Comment from Karen Dalton

Colleagues have noted that: In states where it is now illegal for abortions after 6 weeks gestation we have seen that women are offered medical abortions by these clinics prior to 6 weeks, and then women return there 1 week after taking both mifepristone and misoprostol for followup sonograms. If sono still shows signs of IUP and patient is beyond 6 weeks, patients are being referred out of state, usually to New York for followup surgical abortion. The women go home to think about this and then start reaching out for help sometimes at local pregnancy centers to see if their baby is still alive, as they may be told that the medical abortion procedure failed but are not shown results of the sonogram and do not know what that really means. They may have had bleeding and thought that the procedure was successful. so they now have even less trust in the care at the abortion clinic and may not want to go back and don't want to travel out of state. One of many issues here is that when these women are in this place of uncertainty, they also need ongoing medical care and are risk of complications such as infection, bleeding and death. They may not have health insurance or money to pay for a sonogram at a radiology facility. They may be less than 21 years old with no support system. The answer is not loosened access and decreased active participation of providers, but better medical care with full transparency. More and more women are obtaining the pills online and have no resources other than a busy emergency room when things go wrong, which they do 10% of the time at least - worse the further along they are. THis is inadequate medical care.