A growing number of states are considering laws that would require abortion providers to tell women seeking a medical abortion that it's possible to reverse the procedure — a scientifically unsubstantiated claim that has been roundly rejected by the mainstream medical community.
Since 2012, a small group of doctors has promoted a method that they say can reverse a medical (non-surgical) abortion by flooding the body with the hormone progesterone. Two states — Arkansas and South Dakota — currently require abortion providers to tell women before they get a medical abortion that information is available about a way to reverse or stop the procedure.
Laws mandating that abortion providers tell women their abortion can be reversed have also been introduced this year in Georgia (the bill states, "It may be possible to reverse the effects of a chemical abortion if the woman changes her mind, but that time is of the essence"), North Carolina, Utah, and Idaho. In Arizona, lawmakers passed an abortion-reversal law in 2015, but the bill was quickly challenged in a lawsuit by Planned Parenthood and blocked.
On Feb. 27, Indiana lawmakers passed a bill in the House requiring that pregnant woman "be informed orally and in writing" before obtaining a medical abortion that "the abortion may be possibly reversed." The patient must also be told that additional information about reversing medical abortions exists and "should be sought as soon as possible."
At the same time, the Indiana measure seems to acknowledging the dubious science behind this information; it also requires women to be told that "no scientifically validated medical study confirms that an abortion may be reversed after taking abortion-inducing drugs."
North Carolina HB 62
Utah HB 141
Nearly 3 million women have terminated pregnancies via medical abortion since the method was approved for use in the first 10 weeks of pregnancy in 2000. Patients take the drug mifepristone followed by a second drug, misoprostol, 24 to 72 hours later. Medical abortions, which now make up about a third of all abortions performed in the U.S., are safe and highly effective — about 99 percent effective with almost zero complications, according to a 2012 study in the medical journal Obstetrics and Gynecology.
The mainstream medical community rejects claims that a medical abortion can be undone. The American Congress of Obstetricians and Gynecologists says that abortion-pill reversal is "not supported by the body of scientific evidence" and recommends against trying it. In up to 50 percent of cases where women don't follow up with the second pill (i.e., they take only mifepristone without taking the second dose of misoprostol), they still carry their pregnancies term, with or without taking progesterone, the group points out.
Taking a dose of progesterone in the hopes of reversing a medical abortion "means that even if these doctors were to offer a large dose of purple Skittles, they'd appear to have 'worked' to 'save' the pregnancy about half the time," Cheryl Chastine, an abortion provider at South Wind Women's Center in Wichita, Kansas, told Talking Points Memo. "Those numbers are consistent with what these people are reporting."
Most reproductive health experts point to the lack of scientific evidence on abortion reversal to criticize laws requiring doctors to tell women there is a way to stop the abortion pill. "This is unethical and immoral legislation that makes women guinea pigs in an unmonitored, inappropriate experiment," said Vicki Saporta, the president of the National Abortion Federation.
The most visible proponent of abortion-pill reversal is George Delgado, a practicing family physician with the Culture of Life Family Services clinic in San Diego. He outlined the method in a 2012 paper, which remains the first and only study describing it. Delgado's method consists of giving a woman a heavy dose of the hormone progesterone as soon as possible after taking mifepristone, the first pill in a medical abortion procedure. He says the progesterone counteracts the mifepristone by preventing the uterus from expelling its contents. The study, published in the medical journal Annals of Pharmacotherapy, was not a controlled trial and involved only six women, four of whom still carried their pregnancies to term after taking progesterone.
After publishing his study, Delgado founded the organization Abortion Pill Reversal to "give women a second chance at choice if they so desire it," he said in an interview. APR is mainly a hotline that urges women who have taken the abortion pill to call and be connected with a network of more than 300 doctors Delgado says he has trained about the reversal method. "We need to have a way for women to find out about this because women were not finding out about it in time," Delgado said.
Delgado is often cited as the face of abortion-pill reversal, but he's not the only doctor to promote the concept. The method was first put forward by Matthew Harrison, a practicing family doctor in North Carolina, who now works at Abortion Pill Reversal as the group's associate medical director. In 2006, Harrison was contacted by a woman who changed her mind after taking mifepristone and he says he came up with the idea to administer progesterone to stop the abortion. Two years later, Delgado said, he was approached by a woman in a similar situation and, without knowing about Harrison's case, had the same idea of giving the woman progesterone, which he says led to a successful reversal.
The research on the health effects of taking progesterone during pregnancy is mixed. Some doctors say that taking low doses of the hormone as a supplement can be beneficial, especially if a woman has had miscarriages in the past. But other research has shown that taking progesterone does basically nothing to improve a pregnancy and may come with some negative side effects. "Progesterone, while generally well-tolerated, can cause significant cardiovascular, nervous system, and endocrine adverse reactions, as well as other side effects," according to ACOG.
The FDA has not approved the use of progesterone to "reverse" medical abortions, and Delgado's 2012 study has been debunked and criticized by the mainstream medical community. In 2015, researchers examined the array of scientific literature concerning abortion reversal and found "insufficient evidence" to support any claims of the method's effectiveness. The study, published in Contraception Journal, criticized Delgado's method and went so far as to write, in the conclusion: "Legislation requiring physicians to inform patients about abortion reversal transforms an unproven therapy into law and represents legislative interference in the patient–physician relationship."
Delgado insists that there is plenty of evidence — although none that has been tested in a controlled environment or peer reviewed — to disprove these critiques. In 2015, he told MedPage that ACOG's criticisms in particular are "biased," He said his next step is to submit his own research on the women he's treated through APR to a peer-reviewed medical journal.
Despite the lack of substantiated medical evidence to support it, Delgado's organization is seeking to spread awareness of the abortion-pill reversal method. Some pregnancy resource centers — organizations that offer anti-abortion counseling to pregnant women — have started directing women to APR. Delgado says the organization has "treated" about 800 women, about 60 percent of whom carried their pregnancies to term, although he declined to provide any further evidence of reversed abortions.
Americans United for Life, one of the biggest anti-abortion organizations in the country, has lobbied hard for the passage of abortion-reversal information laws. AUL included abortion reversal in its 2016 model legislation handbook, which is the basis for many of the bills introduced in states this year.
Delgado said he did not have a direct role in drafting or lobbying for laws that require doctors to tell their patients about abortion reversal. But he did give expert testimony in favor of it in Colorado and Arizona when the bills in those states were being debated.
AUL repeatedly cites Delgado, his study, and his organization by name in its draft legislation. Delgado's 2012 study is in fact the only citation AUL uses to back up its claims about abortion reversal.
AUL's argument that women should know about the possibility of abortion reversal is the same argument behind other "informed consent" laws, which include measures requiring doctors to show women seeking abortions pictures of the fetus at its current point in gestation or to give medically disputed information about when the fetus can feel pain. Abortion-rights advocates say these regulations are merely another way to dissuade women from getting an abortion in the first place.
Moreover, reproductive rights experts say measures promoting the idea of abortion reversal, like many other informed consent regulations, offer a quasi-medical solution to a problem that doesn't actually exist. "There is a misperception that women are uncertain about their abortion decisions," said Saporta, of the National Abortion Federation. "The laws are based on a false premise. Women rarely change their minds after beginning a medical abortion."
One study published in 2013 found that 95 percent of women who decided to get an abortion felt it was the right decision a week later.
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