A growing number of states are enacting laws requiring doctors who perform pharmaceutical abortions to inform the mothers that it may be possible to halt the abortion if they change their minds.
Now, the Center for Reproductive Rights and the American Medical Association are suing North Dakota, claiming that the state is forcing physicians to deliver misleading and nonmedical information. Authors of an article in the New England Journal of Medicine also decry these laws on the basis that the “abortion pill reversal” regimen has not been definitively proven to be effective.
The truth is that retrospective clinical studies have shown reversals to be successful more than half the time. And even though randomized and placebo controlled trials have not been performed (and indeed probably cannot be performed from an ethical perspective), the regimen offered to a woman who has changed her mind is the same offered across the world to any woman who is in the process of miscarrying a wanted child. A woman who regrets her decision to abort (and women often resort to abortion under pressure) has the right to be offered the same chance to save her baby as any other woman whose pregnancy is threatened.
A medical abortion is a two-step process. In step one, the woman ingests the drug mifepristone under the supervision of a certified prescriber, followed by misoprostol 48 hours later. The first medication blocks the hormone progesterone and cuts off the nutritional supply to the embryo. This (usually) results in its death. Step two: The misoprostol ingestion causes strong uterine contractions, expelling the fetus after up to 2-4 weeks of intense pain, hemorrhaging, diarrhea, and nausea.
This is how it all works if everything goes as planned. But up to 20% of these abortions result in significant complications. Indeed, 24 U.S. deaths have been documented since the FDA approved medical abortion in 2000. The danger of this procedure has caused the FDA to establish extensive risk-mitigating strategies. Sadly, these strategies have been unable to prevent deaths of women in all cases.
A fear of the pain, trauma, and danger of a chemical abortion may drive a woman to change her mind after ingesting the first pill. Or she may simply decide to go on with her pregnancy after mature reflection. The fact is, studies show that partners or parents often pressure women into abortion. Women can also feel hurried into a decision by personnel at abortion clinics where they’ve gone for a free pregnancy test. Overall, most women seeking abortion are dealing with difficult life circumstances; they’re facing unknowns that can cause intense anxiety. Whatever causes a woman to change her mind, she has the right to know that there is medicine that increases the possibility of her baby’s survival.
In countries across the world, pregnant women in their first trimester with bleeding and pain (threatened miscarriage) are treated with progesterone, an important hormone that supports the pregnancy. Women who miscarry usually have low levels of this hormone, and studies have shown higher survival rates with progesterone treatment. It is the same clinical reasoning that is behind the “abortion pill reversal” regimen. Because mifepristone blocks naturally occurring progesterone, provoking a miscarriage, the abortion pill reversal regimen consists simply of replacing that essential hormone for a few weeks, in hopes that the baby can be saved. Retrospective studies have shown better outcomes in both of these scenarios with progesterone administration.
The New England Journal of Medicine article complains about a lack of a randomized, placebo-controlled trial for abortion pill reversal. This kind of definitive trial does not exist for any pregnancy-saving regimens of this type. This is because, in a placebo-controlled study, a woman who is trying to save her baby would have to agree to the possibility of receiving a placebo instead of the actual drug. A woman who wants her child is not likely to agree to participate in a study that might give her a placebo instead of a hormone that could help save the pregnancy.
Neither the AMA nor the authors of the New England Journal of Medicine article claim that abortion pill reversal regimens are unsafe for the mother or the child. There is extensive evidence to support the safety of progesterone treatment for both patients. Given the safety record of abortion pill reversal (exponentially greater than chemical abortions), it is a simple matter of justice to offer all women who are miscarrying a treatment that can improve the chances of their baby’s survival.
The North Dakota law and similar ones in other states ensure that women who consent to a chemical abortion get all the information they need, including information they need if they change their minds. Women deserve to know that doctors and nurses are available to help them and that they can access the same treatment offered to mothers across the world who are hoping to one day hold their child in their arms.
Grazie Pozo Christie M.D. is a policy adviser for the Catholic Association.
