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Between 2007 and 2012, seven women swallowed the first pill of a two-drug abortion regimen.
Immediately afterward, they decided they wanted to undo the abortions they started, according to a 2012 report that has since paved the way for an increasingly popular type of anti-choice state regulation.
As detailed in the report, the women sought out doctors to help them. In lieu of time-travel technology, the doctors relied on similarly dubious science: an unproven protocol for so-called abortion reversal. Along with other “alternative facts” featured in our False Witnesses series, abortion reversal adds to the longstanding trend of abortion opponents enacting policy based on unsubstantiated claims for ideological reasons.
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Two California doctors who oppose abortion, Dr. George Delgado and Dr. Mary Davenport, published anecdotes in the Annals of Pharmacotherapy about a handful of women who attempted to undo their abortions. Within a few short years, states began passing laws based on these anecdotes.
The extent to which there is a demand for “reversing” abortions is unclear. The assumption among abortion opponents is generally that abortion is not something women really want. Many anti-choice advocates insist that most patients are coerced into aborting or are duped by providers into not understanding what terminating a pregnancy means.
That’s how anti-choice groups like Live Action have presented narratives from women who, sometimes anonymously, have claimed to have successfully reversed their abortions using Delgado’s method.
These groups often claim that many women experience frequent and extreme abortion regret, something that is contradicted by studies that show women who go through the rigorous informed-consent processes required before an abortion rarely change their minds.
Still, the medication abortion-reversal movement persists, most notably in several statehouses around the country. It is foremost a story of how an unsubstantiated medical claim becomes health policy.
Six Test Subjects, Several Laws
The women featured in Delgado and Davenport’s paper were in their first trimesters—between seven and 11 weeks’ gestation, according to the report—and thus able to have their abortions via medication.
Most abortion providers in the United States follow the medical regimen approved (and recently updated) by the Food and Drug Administration. On the first day, the patient goes to her doctor’s office or to an abortion clinic and takes the first dose of medication: mifepristone, designed to deprive the fetus of the hormone progesterone, which it needs to grow and thrive. One to two days later, usually at home, the patient takes the second dose: misoprostol, designed to expel the fetus.
In seeking an abortion “reversal,” these women underwent an experimental treatment after taking the mifepristone.
Though there was no medical literature about how to reverse the course of medication abortion, or even whether that was a possibility, six physicians trained in an obscure Catholic fertility treatment—including Delgado and Davenport—injected their patients with varying doses of synthetic progesterone. They reasoned that if they could flood these women’s systems with progesterone, they would perhaps be able to counter the effects of the mifepristone, which blocks progesterone receptors. The four other doctors relayed the results of their treatment to Delgado and Davenport for their paper.
During the course of their pregnancies, one of the women stopped participating, two of the women’s pregnancies terminated shortly after taking the mifepristone, and four of the women carried their pregnancies to term and gave birth to healthy babies.
Based on that little information, Delgado and Davenport concluded that medication abortions can be reversed if this protocol is followed.
“The experience of these patients suggests that medical abortion can be arrested by progesterone injection after mifepristone ingestion prior to misoprostol due to the competitive action of progesterone versus mifepristone,” Delgado and Davenport wrote.
In the paper, Delgado and Davenport briefly noted that mifepristone is known to be less effective the further along a woman is in her pregnancy, but they didn’t dwell on this or on all of the different factors that could have affected these results.
The American Congress of Obstetricians and Gynecologists (ACOG)—which says that claims of abortion reversal are not based on scientific evidence—also says that mifepristone on its own is not entirely effective at inducing abortion (the drug is, after all, only the first step in a two-drug regimen). ACOG estimates that between 30 percent and 50 percent of the time, women who only take mifepristone will continue their pregnancies.
In a 2015 literature review article published in the medical journal Contraception, seven physicians (most of whom identify as supporting abortion rights) argued with the very premise of Delgado and Davenport’s protocol: that progesterone injections would have any effect on a woman’s pregnancy after she had taken mifepristone. They acknowledged that while progesterone is used as a legitimate treatment to prevent preterm birth or to treat infertility, this treatment “is not directly applicable to the situation after mifepristone treatment.”
“Women treated with mifepristone for abortion have normal pregnancies with high progesterone levels, and it is not clear that adding more progesterone would counteract the effect of the receptor blockade,” they wrote.
Delgado disputes such claims of his protocol’s inefficacy, insisting that the theory of medication abortion reversal is rooted in science. He told Rewire in a phone interview that ACOG and these researchers have conflated embryo death with incomplete abortion—in other words, he says, they are not counting, so to speak, abortions that result in the death of an embryo but not in the removal of the embryo from the uterus. Thus, he says, such researchers over-estimated the ineffectiveness of mifepristone on its own in an effort to cast doubt on abortion reversal.
“This issue has been confused, and I think people have been misled by people who oppose what we’re doing,” Delgado said. He said that ACOG and others are agenda-driven and biased in favor of abortion.
Still, despite the pushback expressed by physicians, the limited figures from Delgado and Davenport’s report were enough to persuade conservative lawmakers to create a brand-new policy.
Delgado and Davenport’s paper circulated among anti-choice groups for a few years, until in 2015, two states—Arizona and Arkansas—amended their mandatory counseling abortion laws to require doctors to tell patients seeking abortions via medication that the procedure can be reversed if they don’t take the second drug and if they act quickly to follow the reversal protocol.
South Dakota followed suit the following year. Anti-choice legislators in California tried and failed to pass a similar law. Louisiana lawmakers entertained a similar policy, but instead passed a resolution calling for the state health department to study the same question Delgado and Davenport presumed to answer in their 2012 paper. A spokesperson for the Louisiana Department of Health told Rewire in an email that this report is still in the draft stages and not yet ready for release. Also in 2016, Arizona repealed its law after the state failed to defend the policy on scientific grounds in a lawsuit.
Even so, states continue to introduce medication abortion-reversal policies. Colorado‘s attempt earlier this year failed to pass, but legislatures are still considering similar bills in Georgia, Idaho, Indiana, North Carolina, and Utah.
The lawmakers proposing these bills have had help. The national lobbying organization Americans United for Life, whose specialty is crafting copycat abortion regulations for states to introduce, drafted a model bill called the Abortion Pill Reversal Information Act, on which most of these state bills appear to be based.
The North Carolina bill, however, goes much further than the others. Its proposed law would force women to return to the clinic after taking the mifepristone and require the doctor to determine whether or not the pregnancy was terminated before giving the patient the dose of misoprostol. The wording of the bill is unclear, but indicates that the patient can only receive the full medication abortion if the mifepristone works on its own, which, doctors say, is not a guarantee for many women.
Cosmopolitan reported that current language of this legislation “could make medication abortions almost impossible to perform.”
The bill’s sponsor, Rep. Larry Pittman (R-Cabarrus), did not respond to a request for comment.
“I Knew I Had Done Wrong!!”
Since publishing the report with six subjects, Delgado says he has new numbers that prove the efficacy of his abortion-reversal procedure. Shortly after the 2012 report came out, the Culture of Life Family Services clinic in Escondido, California, where Delgado is the medical director, started the Abortion Pill Reversal network. Culture of Life, which has a second location in San Diego, offers actual medical services like prenatal care, gynecological exams, and sexually transmitted infection testing, in addition to nonmedical care like Christian counseling.
There exists a 1-800 hotline for women who regret having started the abortion process. Calling that number connects a woman to a network of physicians across the country willing to administer Delgado’s protocol.
Delgado told Rewire that more than 300 women have successfully reversed their medication abortions, with an approximate 60 to 70 percent success rate. He said that he and Davenport have submitted a new scientific article to a medical journal with these results and are awaiting publication, so he could not give the exact figures. He said there are more than 350 doctors in the abortion reversal network with some available in every state and in 13 foreign countries.
By combing through news reports and “crisis pregnancy center” websites, Rewire has been able to identify about 25 physicians and about 20 so-called crisis pregnancy centers that claim to offer this service. Some, but not all, of the doctors we identified work for these centers.
In its fall 2015 edition, Issues in Law and Medicine—a journal whose anti-choice ties are deep but hidden—published a presentation Delgado gave at a conference held by the American Association of Pro-Life Obstetricians and Gynecologists in February 2015.
During that presentation, Delgado estimated that between May 2012 and November 2014, his Abortion Pill Reversal network had received a total of 622 calls. Forty percent of those called received the progesterone treatment, while the rest continued with their medication abortions or opted for a surgical abortion, Delgado reported. Of the 248 who underwent his protocol, 65 resulted in live births, and 84, as of the publication of his report, remained pregnant. Meanwhile, 97 women who underwent the protocol lost their pregnancies. Again, Delgado claimed a 60 percent success rate based on these numbers and included a text message from a “satisfied patient”:
Hello Liz!!! I just got home. Yes I got the shot and I am going to return tomorrow also!!! I just wanted to say thank you from the bottom of my heart!!! You really saved me!!! I knew I had done wrong!! It was by chance I got your number and I am so glad I did!!!! I feel relieved!!!! You are my saving grace!!! God bless you Liz!!!
Delgado told Rewire that he and Davenport have another article slated to be published in a forthcoming edition of Issues in Law and Medicine, which critiques the analysis in the Contraception article on abortion reversal.
Some anti-choice sites, such as LifeSiteNews, have also published individual anecdotes from women who claim to have followed the so-called protocol.
Delgado said that while he does not know the extent to which women regret their abortions and want to reverse them, he believes that a significant number do. For that reason, he said the medical community should be helping to educate women about abortion reversal.
“Even if only 5 or 10 percent of the women would want to change their mind … it’s only fair that women know about this second chance at choice,” Delgado said.
While it is not unheard of for people to change their minds after initiating an abortion, in reality, it is very rare, says Arizona-based OB-family practitioner and abortion provider Gabrielle Goodrick.
In 16 years of providing abortions, Goodrick estimates that she has seen six patients out of about 10,000 who did not want to continue their medication abortions after initiating the process. Goodrick says in these cases she has told the patients not to take the second drug, and about half the time their pregnancies continued to healthy pregnancies.
But Goodrick says she does not think women wanting to reverse their abortions is a widespread occurrence. On the contrary, she says she’s seeing an uptick in women trying to self-induce abortions by various means, as a result of increasingly onerous abortion restrictions in her state.
Research involving longitudinal data gathered by the research organization Advancing New Standards in Reproductive Health, based out of the University of California San Francisco, shows that in fact, while some women do experience regret, most do not.
A Boon to CPCs
The lasting impact of abortion-reversal legislation remains to be seen.
But already it appears to be having an effect—a positive one—on so-called crisis pregnancy centers, facilities that position themselves as health clinics when most of what many of them offer is persuasion to not have abortions.
Now some CPCs are offering abortion-reversal services as a so-called medical service, in the same way many list nondiagnostic ultrasounds and drug-store pregnancy tests. Until recently, for example, crisis pregnancy centers were getting away with teaching California nurses how to provide abortion reversal as part of state-sponsored nursing education.
Brice Griffin, who works for the Charlotte, North Carolina, affiliate of Stanton Healthcare, a national CPC network that is trying to replace Planned Parenthood as the largest provider of sexual and reproductive health services excluding abortion and contraception, says abortion reversal has become a new tool of her movement to persuade women to carry their pregnancies to term.
Though her center does not yet offer the abortion-reversal protocol, she says once they do, the plan will be to stand outside the abortion clinic nearby and talk to women about reversing their abortions. The ultimate goal, Griffin told Rewire in a phone interview, is to get abortion-reversal kits into emergency rooms.
“Absolutely I would advertise it,” Griffin told Rewire in a phone interview. “I mean, I would even put signs out front, because the truth is people don’t necessarily realize that [abortion is] reversible.”
Of course, many doctors would disagree with that statement.
Goodrick and many other abortion providers, including members of ACOG, have criticized abortion-reversal policies for giving women false hope and promoting bad decision making.
“Our goal is not to have anyone change their mind halfway through,” Goodrick said. “They are consented, and they have time to think about things and come in quite resolute in their decision.”