The other day my patient asked me whether or not the abortion reversal pill was actually effective. She wasn’t asking because she wanted to reverse an abortion herself but because she had seen recent news coverage about abortion reversal and subsequent legislation. In 2019, lawmakers in Kansas, North Dakota and Nebraska introduced bills that would require physicians to discuss medication abortion reversal with their patients. Four states, Arkansas, Idaho, South Dakota, Utah, have already mandate abortion reversal counseling by law. At the federal level, government officials—who have blocked young, undocumented girls at the border from getting abortions—have discussed the possibility of counseling undocumented women to use the so-called abortion reversal process.
But there is no scientific or medical evidence that proves “reversing” a medication abortion is possible: There are no clinical trials and no objective or credible data. It is only a theory that has been introduced by anti-abortion activists and politicians to further attack access. When misinformation spreads, it affects the patients who seek care in my exam room.
Medication abortion involves using an FDA-approved regimen of pills to end a pregnancy prior to 10 weeks. Two medications are included: mifepristone and misoprostol. Used first, mifepristone blocks the hormone progesterone and prevents the pregnancy from growing. If taken alone, mifepristone will end the pregnancy in about half the patients who take it. Misoprostol is used six to 72 hours later to soften and dilate the cervix as well as cause uterine contractions to remove the pregnancy. Together, the medication abortion regimen is 98-99 percent effective.
In theory, it could be possible to stop the effect of mifepristone with high doses of progesterone, but this has never been proven. In medicine, we do not expose people to potential risks for no medical benefit, so we would never recommend this as an option for patients. In the unlikely event someone did not want to take the misoprostol, what healthcare providers would suggest is that there is a significant chance that the pregnancy could continue. If the patient wanted to continue the pregnancy after taking the mifepristone, we could advise to not take the misoprostol, and we would support a patient with that decision as well. Anti-abortion lawmakers have used very unethical and flawed research conducted by one anti-abortion doctor to push laws that require doctors to mislead their patients by telling them of this so-called option.
This series of cases studies from 2012 that was completed at a Catholic university where a few women who had taken mifepristone, changed their mind about the abortion and then continued their pregnancy after receiving progesterone. The report was not supervised by an Institutional Review Board (a committee which protects the rights of human subjects) which would have raised ethical concerns. Second, the American College of Obstetricians and Gynecology (ACOG) found that there is not enough evidence from this report to say that the pregnancies continued due to the progesterone. The ACOG called abortion reversal “unproven and unethical.”
The same researcher did another study in the same year with more participants and claimed that he confirmed that progesterone can reverse the effects of mifepristone. But again, his research methods were found to be flawed and there is rigorous systematic review to show that pregnancy continuation was not more likely with progesterone administration. The ACOG, the National Abortion Federation, and Planned Parenthood do not recommend administering progesterone if a patient tries to continue their pregnancy after using mifepristone. There just isn’t enough data to support this.
Dr. Mitchell Creinin, an OB/GYN at the University of California, Davis, who has done significant research in family planning, decided to put this issue to rest. He is currently enrolling patients in a study to determine if progesterone can block the effects of mifepristone and increase the chance of pregnancy continuation. He doesn’t believe that that it will and he’s hoping that his findings will be used to prevent lawmakers from mandating physicians from providing patients with misinformation about medication abortion reversal.
Medication abortion reversal is unfortunately not the only misinformation mandated by some states for providers to share with their patients. Some states require providers to lie about fetal pain, poor mental health outcomes, and risks of cancer with abortion. These claims are not true and not backed by science.
Physicians and healthcare providers provide counseling to all patients undergoing any procedure or medical intervention, including abortion. We are required to obtain informed consent, which means that we must confirm that patients have the capacity to make decisions about their health, that their decision is voluntary and they aren’t being forced to have the abortion, and that they fully understand what the procedure involves. Furthermore, we provide patients with the medical facts they need to help them make decisions about their health. There is no evidence that medication abortion reversal is possible—telling patients otherwise is unethical. Several states, however, have laws that mandate providers give misinformation to patients as part of a greater agenda: to dissuade patients or to advance their own anti-abortion beliefs.
What anti-abortion lawmakers get wrong is that patients choosing abortion are sure of their choice prior to being seen by a medical provider. A national survey in 2008 showed that 92 percent of women had made up their mind before making the appointment. While a patient can change their mind about their abortion, it’s very rare. Almost no one is dissuaded from moving forward with the abortion even when faced with scare tactics. Inaccurate information only causes distress and confusion. Because most patients are sure of their decisions about reproduction, we should be supportive of their ability to do what’s most appropriate for them and their families.
As a doctor and an abortion provider, it’s my ethical duty to provide patients with only scientific facts. Trust between the patient and provider is essential to the informed consent process and legislative interference that requires clinicians to misinform patients is categorically unacceptable. Politicians should never mandate that healthcare providers give their patients inaccurate information; it’s a direct violation of the oath I took to do what’s best for my patients.
Dr. Meera Shah, MD, MPH, MS is the Associate Medical Director of Planned Parenthood Hudson Peconic in New York and a fellow with the Physicians for Reproductive Health.