During the 2017 legislative session, Utah lawmakers passed a bill requiring physicians to inform women seeking a medical abortion about a drug that could potentially “reverse” a pregnancy termination if the women changed their minds.
House Bill 141, “Unborn Children Protection Amendments,” was controversial at the time, with many physicians and women’s rights advocates arguing that the science behind the drug’s efficacy was unsound. Now there is evidence that attempting to reverse an abortion could be dangerous.
Researchers at the University of California at Davis planned to enroll 40 patients in a double-blind, randomized trial to explore the efficacy of progesterone, the drug that purportedly could reverse a medical abortion.
The study was called off after three of 12 women enrolled experienced “severe hemorrhage requiring ambulance transport to (the) hospital,” according to a research article published on Dec. 5 by the American College of Obstetricians and Gynecologists.
‘This is not safe’
Medical abortion, which is used for pregnancies up to 10 weeks, consists of two drug regimens: mifepristone followed by misoprostol. Some believe that taking progesterone after taking mifepristone, and neglecting to take misoprostol, could reverse an abortion.
Two of the three women who hemorrhaged received a placebo and one received progesterone.
Mitchell Creinin, a UC Davis family planning physician who led the study, said the results indicate that taking mifepristone without following through with the second regimen could be harmful for women.
“The study really raised serious safety questions about not completing the evidence-based medical abortion combination regimen,” Creinin said. Creinin called off the study and stopped enrolling women because “this is not safe,” he said.
Since the study was cancelled, the effectiveness of progesterone could not be determined, according to Creinin.
“We could not estimate the efficacy of progesterone for mifepristone antagonization due to safety concerns when mifepristone is administered without (misoprostol),” reads the article, which will be published in January’s “Obstetrics and Gynecology” journal.
Mary Taylor, president of Pro-Life Utah, said she felt that the study highlighted the dangers of medical abortion drugs and painted “a very favorable light for the use of progesterone,” pointing out that mifepristone, not progesterone, caused the hemorrhaging.
“There is absolutely no evidence that the abortion pill reversal procedure … causes any problems,” Taylor said.
Creinin said that all evidence suggests that medical abortion is safe when both regimens are used.
“We know it’s very safe,” he said.
‘There is no reversal pill’
Prior research on the effectiveness of progesterone as a means of abortion reversal came from George Delgado, a San Diego-based physician who self-identifies as “pro-life.”
Creinin said that Delgado’s research consisted of case reports, which Creinin referred to as “the lowest level of medical evidence.” He added that Delgado’s case reports were incomplete, didn’t report the outcomes of all women who participated and were not overseen by an ethics review board.
“The evidence that’s out there is relatively invalid,” said Creinin.
David Turok, a family planning physician and director of surgical services for the Planned Parenthood Association of Utah, called research on abortion reversal “poor quality science” that lacks the scientific rigor that studies typically have.
“There is no reversal pill,” Turok said. “There is no such thing as medical abortion reversal … It has no bearing in medical practice. It’s not a thing.”
Turok said that discussion of abortion reversal is based on the idea that women seeking abortions are uninformed of the consequences of such a procedure or might change their mind after going through with an abortion. The physician said, in his experience, this is rarely the case.
“People come in and they have decisional certainty,” Turok said. “The majority of people who have an abortion know very well what they are doing.”
H.B. 141, which was sponsored by Rep. Keven Stratton, R-Orem, and Sen. Curtis Bramble, R-Provo, amended information “required to be given to ensure that a woman gives informed consent before the performance of an abortion procedure.”
The law mandates abortion-providing physicians in Utah to “inform a woman seeking an abortion of the options and consequences of … a medication-induced abortion,” as well as for the Utah Department of Health to publish materials about medical abortion options.
Similar legislation has passed in other states, including Idaho, Arkansas, North Dakota, South Dakota and Nebraska.
The health department website states that “successful pregnancies have been observed after taking mifepristone alone and then progesterone” with the qualification that “there is insufficient evidence to prove that progesterone is an effective treatment.”
Turok said he thinks mandating the health department put out inconclusive information, and requiring abortion providers to pass it on to patients, is bad policy.
“I think that providing any information that is not evidence-based and that’s potentially damaging to people is irresponsible,” he said.
As a physician, Turok said his duty is to give patient’s credible medical information and treat them with dignity.
“Legislatures interfering with medical care and consent … does not improve the quality of care and it doesn’t promote the dignity of people who want the care,” said Turok.
When asked about the UC Davis study, Stratton said the bill was drafted to be “flexible so that, if other information became available, that it would be shared with (women seeking an abortion) as well.”
“I think we need to certainly look at all the information we have and analyze it and make sure it’s available to the mothers and those who are making those decisions,” the representative said.
He added that legislators “relied on good medical providers to advise us as we (drafted) the bill” and doesn’t see a need to amend the bill at this time.
“I certainly wouldn’t make a decision (about amending the bill) based on the information I have so far,” Stratton said.
Taylor, of Pro-Life Utah, said she still supports the 2017 legislation.
“More than ever,” Taylor said.
Katie Matheson, communications director of Alliance for a Better Utah, a nonprofit that “holds politicians accountable and advocates for progressive policies,” said legislators should only put forward bills that are actively supported by scientific research.
“Legislators are passing legislation based on ideology and not based on fact,” Matheson said. “And that could potentially be very harmful to women in Utah.”