NEWS
27/03/2018 00:55 SAST | Updated 29/03/2018 00:36 SAST

U.S. States Are Passing Laws Telling Women 'Abortion Pill' Can Be Reversed. But That's Unproven

"We should all be concerned when our government forces doctors to recommend an experimental therapy," a doctor said.

The tone of the website abortionpillreversal.com is filled with urgency. Women who have taken the first dose of the “abortion pill” — actually two drugs, mifepristone and misoprostol, taken over the span of several days to terminate a pregnancy — are exhorted to call right away if they regret their decision.

“There is an effective process for reversing the abortion pill, called abortion pill reversal,” the site claims.

Elsewhere, bolded and in all capital letters, the site practically screams: “IT MAY NOT BE TOO LATE, IF YOU CALL QUICKLY.”

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The problem? No credible research backs those claims, and the American College of Obstetricians and Gynecologists has dismissed them outright as bad science. There is no quality evidence that taking the hormone progesterone after a first dose of the abortion pill can undo the process. 

That hasn’t stopped so-called “abortion reversal” laws from quietly cropping up around the country, based on little more than conjecture. Last week, Idaho joined Arkansas, South Dakota and Utah in passing a law requiring that medical providers tell every woman who takes the abortion pill that the procedure can be stopped halfway through.

The authors of these bills rely on small case studies that have been disputed by OB-GYNs — insisting time and again that they simply want to give women more information. The laws are predicated on the idea, disputed by substantial research, that women who have abortions frequently regret their decisions — a common tactic used by anti-abortion activists who ignore studies showing that being denied an abortion tends to harm women’s mental health more than getting one.

We should all be concerned when our government forces doctors to recommend an experimental therapy — without making it clear that it’s experimental. Dr. Daniel Grossman, Advancing New Standards in Reproductive Health

“I think it’s one thing to exaggerate the risks of abortion, but it’s far more concerning when a state codifies into law a medical treatment that is completely unproven,” Dr. Daniel Grossman, an OB-GYN and director of Advancing New Standards in Reproductive Health, told HuffPost.

“We should all be concerned when our government forces doctors to recommend an experimental therapy — without making it clear that it’s experimental.” 

A Shaky Claim

The organization Abortion Pill Reversal describes itself as “a network of over 300 physicians worldwide to assist women that call our hotline.” Grossman calls it a crisis pregnancy center, a group that primarily aims to dissuade women from having abortions.

APR was founded by Dr. George Delgado, a family medicine physician, who in 2012 published a small case series in the journal Annals of Pharmacology purporting to show successful abortion reversal in 4 in 6 women who were given progesterone after taking a dose of mifepristone, the first of the two pills needed for a medication abortion.

The theory goes that giving women extra progesterone — a hormone that helps support pregnancy — will “outnumber” and “outcompete” mifepristone and prevent it from working, APR says. Women then refrain from taking misoprostol tablets — the second drug used in a medication abortion — which affect the cervix and uterus.

“In all biologic systems where two molecules compete for the same receptor the way mifepristone and progesterone do, when the concentration of one is increased, it will tend to win the battle at the receptor,” Delgado told HuffPost. “Therefore, it makes biologic sense that giving supplemental progesterone can block the effects of mifepristone.”

Delgado also told HuffPost that a larger case series is due out this month showing “successful reversal rates” between 60 and 70 percent among women given progesterone orally or via injection.

But groups like the American College of Obstetricians and Gynecologists have been unequivocal in their stance that abortion reversal is simply not supported by any kind of credible science. 

Delgado’s small study was not overseen by an institutional review board, ACOG says, nor was it subject to any kind of ethical review. Moreover, according to ACOG, case series are the weakest form of medical study. They have no controls and are largely descriptive.  

This is just meant to continue the stigma around the supposed harms abortion has on women. Dr. Sarp Aksel, ACOG Gellhaus Fellow

“The proponents of this idea — and it’s a theory — basically took a guess and said to themselves, ‘Because mifepristone is an anti-progesterone, then maybe administering progesterone can stop the effects of the medication abortion,‘” Dr. Sarp Aksel, ACOG Gellhaus Fellow, told HuffPost. “It’s all conjecture. None of it has been ― I don’t even want to say ‘proven’ ― because there hasn’t even been a proper study set up to potentially identify some sort of association.”

And because it’s an untested medical practice, no one is tracking what happens to any woman who may try and reverse her abortion — or what becomes of her fetus.

How Bad Science Becomes Policy

Numerous states have laws requiring that women be told mistruths about abortion as part of scripted counseling sessions. Some overstate the risk to a woman’s future fertility, while others assert there is a definitive link between abortion and subsequent breast cancer ― a claim that research studies do not bear out. 

In many ways, the intended effect of those laws is clear: to convince women it is risky to have an abortion, even though that is not true.

The purpose of abortion reversal laws is less obvious — perhaps because many lawmakers seem to earnestly believe abortion reversal proponents’ claims are true, or at least might be true. 

“Abortion rights opponents are banking on the idea that there is the off chance that stopping a medication abortion is possible and banking on the fact that it’s hard to prove a negative,” Elizabeth Nash, senior state issues manager with the Guttmacher Institute, the policy and research organization that focuses on reproductive rights, told HuffPost. 

“A doctor in a white coat can be persuasive,” echoed Grossman, who has published numerous studies on the safety of medication abortions. Since medication abortions were approved by the FDA in 2000 as an alternative to in-clinic procedures, states have sought to pass restrictions limiting their accessibility.

But reproductive rights advocates also see a broader effort to promote the falsehood that the majority of women are unsure of their decision to terminate a pregnancy — and that many are anguished and regretful after the fact. Abortion Pill Reversal’s website has an entire section dedicated to anonymous “stories of regret.” 

“This is just meant to continue the stigma around the supposed harms abortion has on women,” Aksel said. “I don’t think it’s based on anything scientific, but it preys on common misconceptions about women being unsure about their abortions and women regretting their abortions.”