According to a study by the Spanish Association of Accredited Clinics for the Termination of Pregnancy (ACAI), 85% of women who have abortions prefer to undergo a surgical abortion in an abortion clinic while the remaining 15% prefer to use abortion pills (mifepristone) to have a medication abortion (also known as a medical abortion, chemical abortion or non-surgical abortion).

However, according to data from the Spanish National Institute of Statistics (INE), chemical abortion based on mifepristone combined with misoprostol has grown dramatically, rising from 5.4% of all abortions in 2010 to 25.1% in 2021, a year in which 22,603 medical abortions were registered, i.e. 62 every day.

Both types of abortion can cause complications. In the case of surgical abortions, these may include endometriosis, infections or perforation of the uterus, among others, while adverse events in the case of medical abortions may consist of sepsis and serious bleeding that sometimes requires surgery.

As we previously reported on our website, doctors from the Charlotte Lozier Institute published several studies analyzing the side effects associated with the use of the chemical abortifacient mifepristone (RU-486), related to the need for admission to hospital with complications after a medical abortion. In many cases, women who have taken mifepristone to terminate their pregnancy do not tell the doctor that they have taken the abortion pill, instead saying that they have experienced a natural loss, which increases the risks to their health after the abortion.

In the article “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, the authors conducted a 17-year longitudinal analysis between 1999 and 2015 of 423,000 induced abortions and 121,283 emergency room visits in the 30 days following the abortion.

One of the findings of the study was that, in 2015, more than 60% of emergency room admissions related to the abortion pill were wrongly treated as miscarriages. These data warn of the danger of concealing from the doctor the fact that this abortion has been caused by taking abortion pills.

The authors reported that “Chemical abortion patients whose abortions are misclassified as miscarriages during an ER visit subsequently experience on average 3.2 hospital admissions within 30 days. 86% of the patients ultimately have surgical removal of retained products of conception (RPOC). Chemical abortions are more likely than surgical abortions (OR 1.80, CL 1.38-2.35) to result in an RPOC admission, and chemical abortions concealed are more likely to result (OR 2.18, CL 1.65-2.88) in a subsequent RPOC admission than abortions without miscoding. Surgical abortions miscoded/concealed are similarly twice as likely to result in hospital admission as those without miscoding”.

One of the study authors, Dr. James Studnicki, says that this is because of a cover-up by the abortion industry, as women are encouraged to withhold that information from their doctors and abortion providers are advised not to properly report the complications that the use of the abortion pill may entail for women’s health. When a woman who has had a medication abortion is treated as if the loss were natural, the risks to her health increase.

Dr. Ingrid Skop, a gynecologist who serves as director of medical affairs at the Charlotte Lozier Institute, has said that the abortion pill impairs the immune system, meaning that women experiencing complications have a higher risk of infection, including sepsis, as well as an increased risk of bleeding, which can be severe.

Publisher retracts related articles

The platform Sage Journals, which publishes the journal Health Services Research and Managerial Epidemiology, in which both the aforementioned article and two previous papers authored by the same researcher, J. Studnicki, appeared in 2019 and 2021, retracted all three articles in 2024. This followed a complaint by a reader who denounced that there was an undeclared conflict of interest related to the collaboration of researchers with pro-life groups and alleged inaccuracies in the treatment of the study populations that implied a lack of scientific rigor that would affect the acceptability of the paper’s conclusions.

Thus, the publisher states that in the 2021 and 2022 articles, which were based on the same dataset, the two experts consulted “identified fundamental problems with the study design and methodology, unjustified or incorrect factual assumptions, material errors in the authors’ analysis of the data and misleading presentations of the findings that, in their opinions, demonstrate a lack of scientific rigor and invalidate the authors’ conclusions in whole or in part”. In the 2019 paper, which was based on a different dataset, both experts identified unsupported assumptions and misleading presentations of the findings that, also in their opinion, similarly demonstrate a lack of scientific rigor and render the authors’ conclusion unreliable.

Authors’ response

The authors of the now retracted articles have responded meticulously to each of the objections currently raised by the reviewers, stating, in summary, that “the reviewers claim to have ‘highlighted fundamental concerns with the study design, methodology, assumptions about health care indicators and analyses, such that the conclusions may not be adequately supported by the results.’”

The letter from Sage’s attorney (R. Sander, November 21, 2023) further states that these “substantive findings by the reviewers were most significant in the determination that retraction of the article was necessary under COPE [Committee on Publication Ethics] guidance [sic].”

In their responses, the researchers state that an objective review of each issue clearly demonstrates that: 1) No specific findings in any of the three articles have been explicitly challenged, let alone invalidated; 2) There is no evidence of a major error, miscalculation, fabrication or falsification; 3) There is no breach of any of the COPE guidelines that could permit Sage to retract any of our published articles; and 4) The retraction of any of these papers, let alone all three, is demonstrably unwarranted. Sage’s proposed retractions violate COPE guidelines.

Scientific bias or ideological bias?

The authors’ response to the publisher’s initiative to retract their articles seems to refute the arguments of the two reviewers who were consulted. The accusation of not having declared a possible conflict of interest, given the researchers’ collaboration with pro-life groups, which positions them as critics of induced abortion, does not seem well founded, since the collaboration with the Charlotte Lozier Institute had been made clear.

The obstacles that certain editorials pose to researchers who present findings critical of abortion or contraception are not uncommon, given the widespread tendency of certain scientific societies and the WHO itself to promote those papers that tend to favor the expansion of both abortion and contraception, tending to hamper studies that may question them, such as those that now concern us.

The risks associated with the use of mifepristone

The scientific evidence regarding the risks of using the abortifacient mifepristone is objective and has been documented for some time.

When the abortion is not completed after ingesting RU-486, the fetus has a good chance of suffering serious deformities, according to some studies; these also show that after its administration to the pregnant woman, it can trigger painful contractions, nausea, vomiting, diarrhea and abundant bleeding that may even persist for days after treatment, often requiring the hospital admissions analyzed in the now retracted studies.

Because of these complications, which include some deaths, the FDA required RU-486 leaflets to warn of the risk of infections and bleeding from its use.

Bioethical assessment

Retracting a scientific article, citing among other reasons the fact that the researchers collaborate with pro-life organizations, is unacceptable ideological bias. The possible conflict of interest can be put forth as a cause for rejecting the research if the biases or inaccuracies that may exist both in the design of the study and in its execution are demonstrated.

The authors concerned appear to have sufficiently argued the validity of their work and the absence of consistent arguments justifying the retractions.

We must insist on accumulating evidence on the risks associated with the use of the abortifacient mifepristone, not to mention the ethical rejection that any surgical or pharmacological intervention directly applied to end the life of any human being in all circumstances deserves.

Concealing this information from potential users is an attack on their autonomy, freedom and health. The side effects associated with abortion, including surgical abortion, are substantial enough to be included without exception in the information that must be provided to patients, and which may help to reduce their prevalence.

Julio Tudela

Bioethics Observatory – Institute of Life Sciences

Catholic University of Valencia

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