 95 percent effective at killing and expelling an unborn baby. Mifepristone cut off nutrients to the baby and misoprostol induced uterine contractions, which pushed out the baby’s remains. In 1991, Great Britain became the second country to approve RU-486.
A stalwart pro-life movement in the United States kept mifepristone out of the country for some time, but the drug eventually received an FDA-style thumbs-up after a rushed approval process in 2000. The explicit goal of all the rules: preserve maternal health. An undiagnosed ectopic pregnancy can kill a mother. If done too late in the pregnancy, a chemically induced abortion can cause severe infection. If no one checks with her afterward, no one can confirm the procedure worked. The implicit result of removing the rules: endangering women’s lives in the name of women’s health. —L.H.