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In the New York Times (NYT) opinion piece, “Miscarriages Are Awful, and Abortion Politics Make Them Worse,” abortion rights advocates Amanda Allen and Cari Siestra make the case that politically motivated abortion laws deny women facing miscarriages the best possible care.1 Both authors share tragic personal experiences with miscarriage and how their dread of walking through abortion opponents protesting Planned Parenthood clinics led them to forgo surgical options. Both authors contend the ideal option was forbidden for reasons that have nothing to do with medical care. They write,
In an ideal world, our health care providers would have offered us the best possible treatment to move the process along quickly, with the least amount of pain and in the privacy of our homes. That treatment would have begun with us each taking one pill of mifepristone, which would have blocked the hormone progesterone and signaled to our bodies that the pregnancies we carried were at an end. That would have been followed by several pills of misoprostol, which would have caused the cramping and bleeding needed for our bodies to swiftly finish our miscarriages. Then we could begin the process of healing and prepare, in both our cases, to try for another pregnancy.2
The drug mifepristone is commonly referred to as RU-486, and in cooperation with misoprostol, it is the exact same drug combination currently used to facilitate abortion in most early pregnancies in the United States.3 Even though Allen and Siestra claim mifepristone is safer than Tylenol, access to it is regulated by Food and Drug Administration (FDA) policies enacted to monitor and control its usage and ensure the drug can be disseminated by qualified medical professionals only. The authors contend these policies place women facing a tragedy in the crosshairs of a battle unrelated to their circumstances. Rather than equipping women with the most effective means to expel the lifeless contents of their uterus, these women are sent home with only misoprostol. The result is a higher risk process of expulsion that will be more painful, last longer, and carry a greater risk of needing further medical attention. If anyone deserves the best care possible, it is women and families facing miscarriage. They deserve better than to have their suffering increased due to intrusive laws.
Allen and Siestra’s article contains three basic claims: miscarriage is tragically common, the best treatment for women facing miscarriage is the combination of mifepristone and misoprostol, and pro-life advocates hurt women by politicizing the distribution of a safe drug. The terrible frequency of miscarriage is inarguable. Even one is too many, so the fact that as many as 26 percent of pregnancies end in miscarriage is heartbreaking.4 Granting that point without argument, we have a responsibility to ask questions about the latter two claims. We have a duty to find the best way to help women and families facing miscarriage, but we must critically evaluate the assertion that this drug combination is the best we have to offer while taking an honest look at just why mifepristone gets special treatment from the government. The primary use of that drug is to end human life at its earliest stage of development. Brushing aside that reality makes the authors as guilty of playing politics with this issue as the abortion opponents they accuse in their piece.
Women and Families Facing Miscarriage Deserve Our Best
Miscarriage is a tragedy. Few things inspire the kind of hope, excitement, and anticipation generated by a wanted pregnancy. Few things hurt as profoundly as the untimely severing of those expectations. Hope is replaced with loss, and medical realities intrude upon the mourning process. It can be conceded that all people of empathy want women facing miscarriage to be afforded every reasonable means to move forward. That is the power of Allen and Siestra’s testimony. Who wants to minimize the pain of their personal experiences? These women and all women facing miscarriage deserve the best possible treatment in their time of crisis.
Is Mifepristone the Best Possible Care?
Arguments of this sort require more than empathy. We can simultaneously feel compassion for those touched by a pregnancy that failed to progress to birth and critically evaluate the claims of fact made to support the arguments offered. For example, women facing miscarriage deserve the best possible treatment, but has it been established that mifepristone added to the prescription of misoprostol absolutely improves care? This is exactly the objection raised by Dr. Christina Francis, chair of the board of the American Association of Pro-Life Obstetricians and Gynecologists. She doesn’t object to the use of mifepristone on the basis of religious pro-life principles. She simply remains unconvinced that mifepristone accomplishes what the authors claim.5 The study cited by advocates to argue mifepristone increases the effective and expedient care of miscarriage by 15 percent — 70 percent effectiveness without mifepristone versus 85 percent effectiveness with it — provides too small a sample size to categorically demonstrate that conclusion. Dr. Francis indicated in a 2019 NPR interview that if further study supported that claim more strongly, she would then add mifepristone to her miscarriage treatment plan. Barring more evidence, she sees initially giving her patients additional doses of misoprostol in the event they are needed as an easier solution.6
Oddly, the first hyperlink Allen and Siestra provide in their article, offered to support the claim that 26 percent of pregnancies end in miscarriage, is a National Center for Biotechnology Information article that appears to bolster Dr. Francis’s position. The article recommends misoprostol alone, with no mention of mifepristone, for medical treatment of miscarriage, stating, “Most women will achieve complete expulsion within 3 days, and very few need subsequent uterine curettage.”7
Even the 2018 New England Journal of Medicine (NEJM) article making the case that the addition of mifepristone increases the effectiveness of the medical treatment of miscarriage uses Dr. Francis’s greater point to justify the necessity of their research, saying, “To date, the usefulness of mifepristone in the treatment of early pregnancy loss has remained unclear.”8 Dr. Francis simply maintains that their comparing the outcomes of a sum of 300 patients fails to settle the matter. The issue needs more research.
The NEJM article also appears to undermine Allen and Siestra’s point that a combination of mifepristone and misoprostol is the most desired and effective treatment for women. The authors of the NEJM study reached out to 800 prospective and medically qualified participants. The main reason the 497 who rejected the opportunity to participate gave was that they preferred and chose the surgical option.
Allen and Siestra don’t do their case any favors trumpeting the safety of mifepristone by repeating the claim that it is safer than Tylenol. It is a silly assertion justified by pointing out overdosing on acetaminophen is annually the number one cause of liver failure in the U.S., accounting for 600 deaths per year, while far fewer people have ever died from mifepristone use.9 It is hard to see how it helps their case to acknowledge that a heavily regulated and controlled medicine produces far fewer deaths by abuse than one of the most easily attained and commonly used drugs. A closer look at the story behind the assertion appears to make the case that current regulations might minimize danger.
Just Who Is Politicizing This Issue?
Critics of abortion can hardly be blamed if they are slow to trust the purity of the motives of these authors. The politics of abortion that these authors claim harm women run in both directions. The greater effort to increase the ease with which women can gain access to mifepristone isn’t primarily argued to help women facing miscarriage. Those efforts are far more often focused on abortion. It is because of its use as an abortifacient that mifepristone falls into an FDA category of control called Risk Evaluation and Mitigation Strategy, whereby the FDA sees a need to balance the good and bad of the medicine and takes measures to control and mitigate abuses. This approach creates regulatory hoops that many clinics and practices can’t or won’t jump through to stock mifepristone. Allen and Siestra’s fellow abortion rights advocates actively seek the ending of this regulation to make it easier for women to access RU-486 through the mail and local pharmacies. These regulations were relaxed due to COVID-19, a relaxation that abortion rights advocates insist must be made permanent. Cynthia Pearson of the National Women’s Health Network said, “Anything less than permanently lifting all of the restrictions will be a capitulation to anti-abortion pressure.”10
If the politics of abortion harm women enduring miscarriage, then Allen and Siestra can hardly claim to be innocent bystanders. Granting the sincerity of their concern on the issue of miscarriage, it is understandable why those who disagree with them on the morality of abortion might find it hard to separate the outspoken advocates for abortion rights from the women writing this article as people deeply affected by the tragedy of miscarriage.
The Unborn Count, Too
Allen and Siestra wrap up their NYT piece with this claim: “The mifepristone regulations benefit no one.” Now we reach the crux of the issue. The people who fought for the regulation of mifepristone never did so out of indifference to women facing miscarriages. Mifepristone destroys unborn life. That is its primary purpose. To deny that reality or dance around it is to play exactly the kind of politics Allen and Siestra condemn. Every year more and more women use mifepristone as the means to cause the death of their unwanted unborn offspring.11 It is perfectly reasonable for communities to handle the dissemination of that drug in a more guarded fashion than other drugs.
The authors, ultimately, make the most fundamental mistake made in discussing abortion: they assume the unborn are “no one.” The FDA REMS regulations make the bare minimum effort to acknowledge the profound nature of being in the business of ending human life and how these questions divide our society.12 Even that minimal effort is seen as wildly intrusive by those who demand unfettered access to abortion. They can’t imagine how unborn human life may benefit by society treating the act of destroying them as worthy of being handled seriously and cautiously. That is precisely why they can’t understand when people disposed to pro-life sensibilities are slow to jump to their aid when they argue for the same thing (easier access to mifepristone) for admittedly nobler reasons (to help women enduring miscarriage). Again, the politics run in both directions.
Jay Watts is the Founder and President of Merely Human Ministries, INC., an organization founded to equip Christians and pro-life advocates to defend the intrinsic dignity of all human life.
- Amanda Allen and Cari Siestra, “Miscarriages Are Awful, and Abortion Politics Make Them Worse,” New York Times, June 22, 2021, https://www.nytimes.com/2021/06/22/opinion/miscarriage-abortion.html.
- Allen and Siestra, “Miscarriages Are Awful.”
- Megan K. Donovan, “Medication Abortion and the Changing Abortion Landscape,” Guttmacher Institute, September 26, 2019, https://www.guttmacher.org/article/2019/09/medication-abortion-and-changing-abortion-landscape.
- Carla Dugas and Valori H. Slane, “Miscarriage,” National Center for Biotechnology Information, June 29, 2021, https://www.ncbi.nlm.nih.gov/books/NBK532992/.
- Mara Gordon and Sarah McCammon, “A Drug That Eases Miscarriages Is Difficult for Women to Get,” National Public Radio, January 10, 2019, https://www.npr.org/sections/health-shots/2019/01/10/666957368/a-drug-that-eases-miscarriages-is-difficult-for-women-to-get.
- Gordon and McCammon, “A Drug That Eases Miscarriages.”
- Dugas and Slane, “Miscarriage.”
- Courtney A. Schreiber, Mitchell D. Creinin, Jessica Atrio, Sarita Sonalkar, et al., “Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss,” The New England Journal of Medicine, June 7, 2018, https://www.nejm.org/doi/full/10.1056/NEJMoa1715726.
- “Analysis of Medication Abortion Risk and the FDA Report ‘Mifepristone U.S. Post-Marketing Adverse Events Summary through 12/31/2018,’” Advancing New Standards in Reproductive Health, April 2019, https://www.ansirh.org/sites/default/files/publications/files/mifepristone_safety_4-23-2019.pdf.
- Carrie N. Baker, “Advocates Cheer FDA Review of Abortion Pill Restrictions,” Ms., May 11, 2021, https://msmagazine.com/2021/05/11/fda-review-abortion-pill-restrictions-mifepristone-biden/.
- Donovan, “Medication Abortion.”
- The FDA’s approved Risk Evaluation and Mitigation Strategy (REMS) for mifepristone insists that the drug be regulated and prescribed by doctors, but it doesn’t actually prohibit or reasonably restrict access to the drug for the purpose of destroying life. The FDA regulations regarding the distribution treats it as a serious matter, in that the FDA insists only doctors from qualified clinics be permitted to distribute mifepristone, but it does not restrict the use in any meaningful way beyond that. The drug must be treated with respect, but not so much as to actually limit its use in destroying the next generation before they are born. See, for example, the REMS entry for Mifepristone 200 mg, https://www.accessdata.fda.gov/drugsatfda_docs/rems/Mifepristone_2021_05_14_REMS_Document.pdf.