For nearly eight years, the anti-choice movement has peddled the fraudulent idea that a medication abortion can be reversed. Proponents insist that, in the incredibly rare instance that a patient should change her mind in the middle of terminating, taking a heavy dose of a particular drug will throw on the brakes, allowing her to continue the pregnancy. Medical experts agree that this idea is baseless at best, and dangerous at worst. Nonetheless, six states currently require doctors to inform their patients that “abortion reversal” is possible. But now, we have evidence to suggest doctors’ fears are founded: that attempting to walk back an in-progress abortion may prove life-threatening.
Medication abortion involves two drugs, taken at a set interval: mifepristone, which prompts the pregnancy to detach from the uterus, followed by misoprostol, which cues the uterus to push it out. According to “reversal” proponents, interrupting that combination treatment with progesterone — a hormone associated with miscarriage prevention in certain patients — can curb mifepristone’s effects. Researchers at the University of California–Davis Department of Obstetrics and Gynecology set out to test that theory, but didn’t get very far. They had to cut short their study after severe complications landed three women in the hospital.
At first, the team sought 40 pregnant women already scheduled for surgical abortions. They planned to give each participant a dose of mifepristone, to be followed either by a multiday course of progesterone, or a placebo. Ultimately, they only enlisted 12 women before calling the trial to an abrupt end. Three participants — one who’d taken progesterone, two who’d taken the placebo — were rushed to the hospital with hemorrhaging so severe, one required a blood transfusion.
“I did not expect women to bleed like this,” Dr. Mitchell Creinin, the lead author and a professor of obstetrics and gynecology at UC Davis, told the Cut. “That’s why we stopped the study. I couldn’t continue to enroll women and put them at the same kind of risk.”
Because they had to halt the study so quickly, Creinin explained, the results are inconclusive. Nonetheless, he emphasized, even these preliminary findings suggest that the commonly accepted “abortion reversal” regimen could have serious health consequences. Which seems intuitive, given the way the medication is supposed to work, and may raise questions as to how the implausible-seeming concept entered the medical arena in the first place.
Back in 2012, a stridently anti-abortion doctor named George Delgado published a paper summarizing a series of case reports (which Creinin called “the lowest level of evidence”) on six women. All of them were given mifepristone, followed by progesterone injections; four gave birth. Delgado didn’t say what happened to the others, but in a 2018 follow-up, he expanded his test group, giving 547 women post-mifepristone progesterone. This time, just under half of participants carried their pregnancies to term. Once again, Creinin noted, Delgado left out the participants whose results didn’t fit his desired narrative. Delgado acknowledged that 116 women “were lost to follow-up” and that 57 “changed their minds again,” and ended up getting some kind of abortion.
“When somebody’s only reporting part of what needs to be reported, then it becomes almost invalid. How can I trust it?” he said. Given the high hospitalization rate for Creinin’s study, the omission is particularly troubling — Delgado effectively exposed hundreds of women to a potentially threatening medical procedure, then declined to share the specifics of what had happened to them.
Further straining credulity, Delgado also declined to use a control in either of his efforts. Also missing: ethical review committees to oversee the procedures, a lapse that effectively pushed women into “unmonitored experimentation,” Creinin said. The American College of Obstetrics and Gynecology considered both of these oversights to be serious flaws in the research. If anything, as a cohort of doctors and scientists agreed in a systematic review of the available literature on abortion reversal, Delgado’s efforts indicated that mifepristone’s failure rate climbs without misoprostol as a follow-up. And because of the shoddy design, Delgado’s case series doesn’t tell us anything definitive about the possible role of progesterone.
“The science underlying these laws was bad,” Dr. Daniel Grossman, an abortion provider, director of Advancing New Standards in Reproductive Health (ANSIRH), and lead author on the aforementioned review, told the Cut. “It’s frustrating that the reproductive health community has to invest resources to study something like abortion ‘reversal,’ but our patients deserve to know whether the treatments we are recommending are safe and effective.”
But that’s where we are now: Doctors are being forced to offer an unproven, unethical, and now demonstrably unsafe medical procedure to their patients to serve a political agenda — one that purports to be “pro-life.” And once again, women are seen as collateral damage in an ideological war over what happens to their bodies.