'Reversing' Abortions: The Anti-Abortion Movement Legislates Bad Medicine With Junk Science
Legislative language penned by anti-abortion activists has been made into law by two states, requiring doctors to advise on a procedure that has yet to be tested in a single clinical trial.
Signed by Arkansas Governor Hutchinson (R) late Monday, “The Women’s Right to Know Regarding Abortion Act” requires health professionals to inform women seeking medication abortions that if she changes her mind, the process might be “reversible.” A similar law passed in Arizona earlier this month, and both laws are slated to go into effect in the summer. Both the Arkansas and Arizona laws are based on model legislation from Americans United for Life (AUL), the legal arm of the pro-life movement.
The problem? According to the American College of Obstetricians and Gynecologists (ACOG), “Claims of medication abortion reversal are not supported by the body of scientific evidence.”
Medical abortions have been an alternative to the traditional, more invasive surgical procedure in the United States since 2000, and 36% of all first-trimester abortions are medication abortions. The percentage of medical abortions in the U.S. has quadrupled in the last 10 years--even though the overall number of abortions has decreased. The availability of medication abortions has been a significant factor increase in the number and stability of abortion-providers.
Medication abortions generally require two pill doses, taken days apart. The first dose, mifepristone blocks progesterone receptors and encourages contractions of the cervix. The second dose, misoprostol, flushes out the contents of the uterus. Black market abortion pills often contain only misprotol, though this is not advised by the ACOG. Should a patient change her mind after taking the first pill, and not take the second, she still has a 30-50% chance of conceiving normally.
There is virtually no scientific information on medical abortion reversals, and most leads back to the claims of Dr. Delgado, an anti-abortion doctor who runs the website www.abortionpillreversal.com . The procedure of “abortion reversal” is a regimen of progesterone injected within 72 hours after the first dose of mifepristone, but before the second dose of misprostol. The treatment continues through the first trimester of pregnancy.
Delgado’s website states that “Reversing a mifepristone medical abortion is within reasonable medical practice.” However, the rigorous scientific standards that distinguish anecdotal evidence and one-time experiments (such as Delgado’s) from tried-and-tested medical procedures accepted by the general medical community are absent here. The basis for this procedure lies in a 2012 report Dr. Delgado made to the Annals of Pharmacotherapy, where seven test subjects were given progesterone after taking the first dose of mifepristone. One subject was unavailable for follow up, which shrank the statistical population to six women, four of whom gave birth normally. Since then, Delgado claims that with 78 babies born after “abortion reversal” and 45 women still pregnant (out of 223 attempted reversals) he has a 57% success rate.
In fact, the ACOG has noted that Delgado’s experiment was not a clinical trial or controlled study, and was not overseen by an institutional review board or an ethical committee. The ACOG further noted that the paper did “not provide evidence that progesterone was responsible for the reported outcome” and that “doing nothing [after the first pill] and waiting to see what happens is just as effective as intervening with a course of progesterone. “
The AUL website’s sole source of scientific information on abortion reversals is Delgado’s 2012 experiment. “The political leadership of Arkansas and Arizona are trail blazers,” says Dr. Charmaine Yoest, chairman of AUL, in a statement regarding the recent legislation. “A ‘choice’ is not truly a ‘choice’ unless informed.”
This emphasis by anti-abortion activists on “informed choice” is nothing new. Informed consent provisions require patient be fully informed of all relevant, accurate and unbiased medical information prior to any major medical procedure. Currently, 33 states have informed consent provisions requiring disclosure of medical risks associated with abortion. The Supreme Court has stated that information required for informed consent to abortions must be “truthful and not misleading and designed to help a woman understand the “full complexity” of her decision.” Yet anti-abortion activists have long worked to expand informed consent provisions to include unreliable or inaccurate health information, with little or no scientific basis, designed to intimidate women seeking abortions.
For example, the medical community has long established that first-trimester abortions have no effect on fertility. Yet, in Texas, women seeking an abortion are told that abortion-related complications "may make it difficult or impossible to become pregnant in the future or to carry a pregnancy to term." Anti-abortion activists have long argued a causal link between abortions, even though American Cancer Society concluded in September of 2014 that there was no scientific evidence “to support the notion that abortion of any kind raises the risk of breast cancer or any other type of cancer." Nonetheless, five states use language indicating that that the increased risk of breast cancer after an abortion. In 2012, South Dakota legislature passed a law requiring doctors to inform women seeking an abortion that they face an increased risk of suicide after going through with the procedure. No such evidence exists.
Perhaps the most overt attempt to expand informed consent provisions beyond those required of ordinary surgery involves fetus’s ability to feel pain. The medical community agrees that the fetus only develops the physical structures required to feel pain at 23 to 30 weeks, with the required sensory adaptors only formed at 29 weeks. Fewer than 1% of women nationally seek an abortion after 21 weeks. Nevertheless, despite being physiologically impossible, “fetal pain” information is required in informed consent provisions in eight states.
Now, by telling women that their abortions are reversible, Arkansas and Arizona legislatures have lent validity to a process with almost no scientific backing, and which, according to the ACOG, is unlikely to be much better than doing nothing at all. As Jennifer Dalven, director of the American Civil Liberties Union’s Reproductive Freedom Project, said in a statement in response to the Arkansas law, “Extreme legislators are so focused on preventing a woman from getting an abortion that they are willing to ignore the medical experts and hide behind junk science.”
But junk science has long been a favorite weapon of anti-abortion activists. Before they simply ignored facts provided by the medical community. Now they’re using the law to lend credibility to medical procedures that have yet to be scientifically tested and proven. And this pattern of “inappropriate interference in the exam room,” despite protests from ACOG and other medical groups, shows no signs of abating.