The Abortion Pill Is No Vitamin

Why women in this country must be under a doctor's care, even if foreigners can order it online.

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When I recently heard about the website Women on Web, which allows women in countries like Ireland, Argentina, and Afghanistan that outlaw abortions to purchase abortion pills over the Internet, I had mixed feelings. On the one hand, mifepristone and misoprostol—drugs approved by the Food and Drug Administration to terminate pregnancy before eight weeks—are far safer than back-alley, illegal abortions. On the other hand, the FDA requires that these drugs be dispensed in a doctor's office so a woman can be carefully assessed and informed about side effects. (The website won't ship the regimen to countries like the United States, where it can be legally obtained.)

In fact, news reports this week about a new study of the website point out that 6.8 percent of customers needed a surgical procedure after using the medications due to an incomplete abortion—though study author Rebecca Gomperts, who serves as a consultant for Women on Web, tells me this is also typical for women under a doctor's care. (American doctors routinely perform ultrasounds to date a woman's pregnancy before dispensing the medication, since beyond the first eight weeks, the chances rise of an incomplete result.) Still, the study is a reminder that even with a doctor's supervision, taking an abortion pill isn't like taking a vitamin. A handful of deaths associated with the combination regimen have been reported to the FDA since its approval in 2000, most related to infection with a rare bacteria called Clostridium sordellii. Doctors don't know which women are more likely to get infected and urge anyone who develops a fever to seek immediate medical attention. More common are heavy bleeding, nausea, and cramping, which can also require a doctor's care.

Without a doctor's guidance, desperate women may not fully absorb the consequences of what they're undertaking. Some online support is offered on the Women on Web site, Gomperts says, "with specially trained people who can guide women through the process." Still, she admits, this is certainly not an ideal situation.

I wonder how many female soldiers in the U.S. military find themselves facing it. Military hospitals are not allowed to perform surgical or medical abortions, and it's not hard to imagine the difficulty of finding a willing doctor in Iraq or Afghanistan.