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Failed Study Proves What We Already Know: “Abortion Pill Reversal” Is an Unsupported Claim

| Reproaction

By: Angie Marie Luna

Recently, abortion pills have been targeted with a claim without scientific support, claiming it’s possible to “reverse” a medication abortion. For those unfamiliar with the medication abortion process in a clinic setting, it consists of taking two drugs: mifepristone and misoprostol. Mifepristone, which goes by the brand name Mifeprex, is taken first and blocks the hormone progesterone which is needed for pregnancy to continue. About 24 to 48 hours after taking mifepristone, the second medication called misoprostol, often marketed as Cytotec, should be taken to complete the abortion. This pill softens the cervix and can induce contractions to expulse pregnancy tissue, terminating the pregnancy.

The anti-abortion physician Dr. George Delgado is credited with developing the unproven theory of “abortion pill reversal.” His development of the regimen has amounted to a series of poorly designed, unethical experiments – his second study had no ethical oversight board approval, which is a requirement for medical research on humans. Delgado’s claims are not supported by science, despite a paper he published in 2012 [1] detailing only six patients, four of whom continued their pregnancy once they received progesterone after taking mifepristone. Any real scientist knows that this study cannot be generalized to the population considering the sample size was extremely small and thus highly unlikely to be representative of the population of people that need access to abortion in this country. Delgado then conducted additional research in 2018 [2] where he included 754 patients, of whom 27 percent were excluded for various reasons. However, both studies were flawed in that they did not include a control group, and it’s highly possible that some of the patients weren’t fully aware that they were being experimented on. [3,4] The New England Journal of Medicine also critiqued the validity of Delgado’s experiments. [5] The journal that originally published his second study pulled it after learning that the review board approval was lacking. [6]

Recently, researchers at the University of California, Davis, conducted a study to test Delgado’s claims. [7] Unfortunately, the study had to be stopped after only 12 women had enrolled because three women had to be transported to the hospital for treatment of severe vaginal bleeding. At that point, researchers decided that the risk of participation for the women was too great to continue with the study, though it met other requirements for safety and ethical oversight. Dr. Mitchell Creinin, a professor of obstetrics and gynecology at UC Davis and lead researcher on this study, stated that, “encouraging women to not complete the regimen should be considered experimental … we have some evidence that it could cause very significant bleeding.” [8] Elsewhere, Dr. Daniel Grossman, an OB-GYN and director of the research group Advancing New Standards in Reproductive Health stated, “All of the evidence that we have so far indicates that this treatment [so-called “abortion pill reversal] is not effective.” Furthermore, the American Congress of Obstetrician and Gynecologists says there’s no evidence the procedure actually works to stop an abortion from happening. They also warn no one knows what the side effects of taking progesterone could be.

Delgado claims that “abortion pill reversal” can help abortion seekers who change their mind after taking the first step in the medical abortion process. Interestingly enough, research has proven that 99 percent of women who have abortions do not regret them. [9] Reproductive health advocates are worried about stigmatizing lies about abortion regret, but also that Delgado’s claims are giving a false impression that the procedure can be easily reversed if one changes their mind. This may encourage people to seek abortions before they are ready to do so. More importantly, not finishing the two-drug regimen could in fact be dangerous, as Creinin’s prematurely-ended study suggested.

An important flaw in Delgado’s research is that it is not clear from the paper if patients were informed the treatment was experimental. Unfortunately, as Grossman states, “We know that abortion patients are more likely to be women of color and low-income women” and these populations “have had research performed on them that was clearly unethical.” [10] Some of the unethical procedures performed include use of Black enslaved women for non-consensual medical research on plantations in Alabama, early birth control pills tested on Puerto Rican women without their consent, [4] forced sterilization of Mexican women in Los Angeles, [11] and recently, imposing the experimental practice of “abortion pill reversal” on an unwitting refugee seeking abortion care at a detention facility in Texas. [12] You can read more about how the myth of “abortion pill reversal” perpetuates mistreatment of women of color here. Unfortunately, despite all these grave concerns, many states are forcing doctors to promote “abortion pill reversal.

Doctors are supposed to “do no harm” and inform patients of all their options, not provide them with coercive, false information. We must stand up to legislation aiming to damage abortion access and expose the harm these laws can pose, especially to low-income patients and people of color.

Sources:

  1. https://www.ncbi.nlm.nih.gov/pubmed/23191936
  2. https://www.ncbi.nlm.nih.gov/pubmed/30831017
  3. https://www.acog.org/-/media/Departments/Government-Relations-and-Outreach/FactsAreImportantMedicationAbortionReversal.pdf
  4. https://truthout.org/articles/abortion-pill-reversal-myth-perpetuates-mistreatment-of-women-of-color/
  5. https://www.nejm.org/doi/full/10.1056/NEJMp1805927
  6. https://www.newsweek.com/abortion-reversal-study-didnt-receive-ethical-approval-1031845
  7. https://journals.lww.com/greenjournal/Fulltext/2020/01000/Mifepristone_Antagonization_With_Progesterone_to.21.aspx
  8. https://www.npr.org/sections/health-shots/2019/12/05/785262221/safety-problems-lead-to-early-end-for-study-of-abortion-pill-reversal
  9. https://www.thedailybeast.com/99-percent-of-women-dont-regret-their-abortions
  10. https://www.vox.com/identities/2019/11/11/20953337/abortion-pill-reversal-ohio-bill-law-pregnancy
  11. http://newsroom.ucla.edu/stories/ucla-professor-s-film-documents-forced-sterilization-of-mexican-women-in-late-60s-l-a
  12. https://www.huffpost.com/entry/opinion-sherman-abortion-reversal_n_5aa021a3e4b0e9381c14bc8b?_guc_consent_skip=1579234987
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