Misinformation about reproductive health is always circulating. But since the Supreme Court’s decision in Dobbs v. Jackson struck down Roe v. Wade in June, disinformation about abortions is spreading like wildfire—and it can have some dangerous results. One of the lies spreading is abortion pill “reversal”—a myth proselytized and upheld by crisis pregnancy centers (CPCs) or fake clinics with an anti-abortion agenda. Despite tenuous experimental research, CPCs purport that if people begin to have regrets about going through with an abortion after already starting the process, the person can halt the abortion after taking the first medication.
Abortion medication typically includes two medicines: mifepristone, a progesterone blocker, followed by misoprostol up to 48 hours later. Abortion pill reversal is a high dose of the hormone progesterone taken after mifepristone, utilizing the hypothesis that progesterone will counteract mifepristone’s effects. After taking only the first pill, research found that 8-46% of pregnancies continued, with dosage and advanced gestational age influencing the continuation. Mifepristone alone is not very effective at ending a pregnancy.
When plugging “abortion pill reversal” into a browser, the abortion pill reversal website will likely apex to the top of search results. The website, owned and operated by Heartbeat International, the largest chain of CPCs in the world, lists a hotline for those considering abortion pill reversal and a flurry of nebulous information about the process. After calling the hotline, operators find an anti-abortion doctor who will prescribe progesterone as an oral or vaginal pill or injection.
CPCs outnumber abortion clinics nationally three to one and have been expanding in each state. Abortion pill reversal has become a CPC priority. The Alliance reports that the percentage of CPCs endorsing abortion pill reversal increased from 32% to 35% from 2020 to 2021. Heartbeat International’s 2021 report mentions plans to expand its reach. With fewer abortion facilities and more deceptive clinics, the ability to market to and target vulnerable people looking for abortion services in restrictive states becomes easier to attain.
How it all started
Dr. George Delgado is the developer of abortion pill reversal and the director of ethics and mission at Culture of Life Family Services, an anti-abortion pregnancy clinic that offers Christ-centered medical care. Delgado has pioneered a few studies that anti-abortion clinics and the American Association of Pro-Life Obstetricians and Gynecologists have embraced as substantial enough to offer patients. But reproductive rights advocates and reputable medical institutions heavily criticize Delgado’s studies as speculation over science. The American College of Obstetricians and Gynecologists deems abortion pill reversal “unethical” and “not supported by science.”
“People are not receiving safe medical treatment—they are being experimented on,” said Max Carwile, the programs director of Abortion Access Front, an organization behind Expose Fake Clinics, a site that maps out CPCs to help people avoid deception when looking for abortion care.
Delgado’s first study, published in 2012, used anecdotes of six women who took progesterone after mifepristone. Four of the six women continued their pregnancies. In 2018, Heartbeat International began promoting Delgado’s treatment as safe and effective and took over the abortion pill reversal network. Delgado was and still is a member of Heartbeat International’s medical advisory board.
In 2018, Delgado published a study in Issues in Law and Medicine, which has a history of printing anti-abortion and anti-vaccine material. The study consisted entirely of abortion pill reversal hotline callers. Shireen Rose Shakouri, the deputy director of Reproaction, raised concern over whether participants were informed about the experimental regimen of the treatment, conjuring the country’s shameful history of providing unethical medical care to women of color.
Delgado’s study detailed 754 patients’ experiences with progesterone after mifepristone but only analyzed outcomes for 547 patients. The study used no control group, a vital component of clinical trials. The research was temporarily retracted due to overstating the level of review. Neither of the studies included oversight from an ethics committee.
Dr. Daniel Grossman, the director at Advancing New Standards in Reproductive Health (ANSIRH) and a professor of obstetrics and gynecology, has serious concerns about the unproven abortion pill reversal treatment and its potential for increasing risks for patients.
“We have no evidence that giving progesterone after someone has taken mifepristone increases the likelihood that the pregnancy will continue,” Grossman said.
Not following the mifepristone and misoprostol protocol as instructed could be dangerous.
“We do have some evidence that not taking the misoprostol as planned after mifepristone could increase the risk of heavy bleeding—particularly if someone is pregnant at eight or more weeks gestation,” Grossman said.
In a 2020 study about abortion reversals, lead researcher Dr. Mitchell Creinin sought to find out whether progesterone could reverse the effects of mifepristone. Out of the 12 women enrolled in the trial, three were rushed to emergency care via ambulance for severe vaginal bleeding. Researchers subsequently declared the risk of continuing too dangerous and ended the study.
Legislation requires doctors to counsel patients on abortion reversal
Perhaps even more insidious is that this year alone, 16 states have introduced legislation requiring doctors to counsel patients on abortion reversal as an option. According to the Guttmacher Institute, eight states already require medically inaccurate information that a medication abortion can be stopped after the patient takes the first dose of mifepristone.
“Non-experts legislating what clinicians should tell their patients is plain scary, and no other sector of health care is bound by the imposition of misguided state interests the way sexual and reproductive health is,” Shakouri said.
In the wake of the recent Supreme Court decision to overturn Roe v. Wade, many advocates worry that the mission of CPCs will only grow more emboldened, causing more states to consider these policies. Experts say the goal of these laws is to spread doubt and cast a veil of disinformation about the safety and efficacy of abortion medication.
Studies refute that people have doubts or regrets about their abortions
Doubt over an abortion is very rare, but that’s not something CPCs want you to know. One of the resources that the abortion pill reversal site lists for post-abortion emotional support, a website called “Option Line,” which Heartbeat International also owns, states that overwhelming feelings don’t often show up for years. Abortion Pill Reversal’s landing page asserts that many women change their minds in time.
A 2020 study published in Social Science and Medicine collected data from 30 U.S. facilities that provided abortions over five years and found no evidence that people who obtain abortions regret their decisions as the years go on. At the five-year mark, most people feel positive about their choice to have an abortion or no feelings at all. Relief was the most common feeling experienced. An overwhelming majority, 99.5-97.7% of participants, felt it was the right decision depending on whether they felt no stigma or high stigma about abortion, respectively.
Abortion pill reversal messaging plays on sexist tropes of women as fickle and flighty, and it harms people by imposing rigid, sexist, false notions about their relationships to their bodies and life decisions, said Shakouri.
Shakouri explained that stigma, not doubt or regret, prevents people from making informed, fully invested abortion decisions, along with restrictions on accessing abortion care. “Eliminating barriers to abortion access would significantly shift any (exceedingly rare) instances of doubt or regret people feel around their abortion decisions,” said Shakouri.
A 2013 study on Wisconsin’s mandatory preabortion ultrasound found that 93% of people seeking abortions were certain of their decision, both before and after. A 2008 nationally representative survey showed that 92% of participants made up their minds before making an appointment.
“This [reversal] is not a procedure that patients are asking for or in need of,” Carwile said.
