Women Deserve to Know They Can Reverse In-Progress Chemical Abortions

Published June 24, 2024

Public Discourse

Though abortion supporters would have you believe otherwise, many women regret choosing abortion and experience negative mental-health consequences long afterward. In recent years, doctors have developed a safe and effective method to allow women undergoing a chemical abortion to halt and reverse the procedure if they change their mind before the abortion is complete—and abortion providers are doing everything they can to stop women from finding out about it.

Abortion pill reversal, or APR, is a regimen of progesterone, an essential hormone in gestating an unborn child, that counteracts the harmful effects of the abortion drug mifepristone. In the best-case scenario, if taken at the right time, progesterone can stop mifepristone from cutting off nutrients to the unborn child, allowing the mother to carry a healthy baby to term.

Estimates suggest that more than 5,000 women have successfully used APR to save their unborn children from an in-progress abortion. As the rate of chemical abortions continues to rise in the US, pro-life lawmakers are attempting to make APR more readily available, proposing policies to require abortion providers to notify women about the method as part of giving informed consent to a chemical abortion—what one might consider a “pro-choice” policy.

But these efforts have been met with harsh criticism and even legal pushback from abortion providers and activist organizations, who assert, contrary to the best evidence, that APR is unscientific and harmful to women. Their campaign against APR reveals an ugly truth: abortion supporters refuse to offer women any choice other than abortion.

The Science of Abortion Pill Reversal

According to the most recent estimates from the Guttmacher Institute, chemical abortions now account for nearly two-thirds of all abortions annually. Chemical abortion drugs are approved by the Food and Drug Administration for use before ten weeks of pregnancy, but abortion providers often prescribe them up to about twelve weeks.

Chemical abortion involves the use of two drugs. First, the pregnant mother ingests mifepristone, which blocks progesterone from sustaining the unborn child, which most often leads to the child’s death. Shortly thereafter, she ingests misoprostol, which causes contractions that expel the unborn child.

In order to have a chance of being effective, abortion pill reversal must be administered before the woman takes misoprostol. The method is more effective the sooner it is taken after the ingestion of mifepristone.

Contrary to claims from abortion providers, the best evidence shows that APR is both safe and effective when used on this timeline. The largest case series studying APR surveyed more than 750 women and found that up to 70 percent were able to carry healthy babies to term after taking mifepristone, depending on how progesterone was administered. “These survival rates compare favorably with published embryo and fetal survival rate of 25%, if no treatment is attempted, the rate used as a control,” the study’s authors note. The study did not find any correlation between APR and birth defects or other negative health consequences.

Meanwhile, the chief study that abortion supporters cite to claim that APR harms women actually demonstrates the opposite: mifepristone poses health risks to women, and progesterone has only been proven helpful in treating those negative effects. This result is unsurprising. Doctors have long been safely and effectively prescribing progesterone to treat infertility or care for pregnant mothers with a history of miscarriage or a higher risk of preterm birth. There has never been evidence that progesterone poses serious risks either to mother or child.

Nevertheless, abortion providers and activist groups such as Planned Parenthood, NARAL Pro-Choice America, and the American College of Obstetricians and Gynecologists continue to insist that APR should be disallowed. Some progressive state attorneys general have gone so far as to sue pregnancy resource centers in an attempt to prevent them from facilitating access to APR treatment.

Abortion Pill Reversal Is Increasingly Essential

Abortion pill reversal is particularly important as abortion activists continue to advocate essentially unlimited access to chemical abortion drugs. In the wake of the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, abortion providers have responded to pro-life state laws by pivoting toward increased prescription of chemical abortions, particularly via telemedicine appointments and the mail.

In recent years, the FDA has loosened its safety regulations and medical standards to allow providers to distribute chemical abortion drugs without requiring a patient to see a physician in person, or even to consult a physician at all. The FDA now permits women to obtain chemical abortions from any “certified prescriber,” a category that includes non-physicians such as physician’s assistants and pharmacies. These diminished standards put pregnant women at significant risk of severe health consequences, in addition to the risks already involved in chemical abortions. Particularly if a woman has an undiagnosed ectopic pregnancy or if she misidentifies how far along her pregnancy is, ingesting chemical abortion drugs could lead to severe hemorrhaging or other serious complications that require emergency hospitalization and surgery—and these risks are impossible to mitigate if she never sees a physician before obtaining the drugs.

Even some groups that endorse legal abortion have been willing to acknowledge these risks. The World Health Organization has stated that “it is more difficult to diagnose an ectopic pregnancy during and after medical methods of abortion, due to the similarity of symptoms,” which presents challenges to providing adequate follow-up care should it be necessary. The WHO has also acknowledged that “neither mifepristone nor misoprostol are treatments for ectopic pregnancy, which, if present, will continue to grow. Therefore, healthcare staff must be particularly alert to clinical signs of ectopic pregnancy. Women should be told to seek medical advice promptly if they experience symptoms that may indicate ectopic pregnancy, such as severe and intensifying abdominal pain, particularly if it is one-sided.” These risks are, of course, impossible to assess when a chemical abortion is provided via telemedicine, leaving women at greater risk of significant health consequences and little access to follow-up care.

In this context, and as providers across the country continue to turn to chemical abortions as a means of thwarting pro-life laws, it is essential that women are aware of and able to access APR should they regret their in-progress abortions. And yet, even as lawmakers work to make APR counseling part of informed consent, abortion providers and pro-abortion lobbyists have done everything in their power to block these policies. This rejection of APR is further confirmation that abortion advocates have no interest in affirming or offering any choice besides abortion.

In addition to peddling provably false claims about progesterone’s safety, some abortion supporters argue that informing women about APR is problematic because it suggests that a woman might not be sure of her decision or might come to regret her choice. It suggests, in short, that abortion is less than desirable, that it might not be a real solution for the woman in the waiting room.

For supporters of abortion, admitting this possibility is akin to admitting defeat. The argument for legal abortion rests on the presupposition that abortion is not only acceptable but liberating, that a woman in a difficult situation will always be served by seeking an abortion. Abortion pill reversal is a potent reminder to those who profit from abortion that, if given the option, many pregnant mothers want assistance that will help them choose life.

EPPC Fellow Alexandra DeSanctis writes on culture and family issues, with a particular focus on abortion policy and pro-life advocacy, as a member of the Life and Family Initiative.

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