An unorthodox argument from anti-abortion advocates that abortion pills and the at-home abortion process pose a substantial environmental risk is gaining traction in state legislatures across the country.

Through numerous citizen petitions, court filings, and campaigns, anti-abortion groups Students for Life and Liberty Counsel have claimed that the abortion pill mifepristone and fetal remains from at-home abortions are poisoning public drinking water and other water systems, threatening ecosystems as well as humans.

Recommended Stories

• Anti-abortion group credits Trump with recent success of movement
• NIH to phase out dog and cat testing days after Republican complaints
• Trump DOJ files to lift judge's pause on Planned Parenthood defunding measure

While the claims have caught the ears of some GOP lawmakers, they lack strong evidence, outside environmental and toxicology experts say.

Claims about the abortion pill have added urgency given the recent rise in medication abortions, thanks in part to recent changes from the Food and Drug Administration to the drug’s approval protocols.

While environmental experts favor further investigation into the presence of pharmaceuticals in the water supply, they say there is no evidence to worry specifically about mifepristone.

What anti-abortion groups claim

Both Students for Life and Liberty Counsel have claimed that mifepristone is contaminating public water systems, as well as rivers and streams, after remnants of the medication and pregnancy tissue from at-home abortions are flushed down a toilet.

The activists claim that wastewater treatment plans cannot purify the water entirely of traces of the pills’ active molecules, known as metabolites. They say that the residual effects of exposure to mifepristone can harm wild animals and affect human fertility.

Mifepristone has become the flashpoint for abortion policy debates since the overturning of Roe v. Wade in June 2022, and the FDA’s decision to allow patients to obtain the pills online without seeing a healthcare provider in person.

Since 2022, Students for Life has filed five citizens’ petitions to the FDA, asking the agency to restrict access to the drug as well as require physicians to prescribe medical waste bags and catch-kits to patients along with their mifepristone prescriptions so they can properly dispose of the remains, placental tissue, and other waste expelled during the abortion process.

The petitions claim the existing approvals violate the Clean Water Act, Endangered Species Act, and individual states’ Water Quality Standards, pointing to research that pharmaceuticals can adversely affect animal and aquatic life.

Meanwhile, Republican lawmakers in several states, including Texas, Arizona, Idaho, Maine, West Virginia, and Wyoming, have introduced legislation to implement the requirements suggested by the activists.

Mifepristone’s initial Environmental Impact Statement

Mifepristone became a politicized issue for the FDA in the mid-1990s when then-President Bill Clinton directed the Department of Health and Human Services to begin investigating the drug for approval for early pregnancy terminations.

In 1996, abortion-rights advocate Population Council submitted an Environmental Assessment, a standard part of the FDA drug approval process, as part of the protocol to bring the brand-name drug Mifeprex to market. 

A spokesperson for Danco Laboratories, makers of Mifeprex, told the Washington Examiner that the company has not engaged in any post-market Environmental Impact Studies, particularly for water supply issues, since the 1996 EA. 

Mifepristone is a synthetic hormone that blocks the reception of progesterone, the hormone necessary to sustain pregnancy. Ingesting mifepristone during pregnancy essentially prevents the developing fetus from receiving nutrients, resulting in death. 

In the medication abortion procedure, the medication misoprostol is administered 24 to 48 hours after mifepristone to induce contractions to expel the pregnancy tissue. 

The Population Council’s initial assessment did not identify any substantive environmental effects from the drug itself, which the FDA agreed with. Mifeprex was approved in 2000.

Changing conditions and the call for more studies

Students for Life and other anti-abortion advocates argue that much has changed in the administration of mifepristone since its initial approval, which warrants further environmental investigation. 

In 2016, the FDA changed the gestational age at which mifepristone can be used to terminate a pregnancy, up to 10 weeks, from the original eight. The agency also no longer requires the prescriber to report adverse consequences other than death. 

During the COVID-19 pandemic, the FDA further loosened requirements on mifepristone by eliminating in-person dispensing requirements. This opened the door for pills to be prescribed to patients online, without a physical examination to determine the gestational age and proper location of the pregnancy in the uterus, as opposed to an ectopic pregnancy. 

A recent post-market study on mifepristone use conducted by a conservative think tank found that complications from the at-home abortion protocol are roughly 22 times higher than initially estimated by the FDA, with as many as 11% of women experiencing a potentially life-threatening complication within 45 days of taking mifepristone.

FDA Commissioner Dr. Marty Makary publicly committed to conducting a comprehensive safety review of mifepristone following mounting pressure from anti-abortion advocates after the complications study was released.

The FDA did not respond to a request for comment on whether wastewater effects would be considered, but Students for Life President Kristan Hawkins told the Washington Examiner she has met with Trump administration officials to make her organization’s case.

Before Makary took office, the FDA responded to Students for Life’s 2022 petition this January, rejecting its claims due to a lack of supporting evidence. 

“The Petition offers only conjecture that remnants of Mifepristone in the nation’s water system are ‘causing unknown harm to citizens and animals alike,’” reads the FDA response. “Specifically the Petition provides no evidence showing that the bodily fluid from patients who have used mifepristone (a one-time, single-dose drug product) is causing harm to the nation’s aquatic environment.”

Environmental concerns lack evidence

Out of the roughly 17 studies referenced by Students for Life in their citizens’ petitions, only two mentioned or directly examined the effect of mifepristone. 

One, conducted in China in 2019, found that exposure to mifepristone can substantially affect fish, resulting in a sex reversal of female tilapia. But, rather than measuring natural exposure, the researchers directly added the drug to the fish’s diet. It did not replicate exposure found in an active water system.

The second notable study cited by Students for Life, conducted in 2018 in the Czech Republic, examined the presence of mifepristone and several other drugs, primarily progestins, in wastewater before and after treatment. 

While researchers found small traces of mifepristone in untreated wastewater, it was not found after the water was processed by the treatment facility. The study did not analyze the effect of the occurrence of this drug and others on aquatic life, and its authors have since suggested that the findings cannot be used to draw conclusions about the environmental risks of mifepristone. 

Kristi Hamrick, chief of policy for Students for Life, addressed the lack of data regarding mifepristone runoff by faulting the scientific community and regulatory agencies for failing to research metabolites from medical waste.

The “abortion industry,” she said, “has achieved some kind of special pollution dumping status.” Other medical facilities, she argued, are limited in their ability to dump medical waste.

Still, environmental toxicologists and researchers said that if mifepristone posed a substantial risk to water systems or surrounding environments, the risks would have surfaced by now. 

Vasilis Vasiliou, a professor and department chairman of Environmental Health Sciences at the Yale School of Public Health, told the Washington Examiner that any drug in high concentrations could theoretically cause environmental harm. However, there is no evidence to suggest that regarding mifepristone. 

“There is nothing in the literature, nothing,” he said, adding that he would need to see evidence of a problem to conduct a study on the environmental risks.

“But there is no evidence so far that something is happening,” he said.

Existing research supports arguments that various pharmaceuticals can be found in drinking water, including common medications such as Tylenol and Ibuprofen. 

Tracey Woodruff, who has studied the level of hormonal birth control medications in water systems, told the Washington Examiner that this is common due to the sheer number of individuals consuming these drugs. 

Woodruff, head of the University of California, San Francisco’s Reproductive Health and the Environment program, said that while she believes it would be worth investigating to what extent certain pharmaceuticals are entering the drinking water supply, she would expect to see a higher trace level for common over-the-counter medications than prescribed abortion pills. 

Fetal remains in the water also lack substance

The anti-abortion activists’ claims that fetal remains from at-home abortions also contaminate the water supply are difficult to judge because of a dearth of evidence. A range of experts and medical groups contacted by the Washington Examiner declined to comment, citing a lack of evidence and data.

Natural miscarriage happens in somewhere between 10% and 30% of pregnancies, amounting to about 800,000 each year, many of which are managed at home. 

The vast majority of miscarriages occur so early in pregnancy that the woman does not even know she is pregnant, mistaking miscarriage symptoms for a heavy, painful period. 

By way of comparison, roughly two-thirds of the 1 million annual abortions in the United States use mifepristone.

Neither Students for Life nor the Liberty Counsel was able to provide data to suggest that fetal remains from a mifepristone abortion would be more dangerous in wastewater than those from a natural miscarriage.

A broader pharmaceutical problem 

Still, researchers say they are interested in investigating the level of mifepristone in drinking water. They say that, if there are high levels of mifepristone, it would likely be evidence of a greater problem regarding pharmaceutical contamination and the efficiency of wastewater treatment plants. 

“If you’re going to think about this in, like, addressing what’s the most important items that are impacting drinking water and pharmaceuticals, it wouldn’t be mifepristone. It would be looking across all the different pharmaceuticals that go into drinking water,” Woodruff said. 

“I think it’s worth investing in understanding the extent to which pharmaceuticals are entering the drinking water supply,” she said, adding that contaminants related to pesticides and agricultural sources should also be researched. 

The Environmental Protection Agency has said that pharmaceuticals can be found in water systems, although it has downplayed the risk to the general public.

An agency spokesperson told the Washington Examiner that the EPA takes the issue seriously and employs a “rigorous, science-based approach” to protecting the environment. The agency did not say if it is currently conducting or planning to investigate traces of mifepristone in drinking water. 

“Pharmaceuticals, like Mifepristone, encompass a diverse group of chemicals, including prescription and over-the-counter drugs,” the spokesperson continued. “Generally, pharmaceuticals may be present in surface water, groundwater, drinking water, and sewage — typically at low concentrations.”

TRUMP DOJ FILES TO LIFT JUDGE’S PAUSE ON PLANNED PARENTHOOD DEFUNDING MEASURE

Students for Life says it is moving to help close the gap in research.

Hamrick said that her organization is working on a peer-reviewed study regarding mifepristone metabolites in the U.S. water supply. She declined to provide a timeline on when to expect publication or any details about the findings.