The number of states that require doctors to tell patients their abortions can be reversed with an experimental treatment doubled this year.
The rise of so-called “abortion reversal” bills has alarmed leading medical groups that say such legislation forces physicians to give misleading, unscientific and potentially dangerous advice to women, undermining the trusted doctor-patient relationship.
So far this year, five states ― North Dakota, Nebraska, Oklahoma, Kentucky and Arkansas — have passed legislation mandating that physicians counsel women that a medication abortion, a safe and common method for ending a pregnancy before 10 weeks, can be reversed. Similar laws are already on the books in South Dakota, Utah and Idaho. Arkansas expanded an existing law.
How A Medication Abortion Works
Although it’s colloquially called the “abortion pill,” medication abortion is actually a combination of two prescription drugs. First, a patient takes mifepristone, which stops the pregnancy’s progress by blocking the hormone progesterone. One to two days later, the patient takes misoprostol, which causes cramping and bleeding to empty the uterus.
When taken correctly, the drugs result in an abortion 97% of the time.
Proponents of “abortion reversal” ― a term used that pro-life groups use even though it’s inaccurate, as by definition once an abortion has occurred, a woman is no longer pregnant ― claim that medication abortions can be reversed halfway through. They counsel women who have taken mifepristone to forgo the second drug, misoprostol, and instead take high doses of progesterone, often for months.
Leading medical groups, including the American Congress of Obstetricians and Gynecologists and the American Medical Association, oppose this experimental practice, as it has not been clinically tested or approved by the Food and Drug Administration.
They note that medication abortion is most effective when patients take both drugs, and about half of women who take only mifepristone will continue their pregnancies. Taking progesterone to offset the effects of mifepristone has not been evaluated for safety.
The AMA filed a lawsuit Tuesday to challenge the constitutionality of North Dakota’s “abortion reversal” law, which is set to go into effect Aug. 1. Joining the country’s largest association of doctors is Red River Women’s Clinic, the only abortion clinic in the state, and the Center for Reproductive Rights.
Under state law, physicians must tell patients that it may be possible to reverse an abortion “if she changes her mind, but time is of the essence.” They must also give patients printed materials directing them to medical professionals who support “abortion reversal.”
Corroding Trust
North Dakota’s law violates the First Amendment rights of physicians by requiring them to spread false and nonscientific information, according to Molly Duane, a staff attorney for the Center for Reproductive Rights.
“The notion of ‘abortion reversal’ is based on junk science,” Duane said. “This law effectively forces physicians to lie to their patients, and it forces them to violate their medical ethics to do no harm.”
This can compromise the patient-provider relationship, which is built on trust. “Physicians need to be able to have the ability ― without interference from the state ― to provide their patients with accurate information,” she said.
Kathryn Eggleston, the medical director of the state’s last remaining abortion clinic, wrote in an affidavit that she could not ethically recommend the treatment.
“For one thing, the impact on patients of mifepristone combined with high doses of progesterone is virtually unstudied,” she wrote in the affidavit obtained by HuffPost. “Scientists thus do not know what impact, including potential birth defects, the administration of these drugs could have on the children.”
Eggleston also worried that the law could have the perverse effect of encouraging patients to consent to receive an abortion before they’re ready, under the mistaken belief that abortion can be reversed.
“Before I proceed with any abortion, I ask my patients if they are confident in their decision to have an abortion,” she wrote in the affidavit. “Telling patients that they may ‘reverse’ an abortion will dilute the fundamentally important message I need to deliver that a patient must be certain before deciding to start a medication abortion.”
History Of ‘Abortion Reversal’
The person often credited with inventing the “abortion reversal” procedure is a doctor named George Delgado. In 2009, Delgado received a call from a sidewalk counselor who said she was in touch with a woman who had started a medication abortion but then changed her mind. Was there anything they could do?
Delgado knew that mifepristone blocked progesterone, and that progesterone was also sometimes prescribed during early pregnancy to women at risk of miscarriage.
“It was one of those Holy Spirit moments where he put two and two together in my mind,” Delgado said at an event in March. “I thought, maybe if we give her extra progesterone we can save the baby.”
The woman went on to give birth to a baby girl, according to Delgado, who did not immediately respond to an interview request from HuffPost.
Afterward, he found out that a doctor in North Carolina, Matthew Harrison, claimed to have “reversed” an abortion using the same strategy two years earlier. The two connected and went on to launch Abortion Pill Reversal, a website with a 24-hour hotline to connect women with doctors who will prescribe progesterone in accordance with their unapproved treatment.
Delgado has also done observational research on the experimental protocol, and anti-abortion state legislators regularly cite his work. In 2018, he authored a case series that examined the experiences of 754 women who called the hotline to receive abortion reversal treatment. Forty-eight percent of women who took progesterone within 72 hours of the first pill saw their pregnancies continue. Doctors with the American College of Obstetricians and Gynecologists called that study “poorly designed” and said the procedure is still “unproven and unethical.”
“This law effectively forces physicians to lie to their patients.”
- Molly Duane, a staff attorney for the Center for Reproductive Rights
Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco, said that there is no evidence that the protocol is effective or safe.
“It hasn’t been studied in a rigorous way at all,” Grossman told HuffPost. “The reports that have been published are incomplete and of very poor quality. They have not been done under the supervision of an ethical review board or an IRB, and it’s really an experimental treatment.” Patients deserve to know if there are any safety risks, he added.
The Latest Frontier For Abortion Restrictions
Anti-abortion groups are focusing on “abortion reversal” bills because medication abortion has become such a popular method, said Elizabeth Nash, senior state issues manager at the Guttmacher Institute.
In 2014, medication abortions accounted for nearly a third of all abortions.
“Every single time we do a survey of abortion providers, the proportion of abortion that is medication abortion keeps growing,” Nash said. “Opponents are looking for ways to curtail it.”
Additionally, “abortion reversal” bills are part of a longtime strategy among anti-abortion groups to paint providers as dishonest people who purposely deceive patients, she added.
“They’re trying to make the case that providers are unscrupulous and don’t provide the information that patients need,” Nash said. “But really, it is abortion opponents who rely on flawed and misleading information to push their agenda.”
This article has been updated to include references to Matthew Harrison and the 2018 case series.