A study conducted across 15 Planned Parenthood facilities in California is being used to promote advanced practice clinicians (APC), including nurse practitioners (NP), certified nurse midwives (CNM), and physician assistants/associates (PA), as dispensers of the abortion pill.

But the study results are flawed.

Key Takeaways:

• A study conducted at the site of a California Planned Parenthood affiliate is being used to promote the dispensing of the abortion pill by non-physicians.

• The authors of the study are pro-abortion, and concluded that the dispensing of the abortion pill by APCs, including NPs, CNMs, and PAs, is "noninferior" to dispensing by physicians.

• Certified OB/GYN Dr. Ingrid Skop explained that the study is flawed, in part, because over 1/3 of the women were lost to follow-up — and their outcomes, including safety, are unknown.

The Backstory:

Some physicians don't want to dispense abortion drugs, and as a result, about half of all states allow non-physicians to do so. Big Abortion has been working to get the abortion pill (mifepristone) dispensed by non-physicians as well as pharmacists, and is even pushing for the drug to be available over-the-counter.

According to the pro-abortion Guttmacher Institute, "26 states allow solely physicians to provide abortions..." In these states, only doctors can prescribe the abortion pill, mifepristone (200mg)/Mifeprex, and non-doctors are excluded from doing so. However, the remaining 24 states and Washington, D.C. allow practice clinicians — such as nurse practitioners, physician assistants, and nurse-midwives — to dispense the abortion pill.

Those wanting to become certified prescribers of mifepristone must complete the 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

These qualifications, however, do not specify that practitioners must actually perform such assessments or interventions for the safety of women.

Manufacturers are obligated to decertify those who are out of compliance, but that does not appear to be taking place.

The Details:

Study Claims

The study "Medication Abortion Provision by Advance Practice Clinicians and Abortion Completeness," published this month in JAMA Network Open, said that among the 15 Planned Parenthood locations, there were 59,091 chemical abortions committed between December 2021 and December 2025. It claims 58,473 (approximately 99%) of those were carried out by APCs. It stated:

In 2016, the US FDA Risk Evaluation and Mitigation Strategy for mifepristone changed, permitting advance practice clinicians (APCs; ie, nurse practitioners [NPs], certified nurse midwives [CNMs], and physician associates [PAs]) to prescribe mifepristone.

Most peer-reviewed data focus on the effectiveness and safety of APCs providing procedural abortion.

In the absence of sufficient data, 26 states have physician-only laws restricting APCs from providing medication abortion (MAB).

We assessed the estimated effectiveness and safety of MABs provided by APCs, hypothesizing that MABs provided by APCs are similarly effective and safe compared with MABs provided by physicians.

The study, which was authored by abortion advocates, concluded that "estimated MAB [abortion pill] effectiveness when provided by APCs was noninferior to [abortion drugs] provided by physicians."

But, given the no-test protocol and "Just in Case" (advance provision) abortion pill dispensing practices of Big Abortion, which seem to violate Food and Drug Administration (FDA) safety regulations known as the REMS, is this study an accurate portrayal of real-world results?

Verifying Gestational Age

The study authors claimed, "Ultrasonography was used to confirm pregnancy dating. Patients were dispensed mifepristone and misoprostol."

The no-test abortion pill protocol rolled out by Big Abortion during the COVID-19 pandemic is still ongoing. Today, many abortion providers work under a "trust the woman" mindset, failing to require ultrasounds prior to dispensing abortion pills. This allows potential disparities in gestational dating, which could far exceed the FDA's 70 day/10-week limits.

And while Planned Parenthood claims online to offer ultrasounds, some affiliates are selling the abortion pill "Just in Case" a woman becomes pregnant; in other words, there would be no ultrasounds conducted to confirm pregnancy with either this or the widespread no-test protocol of abortion pill dispensing.

Back to the study...

Planned Parenthood of the Pacific Southwest (PPPSW), the site where the study took place from December 2021 to December 2025, "has 15 MAB-only [abortion pill-only] clinics across Imperial, Riverside, and San Diego counties in California," the study's supplemental stated.

It added:

• Ultrasound was provided in person to confirm all pregnancy dating until 12/2024.

• In 2025, no-test medication abortion and telehealth medication abortion were expanded. Only 4% of MABs were no-test that year, and they were excluded from this analysis.

Again, since the pandemic, "no-test" has been the practice by many providers, especially online abortion pill dispensaries. Clinical trials like this one already have a more structured protocol than the way the abortion pill is dispensed in the real world. As the National Abortion Federation's 2026 Clinical Guideline states, "For most patients, testing before a medication abortion, including ultrasound, is not required."

In addition, the TEACH abortion training curriculum (2025) states, "When pregnancy duration cannot be reasonably determined by other means, ultrasound should be used (NAF 2024)... use is not a requirement for MAB provision" (emphasis added).

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

Adverse Events

The study noted 59,091 medication abortions conducted from December 2021 to December 2025 at Planned Parenthood centers. However, the study noted just "36,609 MABs included in follow-up (62.0%), which not differ between physicians and APCs."

That leaves nearly 40% of those who took the chemical abortion drug not "included in follow-up," opening the door to the possibility of unreported complications.

"Sensitivity analyses estimated complete abortion using multiple imputation of missing data with 10 imputations based on factors potentially associated with follow-up and/or abortion completeness," the authors wrote.

The study's supplemental stated:

The standard affiliate medication abortion protocol was used by physicians and APCs... Post-abortion evaluations were done using transvaginal ultrasound 1-2 weeks later... We included any visit to the affiliate or captured by medical record review in follow-up within 30 days of the abortion visit...

Effectiveness: was defined as the proportion of participants who experienced a complete abortion (without the need for unplanned repeat doses of misoprostol or a follow-up procedure) according to the MARE guidelines.

... Adverse event (AEs): were defined as the proportion of participants who visited an emergency department for an abortion-related complaint or complication within 30 days of the MAB. Minor AEs adverse events included excessive bleeding or infection treated. Severe AEs, including death, hospitalization, blood transfusion and surgery other than uterine aspiration.

... We assumed a baseline equivalent effectiveness of 93.3% (2) based on a control group where all patients had in-person visits for medication abortion.

These definitions are important, suggesting that if the drug was not "effective," i.e. the abortion was incomplete and thus would have been followed by additional drugs or a surgical procedure, it was not considered an "adverse event (AE)."

Should a "clinician" in the real world fail to properly date a pregnancy, it is plausible that a failed abortion could occur, especially given that failures increase with gestational age.

The study then claimed that 130 MABs (0.2%) had an emergency room visit, with 45 having additional adverse events, some classified as serious.

An abortion pill failure can result in an emergency department visit, as the study's authors seemed to acknowledge:

There were 53 ED visits for bleeding, 25 for pain, 39 for incomplete abortion or ongoing pregnancy, 4 for fainting or dizziness, 4 for allergic reaction, 2 for infection, 1 for hematometra, and 2 were unspecified.

Of the 41 minor AEs (0.1%), 26 were hemorrhages and 15 were infections; the 4 severe AEs (<0.1%) were all blood transfusions. Rates were less than 0.1% and equivalent across clinician types.

... Limitations include unbalanced group sizes and loss to follow-up, which we attempted to overcome through imputation. Loss to follow-up is a known challenge in MAB studies and may be explained by the ubiquity of pregnancy tests, allowing for self-assessment of complete abortion...

Imputation methodology was unclear.

Ironically, abortion pill prescribers are required under REMS to have the "[a]bility to provide surgical intervention in cases of incomplete abortion or severe bleeding, or to have made plans to provide such care through others..."

Yet, as Live Action News previously documented, they often advise abortion pill clients to bypass prescribers and present to emergency rooms and lie, claiming to be experiencing a natural miscarriage.

Authors and Funding

Authors of the study came from overtly pro-abortion institutions, some of which train abortionists, namely the University of California San Diego (UCD) and Planned Parenthood.

• Department of Obstetrics and Gynecology, Division of Complex Family Planning, UCD: trains and commits abortions into the second trimester at Planned Parenthood. Author Sheila K. Mody, MD, founded the Fellowship and Division of Complex Family Planning at UCD.

• Center for Gender Equity and Health, Department of Medicine, UCD.

• Planned Parenthood of the Pacific Southwest: Author Antoinette M. Marengo, MD acknowledged she was "Chief Medical and Transformation Officer at Planned Parenthood of the Pacific Southwest, where the data for this study was collected." Author Michelle Luneau is an adult NP in clinical practice at Planned Parenthood.

PPPSW is an abortion factory, committing over 108,000 total abortions, according to 2021 and 2025 fiscal year reports, which may not reflect the study period.

• 2021: 17,688 total abortions (10,879 chemical).

• 2022: 20,575 total abortions (13,239 chemical).

• 2023: 24,227 total abortions (15,506 chemical).

• 2024: 21,996 total abortions (14,779 chemical).

• 2025: 23,638 total abortions (15,936 chemical).

The study was "supported by the Society for Family Planning Research Fund."

The Society of Family Planning (SFP) oversees Complex in Family Planning programs which train in universities across the country.

SFP was founded in 2005 with a “generous contribution” from the David & Lucile Packard Foundation. In recent years, abortion philanthropist Warren Buffett (the Susan Thompson Buffett Foundation) poured nearly $32M into SFP, and millions even further back.

Both Foundations were investors in the abortion pill.

Flaws Ignored

“This study demonstrates the commitment of formerly reputable journals like JAMA Network Open to abortion promotion. Many flaws were ignored," OBGYN Ingrid Skop, MD, Vice President and Director of Medical Affairs for Charlotte Lozier Institute, told Live Action News.

Dr. Skop noted (emphases added):

"Over 1/3 of the women were lost to follow-up with unknown outcomes, although the authors utilized a statistical technique to imply this did not matter. 7-9% experienced failed abortions requiring further treatment, but the authors did not discuss who performed the surgical aspirations these APCs would be unable to perform.

All women received pre-abortion ultrasounds and post-abortion ultrasounds (if they followed up), even though the FDA has allowed distribution of these drugs without pre-abortion testing or mandated follow-up, so the study results are not demonstrative of real-world use."

Dr. Skop added that in addition to these problems, "Planned Parenthood demonstrated their willingness to ignore the minimal guidelines the FDA has retained by providing the drugs one week past the FDA’s gestational age cut-off."