Poland: A hunt for traces of abortion pills in women's blood

A 22-year-old woman arrived at a hospital in Wroclaw, Poland, with a dead fetus. She said she'd had a miscarriage, but hadn't known she was pregnant.

Her apartment, which was subsequently raided by Polish authorities, told a different story. Officials found painkillers, antibiotics, a used pregnancy testing kit and tablets commonly dubbed "abortion pills" scattered around the home.

The woman's blood sample was sent to researchers at Wroclaw Medical University's Department of Forensic Medicine for analysis. Using a new testing method that can detect whether a woman has used these pills, they found traces of mifepristone, one of two drugs commonly used to induce medication abortions. They published the results in the journal Molecules.

In another study also published in Molecules, members from the same team used the technique to analyze two independent samples containing traces of misoprostol, the other drug commonly known to induce pregnancy. This time, they did not trace the drug in maternal blood, but in miscarried fetuses. 

The researchers were able to trace the two drugs using a method called "high-performance liquid chromatography," through which different elements of a liquid sample are separated under high pressure. The technique can be easily replicated and performed considerably quickly. 

The news of this testing method has put women on guard in Poland, where abortion is illegal in most circumstances. Some have expressed concern the techniques outlined in the research could push women's access to abortion care further underground.

Is abortion illegal in Poland?

It is worth noting that Polish law does not criminalize self-induced abortion, but anyone who supports it can be prosecuted. Medication abortions are only legally permitted if the mother's life is at risk or in cases of rape resulting in pregnancy.

Isolated media reports show that Polish officials have increasingly taken to raiding the homes of women under suspicion of facilitating illegal abortions. This has led to wide-spread protests across the country.

In interviews with Human Rights Watch, doctors, lawyers and a woman who had a legal medication abortion described "sweeping and speculative investigations, and overbroad searches."

Since 2020, at least six women have died in Poland after doctors performed a medically necessary abortion either too late or not at all, citing fear of consequences or reasons of conscience, according to research by the European Parliament.

"In Poland, misogyny reigns supreme. The de facto abortion ban pushed through by the Polish government interferes directly with women's autonomy and physical integrity. It is an attack on fundamental and human rights and should be unthinkable in a liberal democracy in 2021," said Evelyn Regner, a Member of the European Parliament from the Group of the Progressive Alliance of Socialists and Democrats.

During 2021-2022, Abortion Without Borders helped 34,000 women from Poland access an abortion — a small chunk of those in need of support.

What are abortion pills?

In simple words, they are orally or vaginally consumed chemicals that artificially terminate a pregnancy and lead to an ejection of the fetus.

For a medication abortion, an individual takes mifepristone, followed by misoprostol up to 48 hours later.

Mifepristone works by blocking the activity of progesterone, commonly known as the pregnancy hormone. Without progesterone, the body is incapable of building the environment needed during the early stages of pregnancy.

However, just stopping the pregnancy is insufficient. The pregnancy tissues have to be expelled from the body to prevent an infection.

Here's where the second drug, misoprostol, comes in. It causes contractions in the abdominal region, especially in the uterus, and helps flush out the tissues over the period of a day or two.

This combination of drugs can successfully terminate a pregnancy in over 90% of the cases — but only during early pregnancy (up to 10 weeks). The rate of failure increases in late pregnancy.

Are abortion pills safe?

Both mifepristone and misoprostol have been approved by the US Food and Drug Administration (FDA) and independently have an efficacy rate of 95-99% during early pregnancy. Even if the abortion fails, the actual risk of death associated with these drugs is very low.

Data from the that out of the 5.9 million women who used mifepristone for medical termination of pregnancy in the US until December 2022, a total of 32 died. That is roughly 0.0005%. 

Global data on unsafe abortions paints a very different picture. According to a 2017 study published in The Lancet, almost half of nearly 56 million abortions worldwide were unsafe. Some 97% occurred in developing countries.

"When grouped by the legal status of abortion, the proportion of unsafe abortions was significantly higher in countries with highly restrictive abortion laws than in those with less restrictive laws," the authors of the study note in their findings.

Access to safe abortion

Further commenting on the implications of testing for abortion pills, the authors say, "The findings call for the need to ensure access to safe abortion to the full extent of the law, particularly in low-income regions of the world. Efforts are also needed to replace the use of unsafe methods with safe methods."

The Wroclaw Medical University researchers have cited the above Lancet statement as the reasoning behind their search for traces of abortion pills in women's bodies. They say they are looking to determine whether illegally purchased drugs were responsible for the abortion. However, the study does not recommend lawful or safe access to abortion.

The testing technique used in the studies published in Molecules have been criticized as an infringement upon women's rights and privacy.

Molecules editorial staff say they have initiated an investigation into the papers in accordance with the journal's complaints policy. Paweł Szpot, the lead author of the study, has said in statements that the group's motivation is scientific and not political.

Szpot did not respond to requests for comment.

Edited by: Clare Roth