Big Abortion sends mixed messages about women's pregnancy knowledge

Abortion advocates frequently suggest that women are able to properly date their pregnancies (without exceeding the 10 week/70 day FDA-approved gestational limits for the abortion pill regimen) while simultaneously claiming that women 'need' later abortions because they were unaware they were pregnant to begin with.

Key Takeaways:

• The abortion industry sends mixed messages, claiming that women are capable of properly dating the gestational age of their preborn children (and therefore taking the abortion pill within allowed FDA limits), as well as claiming they often don't know they are pregnant which leads them to "need" late abortions.

• Despite this, even ACOG (which is pro-abortion) admits that approximately half of women do not know the date of their last menstrual periods.

The Details:

Abortion pill and pregnancy dating

The abortion pill mifepristone (200mg)/Mifeprex has been approved by the Food and Drug Administration (FDA) for chemical abortion up to 70 days gestation (10 weeks of pregnancy) in a regimen with a second drug called misoprostol.

The drug has been placed under strict safety requirements called REMS, requiring certified prescribers to complete a Prescriber Agreement Form and agree that they fulfill the following qualifications:

• Ability to assess the duration of pregnancy accurately

• Ability to diagnose ectopic pregnancies

• Ability to provide surgical intervention in cases of incomplete abortion or severe bleeding, or to have made plans to provide such care through others, and ability to assure patient access to medical facilities equipped to provide blood transfusions and resuscitation, if necessary

Yet, during the COVID-19 pandemic, the abortion industry began utilizing what it referred to as a “no-test” protocol when prescribing the abortion pill to women, which necessitates that a woman can properly estimate the date of her pregnancy. 

The protocol specifically outlined that the pregnancy would be "confirmed by patient."

In a panel discussion about the "no-test" protocol, Ushma Upadhyay, who was in the process of designing a telehealth study which omitted "any clinic visits or clinic tests that are usually required," stated:

To access whether perspective patients are within the ten week gestational limit for medication abortion, we’re going to do something very revolutionary. We’re going to actually believe people when they say that they’re certain of when their last menstrual period is and calculate that date based on that.

Upadhyay is a University of California San Francisco (UCSF) professor. The UC system, which trains in abortion, is heavily funded by abortion pill investors Warren Buffett, the David and Lucile Packard Foundation, and the Gates Foundation. UC has sponsored multiple abortion pill clinical trials.

Meeting the needs of Patients - Post Roe v. Wade

During this time, details of the no-test protocol were discussed at length among high-ranking abortion industry insiders in a webinar. There, Elizabeth G. Raymond, MD, a former Planned Parenthood abortionist and then Senior Medical Associate at Gynuity Health Projects, said the goal was “to develop a protocol to enable safe and effective provision of medical abortion without facility-based tests, that is ultrasounds, blood tests, or pelvic exams.”

She added, “Basically, this means that the entire medical abortion procedure can be done simply by talking with the patient. No physical contact needed. And, indeed, it can all be done remotely without any in-person visit to a clinic except for perhaps pill pick-up.”

The webinar of pro-abortion panelists speaking about the “protocol” was conducted and sponsored by the Society of Family Planning (SFP). Raymond, co-author of the "no-test" abortion pill protocol, admitted that "LMP [last menstrual period] dating is not always accurate, and this protocol will result in treatment of some patients with gestational ages above 77 days” (emphasis added).

Raymond advised:

Each patient should understand that the no-test approach does have its own risks. As I mention, the gestational age could be underestimated, which means that the treatment would have lower efficacy than expected and bleeding and cramping could be heavier. And, in addition the patient may see fetal tissue when the pregnancy is expelled. Also, the patient may have an undetected ectopic pregnancy.

Important note: the "no-test" protocol acknowledges that "each patient should be explicitly informed that LMP-based dating may underestimate [gestational age], in which case efficacy may be lower than expected, bleeding and cramping may be heavier, and, rarely, fetal tissue may be visible."

In addition to prescribing the drug without an in-person visit or ultrasound pregnancy confirmation, the industry is openly prescribing the drug "just in case," in "advance" of a confirmed pregnancy, and as a "period pill" — among other REMS violations.

Studies indicate that women seeking use of the abortion pill frequently underestimate the gestational age of their babies; even the pro-abortion American College of Obstetricians and Gynecologists (ACOG) has stated that “It has been reported that approximately one half of women accurately recall their [last menstrual period] LMP.”

Age of baby aborted by pill "substantially underestimated"

In 2022, Raymond and Upadhyay published the results of a study which sought to "evaluate the outcomes and safety of a history-based screening, no-test approach to medication abortion care."

The retrospective cohort study "included patients obtaining a medication abortion without preabortion ultrasonography or pelvic examination between February 1, 2020, and January 31, 2021, at 14 independent, Planned Parenthood, academic-affiliated, and online-only clinics throughout the US."

Authors wrote:

During follow-up, 9 (0.40%; 95% CI, 0.00%-0.84%) patients were found to have had pregnancy durations greater than 70 days at mifepristone dispensing although not identified at screening (Table 4). Of these patients, 6 had procedures to complete the abortion at 88 to 101 days of gestation, 2 had complete abortions without additional intervention at 16 and 33 weeks, and 1, who received mifepristone at 87 days, had a continuing viable pregnancy at last follow-up contact 3 days after screening. The patient who was estimated to be at 33 weeks of gestation delivered a stillborn fetus at home, brought the fetus to the clinic, and required no further medical care.

Authors admitted that not conducting pelvic and ultrasounds was a concern, noting the exact number of later gestations was unknown:

The risk of inadvertently treating a patient with a pregnancy duration greater than the accepted limit for medication abortion (70 or 77 days) is another concern. In this study, 9 patients were found at follow-up to have been treated at a gestation of greater than 70 days. The true number may be larger, as some advanced gestations may not have been recognized among patients who had successful abortions.

We observed 1 case for which pregnancy duration was substantially underestimated; this patient passed the pregnancy and had a complete abortion at 33 weeks of gestation without additional intervention, medical complications, or sequelae.

"Clinicians offering the no-test approach should counsel patients about the possibility of an unidentified advanced gestation and discuss options for further evaluation and care if the patient were to encounter this situation," the authors wrote.

Industry statistics show that the failure rates for the abortion pill regimen increase as the gestational age of the preborn baby increases. Yet, the "trust the patient" protocol, which is not in line with FDA's REMS, reveals that the abortion pill is being used well into the second and even third trimesters of pregnancy.

The problem is so concerning that even late-term abortionist Warren Hern criticized this trend, questioning the lack of follow-up exams to ensure the uterus is empty and asking who will care for women with complications.

Late-term abortions due to women unsure of pregnancy

While Big Abortion claims women can properly date their pregnancies, they also claim that when it comes to later abortions, women are often unaware "about the pregnancy."

Dr. Eleanor Drey, the medical director of the Women’s Options Center of San Francisco General Hospital (which commits abortions into the second trimester), admitted in an abortion training module published by Innovating Education, ” […] there was a study that showed women’s reasons for presenting at 16 weeks or beyond after their last menstrual period. And what they saw was that women often didn’t realize that they were pregnant.” 

In fact, "Woman did not realize she was pregnant" was at the top of the list.

In her training module, Biftu Mengesha, MD, MAS of the pro-abortion University of California San Francisco echoes this by acknowledging that abortion patients "report late recognition of their pregnancy due to not experiencing typical symptoms of early pregnancy or being unsure of the date of their last menstrual period."

The online abortion dispensary Hey Jane writes:

In some cases, ending a pregnancy in the second or third trimester is done because of health concerns, a lack of access to abortion care, or being unaware of the pregnancy until later on.

A "mixed-methods study of expanding later abortion care at two U.S. facilities" published June 2026 at ScienceDirect.com, noted the survey response of one licensed clinic staff member:

  “This is well documented in all the research, but people later in pregnancy typically have higher levels of need than folks earlier in pregnancy, whether that is medically, whether that's psychosocially, people are more likely to be in worse situations. They're more likely to have had active barriers to getting care or to have barriers to even identifying that they were pregnant."  

Ironically, even Upadhyay has published research that shows a large percent of women included "not recognizing the pregnancy" as a reason for later abortions.

The Bottom Line:

Abortion is not healthcare, and abortion providers will likely never exercise proper medical evaluations a pregnant women could expect to find elsewhere. The industry's double speak for political purposes is not only pervasive and needs to be called out, but is harmful to women and their preborn children.