Unmasking the Silent Horror: Chemical Abortion

“In order to facilitate the spread of abortion, enormous sums of money have been invested and continue to be invested in the production of pharmaceutical products which make it possible to kill the fetus in the mother’s womb without recourse to medical assistance. On this point, scientific research itself seems to be almost exclusively preoccupied with developing products which are ever more simple and effective in suppressing life and which at the same time are capable of removing abortion from any kind of control or social responsibility.” ― Pope St. John Paul II, Evangelium vitae, no. 13

As I write this, the U.S. Supreme Court is weighing the single most consequential abortion case to reach its docket since the overturning of Roe v. Wade.

The case has to do with the question of how women access abortion-causing drugs – the very drugs that Pope St. John Paul II prophetically warned us about decades ago, in the words quoted above, that abortion activists were pouring everything into developing and distributing.

On Monday, May 4, just a few days ago, Justice Samuel Alito issued an administrative stay blocking the Fifth Circuit Court of Appeal’s ruling that would have required that women obtain the abortion drug mifepristone from a doctor in person, rather than by mail. That stay expires today, Monday 11, at 5 p.m. EST. The High Court could rule at any moment.

Whatever the justices decide, this case has already exposed an uncomfortable truth. Overturning Roe has not brought us the deep victory we need to ensure that every human life is protected from conception to natural death.

This is not because the legal victory of June 24, 2022, when Roe was overturned, was hollow. Rather, it’s because while we were celebrating the righting of a grave wrong and that gave states the freedom to protect preborn children, the abortion industry was quietly building a parallel system of drug distribution by mail that has rendered our state laws close to meaningless.

As of today, chemical abortion now accounts for roughly two-thirds of all abortions in the United States. According to Live Action’s tally, more than 732,000 pregnancies were ended by the abortion pill in 2025: one every 44 seconds. Of these, by Guttmacher Institute’s own data, some 91,000 were shipped via telehealth into states with total abortion bans, including more than 9,300 to women in Louisiana alone.

Re-read that sentence: Over 91,000 abortions committed, in states where abortion is illegal, thanks to mail-order abortion drugs. In other words, the abortion pill has done by mail what Roe once did by judicial fiat.

The Fifth Circuit’s Long-Overdue Ruling

The case before the U.S. Supreme Court is State of Louisiana v. Food and Drug Administration, brought by Louisiana Attorney General Liz Murrill with the support of Alliance Defending Freedom.

The lawsuit challenges the FDA’s 2023 decision, finalized under the Biden administration, to drop the long-standing requirement that mifepristone be dispensed in person. That regulatory change, building on a 2016 erosion of safety standards, allowed the abortion pill to be prescribed by telehealth and shipped through the U.S. mail.

On Friday, May 1, a three-judge panel of the U.S. Fifth Circuit Court of Appeals, in an opinion written by Judge Kyle Duncan, sided with Louisiana. The panel’s reasoning cut to the heart of the matter. Citing Louisiana’s law declaring that “every unborn child is [a] human being from the moment of conception and is, therefore, a legal person,” the court wrote that “every abortion facilitated by FDA’s action cancels Louisiana’s ban on medical abortions and undermines its policy.”

Within hours of the Fifth Circuit’s ruling, the abortion pill manufacturers Danco Laboratories and GenBioPro filed emergency applications with the U.S. Supreme Court demanding a reversal. By the following Monday, Justice Alito had issued his administrative stay, allowing the abortion pills to continue flowing while the High Court considers the case.

Reactions divided immediately along expected lines. The Guttmacher Institute (until 2007 a “special affiliate” of Planned Parenthood) called the ruling “the most sweeping threat to abortion since the overturning of Roe v. Wade,” and the American Civil Liberties Union (ACLU) sounded similar alarms.

By contrast, Susan B. Anthony (SBA) Pro-Life America president Marjorie Dannenfelser described the situation as a “five-alarm crisis,” and Students for Life Action’s Kristan Hawkins called it “moral insanity” that “preborn babies die while we argue about how the abortion lobby and Big Pharma might be hurt.”

Perhaps the most pointed observation came from the American Association of Pro-Life OB-GYNs, which named the lie at the heart of the entire “telehealth abortion” regime. There is “no exam, no ultrasound, no screening for coercion, and no doctor accountable when patients are harmed…. This is a transaction; it’s not a medical interaction.”

Indeed.

The Recklessness of the Abortion Industry

Mifepristone works by blocking progesterone, the hormone that sustains a pregnancy. The result is the death of the developing child in his or her mother’s womb. In a so-called “medical abortion,” a second drug, misoprostol, is then taken to induce contractions and expel the body of the deceased child. The two-drug regimen is marketed to women as private, simple, and safe.

It is none of these things.

The FDA’s own label warns that 2.9 to 4.6 percent of women who take mifepristone end up in the emergency room. An Ethics and Public Policy Center analysis of insurance claims data found that roughly one in ten women experienced a serious adverse event within 45 days of taking mifepristone, a rate the authors argue is significantly higher than the FDA’s label suggests. The FDA itself acknowledges at least 36 women died in connection with the drug since 2000, and these are only the deaths the agency has been told about.

Why doesn’t the FDA know more? Because in 2016, the agency quietly removed the requirement that drug manufacturers report adverse events other than deaths. By federal regulation, the very data that would tell us how dangerous the abortion pill actually is has been allowed to disappear.

To this is added a darker pattern. Live Action and other investigators have documented that abortion industry insiders have for years been coaching women with complications to present at the ER and report a “spontaneous miscarriage” rather than acknowledge the drug. Some have even urged ER staff to falsify records. The complications are real. The official numbers are fictions. And women, repeatedly told the abortion pill is safer than Tylenol, are being lied to.

This is not “reproductive health care.” It is, to borrow Pope St. Jon Paul II’s words, the “distortion and contradiction” of the medical profession itself (Evangelium vitae, no. 4).

How Telemedicine Erased Dobbs

The post-Dobbs legal landscape was meant to allow states to enact laws protecting preborn human life. Thirteen states now enforce total abortion bans, and many more have meaningful restrictions. This is phenomenal progress – progress we have waited decades for.

And yet, since Dobbs, abortion numbers have actually risen. Guttmacher Institute reports approximately 1,126,000 clinical abortions in 2025, an increase from the year before. Planned Parenthood committed a record 434,450 abortions in its 2024-25 fiscal year, eight percent higher than the year before.

How is this possible?

The answer is the abortion pill, distributed by telehealth and the U.S. Postal Service into the very states whose laws prohibit it. The pro-abortion data tracker WeCount reported that, by June 2025, nearly 15,000 abortions per month were occurring under so-called “shield laws,” statutes passed by pro-abortion states like New York, Massachusetts, and California that purport to protect abortionists who mail drugs into states where abortion is illegal. In states with total abortion bans, nearly all abortions now occur this way.

In other words, when a young woman in Louisiana, Texas, or Tennessee finds herself with an unwanted pregnancy, she is now one Google search and one telehealth appointment away from a package on her doorstep.

There is no ultrasound to confirm gestational age. No screening for an ectopic pregnancy, which mifepristone cannot treat and which can be life-threatening if missed. No screening for the abusive boyfriend or trafficker who is pressuring her into the abortion. Just pills in the mail.

As Iowa State Representative Devon Wood put it eloquently last week, defending her state’s new bill restricting mail-order abortion drugs: “By requiring in-person screenings we are giving these women a lifeline. We are providing a private, clinical sanctuary where an expert can look them in the eye and ask, ‘Are you safe?’ That opportunity for intervention is lost the moment that we remove this process to a computer screen, a phone or a mailbox.”

Pro-abortion Defiance

The most disturbing element of the past week has been watching the abortion industry openly telegraph its intent to break the law no matter how the High Court rules.

If the Fifth Circuit’s ruling stands, abortion providers have publicly announced that they will switch to a “misoprostol-only” regimen, dispensing the second drug alone, despite the fact that this protocol has never been FDA-approved for abortion and despite its higher rate of incomplete abortions, hemorrhaging, and ER visits.

Even the abortion activist Jessica Valenti has acknowledged that “advocates I spoke to worried that we’d see more ER visits because of miso-only abortions.” Her conclusion? It is “added cruelty from the anti-abortion movement.”

Note the moral inversion. Pro-abortion activists openly admit that their workaround drug regimen will hurt more women, then blame the pro-life movement for the harm they themselves are choosing to inflict. So much for caring about women’s health!

Trump Administration Failures

Tragically, the Trump administration, despite its rhetorical pro-life commitments and its promises of an FDA safety review of the abortion pill, has been conspicuously absent from this fight. Indeed, the administration declined to defend the previous restriction on mail-order pills in court, instead arguing that Louisiana’s lawsuit had procedural defects that warranted ruling against the state.

The promised FDA safety review of mifepristone, announced nearly a year ago, has produced no findings. Sen. Josh Hawley (R-MO) has openly questioned whether the review is even underway.

Last week, in a remarkable interview with the Wall Street Journal, SBA Pro-Life America president Marjorie Dannenfelser said simply: “Trump is the problem. The president is the problem.” Dannenfelser went on to call the administration’s inaction “shameful,” and she announced that her organization would only support candidates committed to “pro-life action at the national level,” explicitly repudiating the “states-only” strategy that has dominated the Republican Party since 2024.

Family Research Council president Tony Perkins added: “Pro-life voters are going to be wondering what’s going on when they head into the polls in November.”

I do not relish criticism of any administration that has done good things for the preborn. Trump’s Supreme Court nominees helped us repeal Roe – a major victory. But the data is the data. Abortions are up, not down, after Dobbs.

The federal government has both the authority and the moral duty to enforce the Comstock Act and to restore basic medical accountability to chemical abortion. It is doing neither. And every month, tens of thousands of preborn children die by means of a drug shipped into states whose laws say their lives must be protected.

The pro-life movement has been a loyal partner to the Republican Party when it has be resolute in defending preborn human life. But pro-life voters did not work for fifty years to overturn Roe only to be told the federal government has no role in stopping drug-by-mail abortion.

The Dignity of Every Life

The Catechism of the Catholic Church teaches that “the inalienable right to life of every innocent human individual is a constitutive element of a civil society and its legislation” (no. 2273). Note the word constitutive. This is not peripheral. A society that fails to protect innocent human life has unmade itself at its very foundations.

Every one of those 732,000 pregnancies ended by chemical abortion last year was the life of a unique, irreplaceable human being, bearing the image and likeness of God. The fact that this enormous loss now happens privately, in bathrooms, with no clinic and no protest line outside, does not diminish its moral weight. If anything, it deepens our obligation to bear witness to what is being lost.

In Evangelium vitae, Pope St. John Paul II taught that civil laws which authorize abortion “are completely lacking in authentic juridical validity;” further, “there is a grave and clear obligation to oppose them by conscientious objection” (nos. 72-73).

This is the principle by which we must judge the present situation. The shield laws of pro-abortion states, the FDA’s decision to permit the mailing of abortifacients, the abortion industry’s open defiance of federal courts and its coaching of women to lie to their doctors: all of this stands condemned in conscience.

The path forward must include action at every level. The U.S. Supreme Court should allow the Fifth Circuit’s decision to stand. The federal government should restore the in-person dispensing requirement (not that we ever condone abortion or the approval of said drugs), enforce the Comstock Act, and complete a serious FDA safety review of mifepristone.

And, as Iowa demonstrated last week with the passage of House File 2788 (now heading to Governor Kim Reynolds for signature), pro-life states must act with urgency to outlaw mail-order abortion within their borders, with strong enforcement teeth. Texas, Florida, and Arkansas have begun this work. Every state that values preborn life and women’s safety must follow.

We cannot win the legal battle of Dobbs and lose the practical war of mifepristone-by-mail.

Reading Pope St. John Paul II’s words quoted at the beginning of this column is sobering. He saw with extreme clarity exactly how abortion activists would ensure that abortion was available, at all costs. However, in the same encyclical the sainted pope also provided us with the tools we need to fight back – starting with prayer and fasting.

Let us use those tools and push back against the culture of death.