Misoprostol-only abortions: An old playbook resurrected

Abortion advocates are trotting out an old playbook, threatening to pivot to a one-drug regimen of misoprostol alone as the FDA-approved two-drug regimen of mifepristone (200mg) with misoprostol comes under further scrutiny.

In Part three of our series on misoprostol abortions, Live Action News breaks down a short history on the promotion of the one-drug regimen. (Read parts one and two.)

Key Takeaways:

• Misoprostol-only, self-managed abortions were “very widespread, well before Roe fell," according to one author.

• The risks of the drug are known, including that it is not as effective as mifepristone/misoprostol (the abortion pill regimen) in combination, failing anywhere from 15-25% of the time.

• Despite knowledge of these risks to women, the abortion industry has been promoting this misoprostol-only protocol once again in case mifepristone is restricted.

The Details:

Predicting misoprostol-only abortions

Despite not being approved as a single-use drug for abortion, some abortion industry insiders have pivoted to a one-drug regimen of misoprostol only, to circumvent the FDA's REMS safety protocols on mifepristone.

In his book, “The Abortion Pill,” French researcher Etienne-Emile Baulieu, who invented the abortion pill, noted misoprostol’s use in countries where abortion was illegal, claiming he had personally “bought misoprostol in pharmacies to experiment with the drug as an abortifacient.”

He wrote, “In the future, the availability and convenience of misoprostol may become crucial if RU-486 is offered under more private conditions than in abortion clinics."

According to the New York Times (NYT):

Dr. Baulieu said that when he got the idea of using Cytotec with RU486... from reading a newspaper article, he was unaware that it was marketed in France. Dr. Baulieu, who is an endocrinologist, said he immediately made plans to carry out the study with an obstetrician-gynecologist, Dr. Elisabeth Aubeny, at Broussais Hospital in Paris with approval from the hospital's ethics committee.

Prior to approval as an abortion drug, Dr. John C. Willke, former president of National Right to Life, testified at an FDA hearing that [misoprostol] Cytotec ''will be on the street literally days after it is made available on prescription,'' and that it will be used specifically to produce abortions, the NYT reported in 1988.

An old playbook

"In a study of 610 women at three New York clinics in largely Dominican neighborhoods conducted eight years ago, 5 percent said they had taken misoprostol themselves, and 37 percent said they knew it was an abortion-inducing drug," NYT reported in 2009.

"The side effects can be serious, and include rupture of the uterus, severe bleeding and shock," NYT wrote, adding:

In 2007 in Massachusetts, an 18-year-old Dominican immigrant named Amber Abreu took misoprostol in her 25th week of pregnancy and gave birth to a 1-pound baby girl who died four days later; a judge sentenced her in June to probation and ordered her into therapy.

In South Carolina in February, a Mexican migrant farm worker, Gabriela Flores, pleaded guilty to illegally performing an abortion and was sentenced to 90 days in jail for taking misoprostol while four months pregnant in 2004.

A Virginia man, Daniel Riase, is serving a five-year prison sentence after pleading guilty in 2007 to slipping the pills into his pregnant girlfriend’s glass of milk.

In 2021, Live Action News documented the reckless way abortion advocates promoted the unapproved method of abortion, going as far as advising women to deceptively obtain misoprostol. One tweet even claimed, “People have successfully acquired pills by telling the pharmacist their grandparent with rheumatoid arthritis is visiting and forgot their pills at home” and contacting your dog’s vet for the drug.

“Misoprostol is also used to treat stomach ulcers in dogs. If you have a relationship with a local, friendly vet, you might be able to work it to your advantage!” tweeted @bpdbasedgirl.

In 2023, Live Action News' Bad Actors series took a deeper dive, displaying examples of abortion facility websites advertising the less effective method of chemically ending the life of a baby in the womb.

Pro-life OBGYN Dr. Ingrid Skop wrote at the Charlotte Lozier Institute website:

The abortion industry has utilized this playbook before. In response to staffing shortages, when few ob/gyns were willing to perform surgical abortions and abortion clinics had trouble hiring and retaining surgeons, the industry began promoting medication abortions over surgical abortions, even though studies demonstrate that approximately four times as many complications occur following mifepristone and misoprostol abortion compared to surgical aspiration abortion.

Big Abortion collaboration

Misoprostol-only, self-managed abortions were “very widespread, well before Roe fell," wrote pro-abortion author Carrie Baker in her book, "Abortion Pills: US History and Politics."

1990s: "In November of 1990, women’s rights activists from across Latin America met in Argentina to share the knowledge about misoprostol for medical abortions. Delegates from the United States attended," Baker wrote.

Early 2000s: Susan Yanow at the Abortion Access Project (later named Provide) was instrumental in collaborating with Big Abortion to push the one drug regimen. Yanow was involved with Women on Waves, founded by Dutch physician Rebecca Gomperts who also founded Aid Access.

According to Baker:

The Abortion Access Project convened a Misoprostol Alone Working Group between 2004 and 2010, which included Ibis Reproductive Health, Gynuity Health Projects, National Latina Institute for Reproductive Health, and later, the Center for Reproductive Rights.

The Working Group sparked several research projects, developed talking points, and began to raise awareness about self- induced abortion in the United States. The Working Group also discussed whether it was ethical to recommend self- induced abortion with misoprostol given it was not considered the “gold standard”— that is, clinic- based medical care with mifepristone and misoprostol.

Ibis Reproductive Health and the Office of Population Health at Princeton University developed a website, www.medicationabortion.com, in the early 2000s, providing information on three early abortion regimens, including misoprostol alone, in multiple languages.

The website shows less than effective outcomes:

The best available evidence suggests that the optimal protocol has an overall completion rate of 75% to 85% when used in the first nine weeks of pregnancy.

Efficacy appears to be at the higher end of this range when the pregnancy is at an earlier gestational age.

In the roughly 15%-25% of cases where misoprostol administration does not lead to a complete abortion, additional intervention in required. Recent studies have shown that approximately 10% of women using misoprostol for early pregnancy termination will experience an ongoing pregnancy. 

If their website is to be believed, then out of the 732,000 estimated abortion pill abortions in 2025, at least 73.2K may face an incomplete abortion from misoprostol alone.

According to Baker, Beverly Winikoff, who founded Gynuity Health Projects, had hoped that the number of women using misoprostol alone for abortion would put pressure on Danco to reduce the price of mifepristone: “If people know there’s a competing thing, even if it’s not quite as good, at some price point, you begin to lose people."

2012: Abortionist Daniel Grossman, who has overseen clinical trials on the two-drug abortion pill regimen, warned of potential failures, telling NYT in 2012:

“The biggest risk for these women is that it’s not going to be effective” at ending their pregnancies, he said. A woman for whom the drug doesn’t work might well not know it, he added. “She could potentially have a continuing pregnancy and not get a follow-up.”

2013: Abortion advocates met in D.C. in 2013, where, according to Baker, "They brainstormed about advance prescriptions for misoprostol and adding the medication to collaborative practice agreements with pharmacies." Among them was Francine Coeytaux, co-founder of Plan C, who co-authored a paper calling for “bold action to meet women’s needs: putting abortion pills in U.S. women’s hands.”

Coeytaux and her co-authors made two proposals, wrote Baker: "First, eliminate the FDA’s... restrictions on access to mifepristone and, second, promote the off-label use of misoprostol alone."

Still, there was pushback from Big Abortion, which "resisted these proposals. Some argued misoprostol alone lowered the standard of care," Baker wrote, noting that despite the concerns, their ideas "became the blueprint for Plan C’s approach to mifepristone and misoprostol."

"Despite the misoprostol-alone contingency plan, reproductive rights advocates fought to keep mifepristone on the market," Baker pointed out.

2020: The Covid-19 pandemic ushered in multiple chemical abortion expansions, including misoprostol only. "Carafem, a reproductive healthcare company that prescribes abortion medication via telehealth in 19 states and D.C., providers have offered the option of misoprostol-only abortions since 2020," Slate.com reported.

2023: Within a few short years, the one drug misoprostol-only regimen was ingrained in the larger abortion landscape, with known abortion researchers publishing a misoprostol protocol warning:

Outcome assessment is important with use of a misoprostol-only regimen.

The risk of ongoing pregnancy and need for further treatment is higher with misoprostol-only than with regimens that include mifepristone.

That protocol was authored by:

• Elizabeth G. Raymond (Gynuity Health Projects)

• Alice Mark (National Abortion Federation)

• Daniel Grossman and Ushma D. Upadhyay (Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Oakland, CA)

• Mitchell D. Creinin (Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA)

• Melissa Grant (Carafem, Washington, DC)

• Jen Castle (Planned Parenthood Federation of America, New York, NY)

• Jamila Perritt (Physicians for Reproductive Health, New York, NY)

... and others.

The Bottom Line:

Big Abortion's determination to end the lives of as many preborn babies as possible by a variety of chemical abortion drugs may only end when the federal Comstock Act, which prohibits the mailing of abortion-inducing drugs, is finally enforced.