The recent study published by the EPPC has prompted backlash from pro-abortion advocates, with one of the most widely circulated criticisms appearing in an AFP Fact Check article, which claims that the study is misleading and methodologically unsound.[i]
Fact-checking bodies like AFP face growing scrutiny for ideological bias. Dr Joanna Howe, a legal academic and pro-life advocate who is doing invaluable work, has publicly challenged their neutrality, arguing that many of these organisations advance ideological narratives under the guise of objectivity.[ii] Nonetheless, setting aside questions of bias, the following addresses each of the AFP’s key criticisms on their merits.
Criticism 1: The study is methodologically flawed and misrepresents the data.
The study undertaken by the EPPC uses Medicaid insurance claims data, which is generally a widely accepted method of research in public health.[iii] It is common practice for administrative claims databases to be used in research to assess health outcomes across large populations. The authors’ use of this sort of data captures real-world outcomes which can provide a different type of information compared with a controlled trial, which fails to draw on real-world experience. Like any study, it has limitations. However, its methodology is consistent with standard practices in population health research.
Criticism 2: The data may conflate treatment for miscarriage with medical abortion.
One of the key points raised by the AFP Fact Check Article was that the data is unreliable as it includes cases of miscarriage treatment. The EPPC article highlighted the ways that they identified medical abortions in the data, it was done in the following ways:
- Procedure code S0199: medically induced abortion by oral ingestion of medication including all associated services and supplies;[iv]
- A prescription for mifepristone (with or without misoprostol within the next 3 days);[v] or
- A diagnosis code for elective termination or unwanted pregnancy, along with other billing coding consistent with manufacturer instructions for reimbursement for a mifepristone abortion for a given state or insurer combination.[vi]
The points raised in response to this by the AFP Fact Check Article specifically relates to point number 2 above – a prescription for mifepristone. This is because mifepristone can be used in the treatment of a miscarriage where the body needs assistance.[vii] However, it is important to recognise that standard practice for the medical management of miscarriage can include a prescription of misoprostol without mifepristone.
The author of the EPPC study was asked about this and his response was “we could not count that as an abortion, even if she was given mifepristone on that visit”.[viii] While administrative coding is not foolproof in any dataset, the authors of the EPPC study were aware of this coding and took reasonable steps to isolate the relevant cases.
Criticism 3: The study lacks peer review and was published by a conservative think tank.
While the EPPC is not a medical journal, the absence of formal peer review does not invalidate the study’s data or conclusions. It is common for research from policy institutes across the political spectrum to inform legislation, clinical policy, and academic debate. For example, the Grattan Institute’s 2019 report Saving Private Health 2, authored by former Health Secretary Stephen Duckett, has been cited in federal debates and health reform proposals despite not being published in a peer-reviewed journal.[ix] This underscores that methodological clarity and real-world relevance not academic publication status are what make research useful and credible in shaping public health outcomes.
What matters is not whether a study is peer-reviewed, but whether its data sources and methods are transparent, reproducible, and methodologically sound. Dismissing findings solely based on the publisher’s ideological position is unhelpful and not evidence-based. Nearly all research is conducted within philosophical, institutional, or political frameworks. Rather than disqualify findings due to suspected bias, we must assess studies on their merits, including their relevance, clarity of method, and potential implications for public health. Especially when dealing with health outcomes, scrutiny and further investigation not dismissal should be the appropriate response
Criticism 4: The study misclassifies normal or expected follow-up care as serious complications.
This criticism is an attempt to downplay the significance of the outcomes which have been reported. Emergency department visits, surgical follow-ups, and hospitalisations are not trivial, even if they are statistically expected. The fact that women are finding themselves in the emergency room for any reason should be at least a cause for investigation, given that medical abortion is marketed as “safe and effective”. The fact that complications can be ‘common’ does not make them medically insignificant. To say that, is to invalidate the experiences of women across the world who take these medications and end up with some sort of complication. These findings warrant serious governmental review to ensure women’s health is adequately protected.
Criticism 5: The study does not confirm whether mifepristone was actually ingested.
This is a known limitation of all research that uses pharmacy dispensation records, not a flaw unique to this study in particular. In real-world research, it has to be standard practice to treat prescription and dispensing data as a proxy for usage. If a woman is dispensed mifepristone and subsequently presents to emergency care, a reasonable causal inference can be drawn at the population level. To dismiss the findings on this basis would invalidate a wide range of established pharmaceutical safety research.
Conclusion
Whether one agrees with the policy implications of the EPPC study or not, as a piece of research, it offers critical insight into the risks women may face after taking the abortion pill. Rather than immediately discrediting the findings, the criticisms reveal an unwillingness to acknowledge data which points to real-world harms of chemical abortion. In the US, Senator Josh Hawley has advocated for a review of the abortion pill’s approval, leading Robert F. Kennedy Jr. to direct the FDA to reconsider its regulations. This high-level policy attention underscores how seriously the study’s findings are being treated internationally – and why Australian authorities must likewise investigate.[x]
If even a fraction of the study’s findings are accurate, the case for greater oversight, better informed consent and investigation into the potential dangers of medical abortion is vital. This research needs to serve as a catalyst for further independent, transparent study of the safety of medical abortion.
[i] FP Fact Check, 2024, May 14, U.S. study linking abortion pills to ER visits is misleading. AFP Fact Check. https://factcheck.afp.com/doc.afp.com.444Z863. Accessed 18 June 2025.
[ii] Dr Jo Show. (2024, April 26). The hidden agenda behind “fact‑checking” – Exposing media bias [Video]. YouTube. https://www.youtube.com/watch?v=a6oUWcmx9Oc. Accessed 18 June 2025.
[iii] Crystal, S., Akincigil, A., Bilder, S., & Walkup, J. T. (2007). Studying prescription drug use and outcomes with medicaid claims data: strengths, limitations, and strategies. Medical care, 45 (10 Supl 2), S58–S65. https://doi.org/10.1097/MLR.0b013e31805371bf
[iv] Anderson, Ryan T. & Jamie Hall. “‘The Abortion Pill Harms Women: Insurance Data Reveals One in Ten Patients Experiences a Serious Adverse Event.” Ethics & Public Policy Center. Accessed 11 June, 2025. https://eppc.org/publication/insurance-data-reveals-one-in-ten-patients-experiences-a-serious-adverse-event/
[v] Anderson, Ryan T. & Jamie Hall. “‘The Abortion Pill Harms Women: Insurance Data Reveals One in Ten Patients Experiences a Serious Adverse Event.” Ethics & Public Policy Center. Accessed 11 June, 2025. https://eppc.org/publication/insurance-data-reveals-one-in-ten-patients-experiences-a-serious-adverse-event/
[vi] Anderson, Ryan T. & Jamie Hall. “‘The Abortion Pill Harms Women: Insurance Data Reveals One in Ten Patients Experiences a Serious Adverse Event.” Ethics & Public Policy Center. Accessed 11 June, 2025. https://eppc.org/publication/insurance-data-reveals-one-in-ten-patients-experiences-a-serious-adverse-event/
[vii] Chu, J. J., Devall, A. J., Beeson, L. E., Hardy, P., Cheed, V., Sun, Y., Roberts, T. E., Ogwulu, C. O., Williams, E., Jones, L. L., La Fontaine Papadopoulos, J. H., Bender-Atik, R., Brewin, J., Hinshaw, K., Choudhary, M., Ahmed, A., Naftalin, J., Nunes, N., Oliver, A., Izzat, F., … Coomarasamy, A. (2020). Mifepristone and misoprostol versus misoprostol alone for the management of missed miscarriage (MifeMiso): a randomised, double-blind, placebo-controlled trial. Lancet (London, England), 396(10253), 770–778. https://doi.org/10.1016/S0140-6736(20)31788-8
[viii] AFP Fact Check, 2024, May 14, U.S. study linking abortion pills to ER visits is misleading. AFP Fact Check. https://factcheck.afp.com/doc.afp.com.444Z863. Accessed 18 June 2025.
[ix] Duckett, S., Cowgill, M., and Nemet, K. (2019). Saving private health 2: Making private health insurance viable. Grattan Institute. Accessed 18 June 2025.
[x] Susan Rinkunas, (2025, May 14). RFK Jr orders FDA review of abortion pill mifepristone. The Guardian. https://www.theguardian.com/us-news/2025/may/14/rfk-jr-fda-abortion-pill-mifepristone. Accessed 18 June 2025.