The mainstream media is warning us in anxious tones that an “Ohio abortion pill law led to worse health outcomes.” Allow me to briefly describe the new law and show why the case against the law is at best weak, and at worst, dangerously confused.

The drugs mifepristone and misoprostol are sometimes injected into pregnant women to kill the lives inside their wombs. The procedure is called a “medical” or “medication abortion” to distinguish it from other methods of killing the unborn, usually involving sharp objects or vacuums.

In 2000, the U.S. Food and Drug Administration approved a version of the mifepristone + misoprostol method of killing. This version requires medium doses of both drugs to be given at an abortionist’s office on different days. To ease demands on their time, some abortionists instead prefer another, “off-label” combination of these drugs, one not approved by the FDA: a high dose of mifepristone at the office and a low dose of misoprostol self-administered at the would-be mothers’ homes.

The distinction is important because Ohio in February 2011 passed a law requiring abortionists to use only the FDA-approved method. The law was passed in dispute. Some abortionists complained that the work of killing was better using the off-label method.

Apples, Oranges and the Unborn

A group of researchers led by Ushma D. Upadhyay tried to investigate the questions, studying pre-law and post-law abortion data. They published their attempt in “Comparison of Outcomes before and after Ohio’s Law Mandating Use of the FDA-Approved Protocol for Medication Abortion: A Retrospective Cohort Study” in the journal PLOS: Medicine.

The researchers found four abortion sites willing to cooperate with their research. The immediate finding was that the fraction of medication abortions dropped dramatically at all four of the abortion sites after the law passed. The average rate was 22% of all abortions were medication before the law, which dropped to only 5% some time after. One site even discontinued medication abortions for a period of almost two years.

The researchers do not say if the medication abortions that were performed post-law were all the FDA-approved method or if any were the now illegal off-label method. This is not surprising, because admitting to use of the off-label method would be admitting violating the law. Given that the sympathies of the abortionists and the researchers was not with the law, it is possible biases creep in, both in the analyses and in way treatments themselves are administered. Confirmation bias is ever a possibility.

That sort of bias might account for why the researchers did not trouble to report what fraction of FDA-approved medication abortions were performed before the law. All? None? We never learn. And it is a crucial number to know if we are to compare pre-law with post-law adverse events, especially if it is to be asserted that the FDA-approved method causes greater harm to the would-be mothers (both methods, of course, cause ultimate harm to the lives inside their wombs).

Further muddying matters, many of the characteristics of the women given medication abortions changed pre- to post-law. For instance, pre-law only about 15% of would-be mothers had at least a Bachelor’s degree, compared to over 23% post-law. Blacks represented 21% of the pre-law sample but only 16% of the post-law sample. Importantly, only about 27% of the women had private insurance pre-law, jumping to 34% post-law. Better educated women with insurance might be more willing to be checked for adverse effects, which would boost reported rates.

Number of Gestation Days Before Killing

The oddest discrepancy was in the number of gestation days, i.e. number of days the women were pregnant before seeking an abortion. In the pre-law sample, 13.4% of women had medication abortions at 34 gestation days or fewer, contrasted with only 7.2% post-law. Also, 52.2% of women pre-law had abortions between 42 and 49 days, versus 63.6% after. These figures are notable because it has been found that the greater the gestation period before the lives inside the women are killed, the greater the likelihood of an adverse effect upon the women.

Before the law, medication abortions were legal for gestations greater than 49 days. In the new law, all medication abortions had to be performed before 50 days. So the greater number of post-law abortions in the 42-49 day period could be accounted for by women who might have rushed in before the new deadline. But this doesn’t explain why fewer women opted for earlier abortions. Whatever the reasons, the changes imply that the characteristics of the women, or the practice of abortionists, changed after the law.

And there was another questionable maneuver by the researchers. All pre-law medication abortions greater than 49 gestation days were excluded from the researchers’ analysis. Of the rate of adverse events in this important and risky group we therefore never learn. This exclusion really makes it impossible to compare health effects pre- to post-law, as do the other points made above. Nevertheless, the researchers soldiered on.

Medication Abortion: Dangerous Medicine

About those adverse events: these included “acute hemorrhage, or infection.” Nasty business, abortion.

As the authors emphasize, but fail to realize the importance of, post-law women were required under the law to go to the abortion site “a minimum of four visits instead of two,” and so there was greater opportunity post-law to report or discover adverse events (in addition to the other reasons noted above).

Now 4.9% of the pre-law women required “additional interventions,” which were things like aspiration (vacuuming up the remains inside the womb), repeated misoprostol doses, and blood transfusions. These interventions rose to 14.3% post-law. Some 12.6% of pre-law women had “at least one side effect during their medication abortion” compared to 15.6% after. Side effects included nausea, vomiting, pain and so on. These numbers comprise the authors’ main “findings.”

Yet even if it were true, as the authors suggest, that the FDA-approved method is causing the boost in rates of interventions and side effects, the number of women who suffer ill effects caused by medication abortion could still shrink. Why? Because even though the rates of ill effects increase, the number of medication abortions procured fell sharply under the law.

The calculation that could prove this is tough to do because we don’t know about the adverse rates for women with gestations greater than 49 days pre-law (a shocking omission) — nor do we know them for other abortion methods. Plus, for the many reasons given above, we do not know that the FDA-approved method is causing the boost in rates for medication abortions, even though the researchers are anxious to suggest that it is.

Perhaps most interesting is the finding (admission?) that such large percentages of women undergoing medication abortions will require “interventions” or will suffer an adverse effect. That is news worth spreading.