Vice President Kamala Harris is expected to speak about abortion Friday in Georgia, where two women’s deaths have been tied to a state law that mostly bans the procedure after roughly six weeks.
Amber Thurman died after waiting 20 hours for a hospital to treat complications that occurred after she took abortion pills. Reported by ProPublica earlier this week, the case is the first publicly reported instance of a woman dying from delayed care tied to a state abortion law.
The news organization also reported on the death of Candi Miller, a woman with lupus, diabetes and hypertension who took abortion pills she ordered online. An autopsy found fetal tissue that hadn’t been expelled and a lethal combination of painkillers, ProPublica reported. The state’s maternal mortality review committee did not believe abortion medication caused her death.
Still, the fact both women used the pills — mifepristone and misoprostol — may raise questions about whether they are safe. Here are some facts.
The U.S. Food and Drug Administration approved mifepristone in 2000 as a safe and effective way to end early pregnancies. The drug, which blocks the hormone progesterone, also primes the uterus to respond to the contraction-causing effect of another drug typically used along with it, misoprostol. The pills are used in more than six in 10 abortions nationally.
There are rare occasions when mifepristone can cause excessive bleeding that requires emergency care.
Because of that, the FDA initially imposed strict safety limits on who could prescribe and distribute it — only specially certified physicians and only as part of three mandatory in-person appointments with the patient getting the drug. The doctors also had to be capable of performing emergency surgery to stop excess bleeding and an abortion procedure if the drug didn’t end the pregnancy.
Over the years, the FDA reaffirmed mifepristone’s safety and repeatedly eased restrictions, culminating in a 2021 decision doing away with any in-person requirements and allowing the pill to be sent through the mail.
In 2022, a coalition of anti-abortion groups filed a federal lawsuit against the FDA challenging the agency’s long-standing approval of mifepristone. Justices ruled in June that the abortion opponents lacked the legal right to sue and preserved access to the medication.
Abortion opponents say the more lax restrictions resulted in many more “emergency complications.” But that argument lumps together women experiencing a range of issues with mifepristone — from the drug not working to people who may simply have questions or concerns but don’t require medical care.
OB-GYNs say a tiny fraction of patients suffer “major” or “serious” adverse events after taking mifepristone.
A legal brief by a group of medical organizations including the American College of Obstetricians and Gynecologists says: “When used in medication abortion, major adverse events — significant infection, excessive blood loss, or hospitalization — occur in less than 0.32% of patients, according to a highly regarded study with more than 50,000 patients.”
The definition that scientists generally use for serious adverse events includes blood transfusions, major surgery, hospital admissions and death, said Ushma Upadhyay, one of the authors of that 2015 study.
The prescribing information included in the packaging for mifepristone tablets lists slightly different statistics for what it calls “serious adverse reactions.” It cites ranges for how frequently various complications occur: 0.03% to 0.5% for transfusion; 0.2% for sepsis and 0.04% to 0.6% for hospitalization related to medication abortions. The ranges reflect findings across various relevant studies, experts said.
Mifepristone’s labeling also lists a complication that most medical groups don’t consider a serious or major adverse event: ER visits, which ranged from 2.9% to 4.6%. The current FDA label lists going to the ER as an option if patients experience prolonged heavy bleeding, severe abdominal pain or a sustained fever.
But ER visits don’t always reflect big problems, doctors told The Associated Press.
Some people may go there after a medication abortion because they want to be checked out or have questions but don’t have a doctor, said Upadhyay, a professor at the University of California, San Francisco. Others, she said, “don’t want to go to their primary care provider about their abortion” because of stigma.
A study she co-authored in 2018 found that slightly more than half of patients who visited the ER because of abortions received only observational care. Some, Upadhyay said, “don’t receive any treatment.”
Mifepristone results in a completed abortion 97.4% of the time, according to U.S. studies cited in the FDA label.
But in 2.6% of cases, a surgical intervention is needed. And 0.7% of the time, the pregnancy continues.
That’s compared to a procedural abortion in a clinic, where the chance of the procedure failing to end a pregnancy “is extremely, extremely low,” probably less than 0.1%, said Dr. Pratima Gupta, a board member for the college of OB-GYNs.
“Any time a procedural abortion is done, the clinicians ensure that it was a complete abortion” by examining the tissue that is removed or performing an ultrasound during or after the procedure, she said.
Gupta, who has done abortion procedures for more than 20 years, said there are “very few complications from abortion — any kind of abortion, medication or procedural abortion.” A recent study suggests that’s just as true for medication abortions that happen in a clinic, a doctor’s office or at home with the help of telehealth.
The FDA makes drug approval decisions on a case-by-case basis, weighing effectiveness, safety and other factors.
No drug is 100% effective, and many common medications don’t work for a significant portion of patients.
Antidepressants typically help between 40% and 60% of people with depression. New antibiotics approved by the FDA often resolve about 70% of infections.
Since 2000, roughly 6 million patients have taken mifepristone, according to the FDA. A 2021 review of agency records looking for deaths that were likely related to the drug identified 13, or .00027% of patients.
Medical organizations supporting mifepristone’s availability say the drug’s safety — given the rate of deaths — compares to “ibuprofen, which more than 30 million Americans take in any given day.”
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
FILE - A patient prepares to take the first of two combination pills, mifepristone, for a medication abortion during a visit to a clinic in Kansas City, Kan., on, Oct. 12, 2022. (AP Photo/Charlie Riedel, File)
BEIRUT (AP) — The leader of Hezbollah vowed to keep up daily strikes on Israel despite this week's mass bombing attack on its communication devices, and said Israelis displaced by the fighting from homes near the Lebanon border would not be able to return until the war in Gaza ends. Hezbollah and Israel launched fresh attacks across the border as Hassan Nasrallah spoke for the first time since the deadly device bombings he described as a “severe blow” — and for which he promised to retaliate.
The two-days of attacks targeting thousands of Hezbollah pagers and walkie-talkies have been widely blamed on Israel, heightening fears that 11 months of near-daily exchanges of fire between Hezbollah and Israel will escalate into all-out war.
During the speech, Hezbollah struck at least four times in northern Israel, and two Israeli soldiers were killed in a strike earlier on Thursday. Israeli warplanes flew low over Beirut while Nasrallah spoke and broke the sound barrier, scattering birds and prompting people in houses and offices to quickly open windows to prevent them from shattering.
Israel also launched attacks in southern Lebanon on Thursday, though it was not immediately clear if there were any casualties.
In recent weeks, Israeli leaders have stepped-up warnings of a potential larger military operation against Hezbollah, saying they are determined to stop the group’s fire to allow tens of thousands of Israelis to return to homes near the border.
The attack using electronic devices appeared to be the culmination of a monthslong operation by Israel to target as many Hezbollah members as possible all at once — but civilians were also hit. At least 37 people were killed, including two children, and some 3,000 wounded in the explosions Tuesday and Wednesday.
Nasrallah said the group is investigating how the bombings were carried out.
“Yes, we were subjected to a huge and severe blow,” he said. “The enemy crossed all boundaries and red lines,” he said. Pointing to the number of pagers and walkie-talkies, he accused Israel of intending to kill thousands of people at one time. "The enemy will face a severe and fair punishment from where they expect and don’t expect.”
He said Hezbollah will continue its barrages into northern Israel as long as the war in Gaza continues, vowing that Israel will not be able to bring its people back to the border region. “The only way is stop the aggression on the people of Gaza and the West Bank,” he said. "either strikes, nor assassinations nor an all-out war will achieve that.”
Earlier Thursday, Hezbollah said it had targeted three Israeli military positions near the border, two of them with drones. Israeli hospitals reported eight people lightly or moderately injured. Overnight, the miltiary said it struck several militant sites in southern Lebanon,
Hezbollah says its near daily fire is a show of support for Hamas. Israel’s 11-month-old war with Hamas in Gaza began after its militants led the Oct. 7 attack on Israel.
Israel has responded to Hezbollah’s fire with strikes in southern Lebanon, and has struck senior figures from the group in the capital Beirut. The exchanges have killed hundreds in Lebanon and dozens in Israel and forced the evacuation of tens of thousands of residents on each side of the border.
Israel and Hezbollah have repeatedly pulled back from an all-out war under heavy pressure from the United States, France and other countries.
But in their recent warnings, Israeli leaders have said they are determined to change the status quo dramatically.
Speaking to Israeli troops on Wednesday, Israeli Defense Minister Yoav Gallant said, “We are at the start of a new phase in the war — it requires courage, determination and perseverance.” He made no mention of the exploding devices but praised the work of Israel’s army and security agencies, saying “the results are very impressive.”
Gallant said that after months of fighting Hamas in Gaza, “the center of gravity is shifting to the north by diverting resources and forces.”
Israel began moving more troops to its border with Lebanon on Wednesday as a precautionary measure, Israeli officials said. Israel’s army chief, Lt. Gen. Herzi Halevi, said plans have been drawn up for additional action against Hezbollah, though media reported the government has not yet decided whether to launch a major offensive in Lebanon.
Lebanon is still reeling from the deadly device attacks of Tuesday and Wednesday.
The explosions have rattled anxious Lebanese fearing a full-scale war. The Lebanese Army said it has been locating and detonating suspicious pagers and communication devices, while the country’s civil aviation authorities banned pagers and walkie-talkies on all airplanes departing from Beirut’s international airport until further notice.
The attack was likely to severely disrupt Hezbollah’s internal communication as it scrambles to determine safe means to talk to each other. Hezbollah announced the death of five combatants Thursday, but didn’t specify if they were killed in the explosions or on the front lines.
The blasts went off wherever the holders of the pagers or walkie-talkies happened to be in multiple parts of Beirut and eastern and southern Lebanon — in homes and cars, grocery stores and cafes and on the street, even at a funeral for some killed in the bombings, often with family and other bystanders nearby.
Many suffered gaping wounds on their legs, abdomens and faces or were maimed in the hand. Tuesday’s pager blasts killed 12 people, including two children, and wounded some 2,300 others. The following day’s explosion killed 25 and wounded more than 600, Health Minister Firas Abiad said, giving updated figures.
Abiad told reporters that Wednesday’s injuries were more severe than the previous day as walkie-talkies that exploded were bigger than the pagers. He praised Lebanon’s hospitals, saying they had managed to deal with the flood of wounded within hours. “It was an indiscriminate attack. It was a war crime,” he said.
Israelis take cover next to a shelter as a siren sounds a warning of incoming rockets fired from Lebanon, in Nahariya, northern Israel, Thursday, Sept. 19, 2024. (AP Photo/Baz Ratner)
People watch the speech of Hezbollah leader Hassan Nasrallah on a tv screen as they sit in a cafe in the southern suburbs of Beirut, Thursday, Sept. 19, 2024. (AP Photo/Hassan Ammar)
Hezbollah members carry the coffin of their comrade who was killed on Wednesday when a handheld device exploded, during a funeral procession in the southern suburbs of Beirut, Thursday, Sept. 19, 2024. (AP Photo/Hussein Malla)
A man mourns during the funeral procession of two Hezbollah members, killed on Wednesday when a handheld device exploded, in the southern suburbs of Beirut, Thursday, Sept. 19, 2024. (AP Photo/Hussein Malla)
A girl cries during the funeral procession of two Hezbollah members, killed on Wednesday when a handheld device exploded, in the southern suburbs of Beirut, Thursday, Sept. 19, 2024. (AP Photo/Hussein Malla)
Hezbollah members attend the funeral of two of their comrades who were killed on Wednesday when a handheld device exploded, during a funeral procession in the southern suburbs of Beirut, Thursday, Sept. 19, 2024. (AP Photo/Hussein Malla)
Police tape cordons off the area as security members and an explosive specialist investigate a suspicious device in Beirut, Thursday, Sept. 19, 2024. (AP Photo/Hassan Ammar)
Hezbollah members carry the coffins of two of their comrades who were killed on Wednesday when a handheld device exploded, during a funeral procession in the southern suburbs of Beirut, Thursday, Sept. 19, 2024. (AP Photo/Hussein Malla)
A boy cries during the funeral procession of two Hezbollah members in the southern suburbs of Beirut, Thursday, Sept. 19, 2024. (AP Photo/Hussein Malla)
A woman holds a picture of a Hezbollah member who was killed on Wednesday when a handheld device exploded, during his funeral procession in the southern suburbs of Beirut, Thursday, Sept. 19, 2024. (AP Photo/Hussein Malla)
Lebanese soldiers stand guard as their comrades prepare to detonate a walkie-talkie that was found at the parking of the American University Hospital, in Beirut, Lebanon, Wednesday, Sept. 18, 2024. (AP Photo/Hassan Ammar)
This video grab shows a walkie-talkie that was exploded inside a house, in Baalbek, east Lebanon, Wednesday, Sept. 18, 2024. (AP Photo)
Hezbollah fighters salute as they stand next to the coffins of four victims who were killed Tuesday after their handheld pagers exploded, during their funeral procession in the southern suburb of Beirut, Lebanon, Wednesday, Sept. 18, 2024. (AP Photo/Bilal Hussein)
Mourners carry the coffins of victims who were killed Tuesday after their handheld pagers exploded, during their funeral procession in the southern suburb of Beirut, Lebanon, Wednesday, Sept. 18, 2024. (AP Photo/Bilal Hussein)
