Is there forensic evidence of abortion after someone has taken abortion pills?
Testing women and/or fetuses for evidence of abortion after use of abortion pills is very complicated. In fact, it is not likely to be feasible except in highly sophisticated facilities – if at all – and it is not even clear that anyone who has the technical capacity to do so is even interested in doing it.
Here is an attempt to summarise the issues and the “evidence” to date and then share a response from the Abortion Dream Team, Poland
Background: On 14 September 2023, the New York Times published an opinion piece entitled: “In Poland, testing women for abortion drugs is a reality, it could happen here” (‘here’ meaning the USA). This was a highly unfortunate article, for several reasons. The most important reason is that it is probably not true as understood by the NY Times journalist. The second reason is that false news travels as fast as bad news, and this false news was shared with hundreds of us within hours by at least one listserv and probably other places too, such as on social media.
What happens when you take pills?
When we swallow or otherwise put medications into our bodies, e.g. pills, they are absorbed by and act on specific parts of us, and the body then metabolises the substance. Some of these metabolic transformations may (or may not) be detectable, whether briefly or for a longer period of time, or not at all.
Why study whether a medication is detectable in the body after it is taken? This could be to find out whether it is working well enough or whether it is causing unwanted adverse effects. Or, if it is an illegal substance, it could be for purposes of arresting the person who used it and prosecuting them. With medical abortion pills, the prosecution reason has been put forward in Poland – even though a woman who takes abortion pills herself up to 22 weeks of pregnancy has not broken the law there. But if it can be shown she used the pills, then she could be pressured to say who supplied her with the pills, and that person or persons could potentially be prosecuted.
This would be quite threatening for anyone who seeks to use abortion pills to end an unwanted pregnancy on their own. But the first question is: Is it possible to test for the presence of any such residue from the pills in a woman’s body or in the aborted fetus?
The main information comes from the following two papers, published in a journal called Molecules, in late 2022. The one article ̶ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9572746/ – starts by making a case that medical abortion pills bought on the internet are dangerous and cause a lot of complications and deaths. The references intended to support this claim are about unsafe abortions in general, however, mostly going back some years. It’s a very strange and not very useful introduction to a paper about the process of identifying mifepristone metabolites in a woman and a fetus, because there is no connection between them.
The authors do find mife metabolites in testing one woman’s blood 24 hours after she used the pills and also in the fetus, which was dead. They found more metabolites in the woman because she was still alive, presumably, than in the dead fetus.
The other article – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9657224/ – is about finding mifepristone metabolites in whole blood from another woman, the placenta and the fetal liver. Toxicological analysis of the woman’s blood two days after the abortion found no evidence of abortifacients in her blood, it had dissipated, but misoprostol acid was found in the placenta and the fetal liver. In another case, in a dead fetus found near a garbage container, misoprostol acid was also found.
This article also opens with general information and concern about unsafe abortions. It then moves on to show that “after administration, misoprostol is rapidly absorbed and converted into its pharmacologically active metabolite, misoprostol acid. After oral ingestion, plasma concentrations of misoprostol acid peak in approximately 30 minutes and decline rapidly thereafter. If the misoprostol is administered vaginally, the peak plasma concentration of misoprostol acid is reached in 1–2 hours and then declines slowly. The therapeutic dose of misoprostol is very small, usually 400–800 µg daily, meaning that the highest concentration of the active metabolite is very low (below 1 ng/mL), and therefore, a sensitive method for the quantification of misoprostol acid is necessary.”
The article then sidelines into the risk of overdosing on misoprostol and the risks thereof, but provides no evidence that this is happening.
To sum up the main points of both these articles: –
There are many unsafe abortions globally (no new or useful information provided).
Women are increasingly buying abortion pills on the internet and using them without a local clinician overseeing them – the authors disapprove of this because they believe it leads to many unsafe abortions (although they provide no such evidence).
The authors believe no one has managed or even perhaps attempted to isolate mifepristone or misoprostol from the blood of a woman who has had an abortion using pills, nor from the placenta, nor from the liver of the dead fetus. Seeking to achieve these aims emerges as their main purpose, and they succeed in isolating metabolites of mifepristone and misoprostol acid in various ways. The methods they use to do this are complex, with lengthy steps, using sophisticated equipment and a great deal of complicated verbiage to describe them. All of these would prevent normal clinics or hospitals that provide abortions and abortion pills to find out if someone had had an abortion.
The authors find that the half-life of the mifepristone metabolites/misoprostol acid is short and their value for prosecution reasons seems to be exceedingly limited – since women self-managing abortions at home are not waiting in line to be examined within the short time parameters involved.
Moreover, apart from being pleased at being the first to have achieved these ends as scientific ends in themselves, these scientists did not give any other reason why they had wanted to do this research nor whether or how they intended to use or share what they have learned, apart from these two papers.
They do not say anything about handing information over to the Polish police or the government as a means of trapping or criminalising women who have abortions, nor to anyone else, though the Polish police and anti-abortion government members might wish they would do so.
Overall, it seems that the Abortion Dream Team’s analysis – see below – and their response to the apparently false claim in the New York Times article – that this is already happening in Poland – is correct. That is to say: it does not appear to be happening in Poland.
On the other hand, the fearmongering it has created is certainly very bad news.
Many thanks to Beverly Winikoff, President of Gynuity Health Projects, for helpful explanations and pointing me to valuable information. See this information sheet – Misoprostol Detection in Blood by Gynuity Health Projects – which they published in 2014.PHOTO
by Natalia Broniarczyk, Kinga Jelinska, Justyna Wydrzynska
>>“We think the wise thing is to de-escalate. Unfortunately, we did several interviews in Poland in the aftermath of this New York Times publication. Here is the Google translation from Polish of what we wrote on the Abortion Dream Team Facebook page:
>> Is it true that Polish scientists* developed a method for the detection of mife and miso in the blood of the fetus and pregnant person? YES
>> Is there anything to be afraid of at this moment? In our opinion, NO
>> Do we have the right to be pissed off? YES
>> This piece of bad science was funded by public money under the rule of idiots who hate women.
>> The New York Times journalist, Patrick Addams, described this as the “achievement” of scientists from the University of Wrocław in Poland. As forensic medicine researchers, they boasted that they have developed a test for detecting abortion pills in the blood of a fetus and a pregnant person. The motivation was supposed to be concern for pregnant people…. and the desire to “protect women from being forced to have an abortion by their partner…”
>> These scientists may have developed a method for detecting mife and miso in blood, but they have absolutely no knowledge of the reality of abortion or the method of taking pills.
>> In fact, many women are forced by their partners to continue their pregnancies. Every day we accompany people undergoing abortions who take pills secretly, without their partners knowing. This is the reality. We do not need false concern that serves as packaging for further persecution.
>> MOST IMPORTANT ‼️: To cause your own abortion up to week 22 is not a crime in Poland! Even if there are tons of abortifacient agents in the blood in a hypothetical future.
>> Scientists from the University of Wrocław examined a fetus from an abortion in the second trimester – the “sample” is therefore very small.
>> The so-called “scientific article” shows that the authors absolutely do not understand the difference between “unsafe abortion” and pill abortion.
>> Abortion pills are a method recommended by WHO, and mifepristone and misoprostol are on the WHO list of essential medicines that can be used to cause an abortion. Developing research to detect these substances is just another attempt to control pregnant people with the threat of criminalisation.
>> WHAT COULD BE THE EFFECT OF THIS?
>> Even more fear of medical staff, which is already huge.
>> Fears of stigmatisation, judgment or punishment can only be increased by such unethical and unjustified research.
>> It is not known whether these tests are being carried out at all, or just for research purposes, to create a brilliant scientific article, or to get fame, champagne or prizes.
>> OR: Someone wants to win the title of the biggest villain.
>> Remember also that medical personnel cannot distinguish a spontaneous miscarriage from an abortion with pills — and a wise doctor has no reason to think about it.
>> Possible medical assistance during pill abortion is necessary in less than 2% of cases.
>> SO — YOU TOOK ABORTION PILLS AND YOU ARE AFRAID THAT A TEST WILL BE PERFORMED TO DETECT THEM?
>> In our opinion, based on supporting you every day, such tests are not currently performed after abortions.
>> Are you afraid of going to the doctor during/after abortion with pills? CONTACT US!
>> We will help you assess whether it is necessary and advise you on what to say and how to behave. You’re not alone!