The Hidden Dark Side Of Mail-Order Abortions

Picture a young woman living in a rural area. She’s just learned she’s pregnant. She’s scared. She has no support. In desperation, she turns to one of dozens of websites offering abortion pills by mail. No ultrasound, no physical exam, no confirmation of how far along she is.

She’s told the pills are “very safe,” and the process will feel like “a heavy period.” But instead of a discreet, manageable experience, she winds up in severe pain, bleeding heavily. Alone. Her bathtub fills with blood. She delivers the baby. She keeps bleeding. There’s no transportation, no nearby hospital, no follow-up. And the anonymous provider on the internet is nowhere to be found.

This isn’t a rare or hypothetical story. As an OBGYN hospitalist, I’ve encountered situations like this. Over and over.

The 4th Circuit court recently upheld a West Virginia law regulating abortion, including mifepristone. This comes on the heels of RFK Jr. ordering a review of the latest data surrounding the abortion pill.

The widespread distribution of abortion pills online has created a dangerous, unregulated marketplace. Women are ingesting drugs with known serious complications, without supervision, screening, or informed consent. The risks are not abstract. They’re medical, tangible, and too often, tragic.

Mifepristone, the first drug in the abortion pill regimen, has long been known to carry serious risks like hemorrhage, infection, sepsis, and even death. When it was first approved, its use was tightly regulated. In-person visits were required, strict gestational limits enforced, and all adverse events were tracked and reported to the FDA. Not anymore.

Over the last decade, the FDA has quietly rolled back nearly every one of those safeguards, even as mifepristone still carries a black box warning. These changes have been made not based on new safety data, but under mounting political pressure and in response to lobbying from pro-abortion medical groups that often downplay risks to women.

Now, a coalition of more than 30,000 physicians and healthcare professionals is calling on HHS Secretary Robert F. Kennedy Jr. and FDA Commissioner Dr. Martin Makary to reintroduce those basic safety measures. This is not a fringe plea, it’s a demand for the kind of regulatory oversight the FDA was created to provide.

Meanwhile, many women are being told mifepristone is “safer than Tylenol”—a phrase repeated so often it barely raises eyebrows. But our clinical experience, along with recent data, paints a very different picture.

In 2024, two separate insurance claims analyses examined data from more than 865,000 mifepristone abortions in the US. Their findings? Nearly 11% of women who took mifepristone experienced sepsis, hemorrhaging, surgical intervention, or other serious complications within just 45 days. That includes undiagnosed ectopic pregnancies, which can be fatal if missed. These aren’t outliers. These are outcomes I see regularly in practice. And they far exceed the FDA’s official complication rate of 0.5%.

Some of the worst cases end in death. Amber Thurman and Candi Miller were both young women when they took abortion pills without appropriate medical supervision. They’re no longer here. Their deaths were completely preventable. 

We don’t need politics here. We need policy grounded in data and ethics. First, the FDA and HHS must act immediately to reevaluate the current safety profile of mifepristone, using real-world data that reflects how the drug is actually being used today, not outdated clinical trial conditions. Second, it must immediately reinstate the original safeguards, including mandatory reporting of adverse events, that were in place when the drug was first approved in 2000.

Finally, an ultrasound scan should be required prior to dispensing mifepristone to determine gestational age and confirm the pregnancy is in the woman's uterus, thus ruling out risk factors for the drug's potentially life-threatening complications and offering patients proper informed consent. 

These are not radical demands. They are foundational steps toward informed consent and medical accountability, values that should unite us regardless of political affiliation or one's attitude toward abortion.

Women deserve to know the truth. They deserve transparency. And they deserve real care, not a faceless transaction over the internet that leaves them bleeding in a bathtub, wondering if they’ll survive the hour it takes to reach a hospital.