Complications associated with the practice of abortions affect not only the embryo or fetus, which they terminate, but also its mother, who, as several studies have shown, significantly increases the risk of suffering from mental disorders such as anxiety, depression, alcoholism, or drug use, among others.
A study recently published in the New England Journal of Medicine analyzes the efficacy and safety of pharmacological abortion, with a combination of mifepristone and misoprostol. Although it refers to chemical abortion as effective and safe, it also includes among its conclusions that “there is insufficient evidence about its efficacy and safety in very early stages of pregnancy, before the pregnancy can be visualized with ultrasound.” It also concludes that medical abortion before a confirmed intrauterine pregnancy was not inferior to late standard treatment with respect to complete abortion.
The study included 1504 women from 26 backgrounds in nine countries, and they were randomly assigned to either the early-start group (754 participants) or the standard group (750 participants). In an intention-to-treat analysis, complete abortion occurred in 676 of 710 participants (95.2%) in the early-start group and in 656 of 688 (95.3%) in the standard group; the absolute difference between groups was -0.1 percentage points (95% confidence interval, -2.4 to 2.1). Ectopic pregnancies occurred in 10 of 741 participants (1.3%) in the early-start group and in 6 of 724 (0.8%) in the standard group, with rupture before diagnosis (early-start group). Serious adverse events occurred in 12 of 737 participants (1.6%) in the early-start group and in 5 of 718 (0.7%) in the standard group (P = 0.10); most were uncomplicated hospitalizations for treatment of ectopic pregnancy or incomplete abortion.
Safety of the technique
The efficacy, understood as the total number of abortions that were completed, was 95%, that is, five out of every hundred women, according to this study, were unable to complete the abortion and had to resort to other complementary abortion techniques.
As we have previously reported, the available scientific evidence on the risks of using the abortifacient mifepristone is objective and has been documented for some time.
When RU-486 is not taken in combination with misoprostol, the abortion is not carried out, the fetus is at high risk of serious deformities, as shown by some studies, which also show that its administration to pregnant women can trigger painful contractions, nausea, vomiting, diarrhea and heavy bleeding that even persists for days after treatment, and often requires hospitalization.
Due to these complications, which include some deaths, the FDA required that RU-486 leaflets warn of the risk of infections and hemorrhages resulting from its consumption.
A previous study, “A Post Hoc Exploratory Analysis: Induced Abortion Complications Mistaken for Miscarriage in the Emergency Room are a Risk Factor for Hospitalization,” published in 2022 in the journal Health Services Research and Managerial Epidemiology, which the publisher retracted, as we have reported, for unclear reasons, such as, among others, that the researchers collaborated with pro-life organizations, showed the results of a longitudinal analysis over 17 years of 423,000 induced abortions and 121,283 emergency room visits within 30 days after the abortion between 1999 and 2015.
One of the data shown in the study is that more than 60% of emergency room admissions related to the abortion pill were wrongly treated as spontaneous abortions in 2015. These data warn of the danger of hiding from the doctor that this abortion was induced after taking pills abortive.
Chemical abortion patients whose abortions are misclassified as spontaneous abortions during an emergency department visit subsequently experience an average of 3.2 hospital admissions within 30 days. According to this study, and in contrast to the now published data with a smaller sample, 86% of patients eventually undergo surgical removal of retained products of conception (RPOC). Chemical abortions are more likely than surgical abortions to result in a RPOC admission (OR 1.80, CL 1.38-2.35), and concealed chemical abortions are more likely to result in a subsequent RPOC admission than abortions without miscoding (OR 2.18, CL 1.65-2.88). Miscoded/concealed surgical abortions are also twice as likely to result in hospital admission than those without miscoding.
Bioethical assessment
It is incorrect in any case to speak of “safe abortion” to refer to both chemical and surgical abortion. The complications associated with the practice of abortions affect not only the embryo or fetus, which they terminate, but also its mother who, as several studies have shown, significantly increases the risk of suffering from mental disorders such as anxiety, depression, alcoholism or consumption of narcotic substances, among others. Continuing with pregnancy in adolescents is a protective factor that reduces the risk of suicide by 50% and death from other causes by 40%. In women who have undergone an induced abortion, the risk of mortality is 170% higher compared to those who have given birth to a live child. In addition, they present double the risk of death in the year following the induced abortion compared to those who have suffered a spontaneous abortion.
Hiding this scientific evidence from women who request an abortion is denying them their right to choose freely, adequately weighing the negative consequences associated with abortion.
Abortion is an attack not only on the life of the unborn child, but also on the health of its mother. It is also not safe, if we take into account the available evidence on its associated risks. Therefore, the statements in the recent article mentioned calling chemical abortion effective and safe, hide a manipulation by those who defend abortion, and ignore its consequences.
Julio Tudela – Bioethics Observatory – Life Sciences Institute – Catholic University of Valencia
