Study finds 75% of women treated at ERs after taking abortion pills rated ‘severe or critical’

Women who visit emergency rooms after taking abortion pills are more likely to be seen for serious medical problems than their cohorts whose pregnancies end with surgical abortions or live births, according to newly released research.

A peer-reviewed study of Medicaid-eligible women by researchers at the pro-life Charlotte Lozier Institute found they were “significantly more likely to have a severe or critical acuity rating” within 30 days of using the two-drug abortion protocol than were other women seen at ERs.

That includes women who had recently given birth; undergone surgical abortions or visited the emergency room for any reason, a finding based on 2004-15 data in the 17 states where Medicaid covers abortion expenses.

“Consistent with national trends for [Emergency Department] visits, both the number and acuity of ED visits following pregnancy outcomes are increasing,” said the paper published last month in the International Journal of Epidemiology and Public Health Research.

“ED visit acuity following chemical abortion is persistently and significantly higher than for surgical abortion or live birth,” the study concluded.

The paper comes as Lozier’s latest missive in its battle with the U.S. medical establishment over the relative safety of the abortion-pill protocol, now the most popular U.S. method of pregnancy termination.

Using the five-level Ambulatory Payment Classification System, the research found that ER visits coded at the most serious “severe or critical” levels increased as follows: no pregnancy, 101.0%; surgical abortion, 450.6%; abortion pill, 4041.1%, and live birth, 20.9%.

By 2015, 75.7% of visits following abortion-pill usage were rated in the “severe or critical” categories versus 66.1% for surgical abortions; 56.6% for live births, and 54% for no pregnancy.

The two-pill regimen’s increased usage comes as the FDA loosens restrictions on access, including raising the gestational age limit from seven to 10 weeks; making the pills available via telehealth and mail, and eliminating the requirement for three doctor visits, one of which was previously required after taking the pills.

The result is that emergency rooms are increasingly been left to treat women grappling with excessive bleeding and other complications after taking the mifepristone-and-misoprostol combo, said Dr. Ingrid Skop.

“The reason many women go to emergency rooms is they have no relationship with the abortion provider,” said Dr. Skop, an obstetrician and the institute’s vice president of medical affairs. “There is no provider for them to contact other than our overworked, overstressed, overly expensive emergency-room system.”

The study led by James Studnicki, the institute’s vice president and director of data analytics, also comes with the Lozier researchers fighting a February decision by Sage Publishing to retract three of their papers, including a 2021 study showing more ER visits after abortion-pill procedures than surgical abortions.

The research drew widespread notice after being cited by the Alliance for Hippocratic Medicine in its lawsuit against the FDA’s approval of mifepristone. The Supreme Court ruled in June that the alliance lacked standing to sue the agency.

Those criticizing the paper included Dr. Michael Belmonte, a fellow at the American Academy of Obstetricians and Gynecologists, who said that adverse events are “extremely rare” and that many ER patients are there for “reassurance rather than a true safety concern.”

“When people have a medication abortion they’re experiencing it alone, and they don’t have a provider with them to ask questions,” Ushma Upadhyay, a public health social scientist at the University of California San Francisco, told Wired. “People are going to the ER to understand whether the bleeding that they’re experiencing is normal and to assess whether the medications worked.”

The Lozier researchers countered by examining not just the frequency but the severity of the post-pill ER trips, finding such visits are significantly more serious than previously characterized.

“This really blows the argument out of the water that was levied against us, that these are just women who want reassurance,” said Dr. Skop. “Because many of these women are having complex medical events, and that’s what this study shows.”

The paper, “Comparative Acuity of Emergency Department Visits Following Pregnancy Outcomes Among Medicaid Eligible Women, 2004-2015,” concluded that “a greater level of surveillance will enhance patient safety for these patients.”