There’s no conclusive evidence that it’s possible to “reverse” a medication-induced abortion, but six states have laws on the books that require abortion providers suggest it might be an option anyway.
Now, a study published last week is raising questions about the dangers of even attempting an “abortion reversal.” The study, which sought to determine whether medication abortions can be halted with a hormone, instead ended early after three women started hemorrhaging so much blood they went to the ER.
Despite these findings, multiple state legislators are standing by laws mandating providers tell patients about the possibility of reversing their abortions. VICE News reached out to dozens of lawmakers who had supported that kind of legislation in Arkansas, Idaho, Kentucky, Nebraska, South Dakota, and Utah. VICE News also reached out to legislators in North Dakota and Oklahoma, where court challenges have temporarily blocked similar laws from going into effect.
Just five of those legislators replied to inquiries. Four were adamant that there’s no need to amend the laws.
“It is up to the woman to decide if she wishes to take the risk. So for me, you know, it’s informed consent,” said Oklahoma state Sen. Julie Daniels, who sponsored a law requiring abortion clinics post a sign about abortion reversal, with contact details for an anti-abortion group.
Daniels, a Republican, told VICE News she had “no regrets at all for authoring this bill.”
“There are many procedures that could have harmful effects,” she said. “I think it’s troubling that if ever we’re attempting to save a child, that these things become so important, but for other medical procedures, we take it as part of the risk that something might not go correctly. But for those of us who propose trying to save the child, we appear to be held to a higher standard of perfection.”
Typically, in a medication abortion, a patient would end her pregnancy by taking doses of two drugs, mifepristone and misoprostol, several hours apart. But if a woman regrets her abortion after taking mifepristone, proponents of abortion reversal say she can skip the misoprostol and instead try progesterone.
While those supporters have published a few studies that they say show that progesterone can work, abortion reversal is not recommended by the American College of Obstetricians and Gynecologists. Experts have also said that one of those studies was poorly designed. Another involved just seven patients.
So researchers from the University of California, Davis, had planned to enroll 40 women in what’s thought to be the first randomized, double-blind study on abortion reversal.
The women who participated in the UC Davis study took mifepristone before receiving either progesterone or a placebo. (All of them were ultimately set to undergo surgical abortions.) But the study only enrolled 12 women before three of the patients started bleeding from their vaginas so severely they had to be taken to the ER in ambulances. One woman even needed a blood transfusion. Of those women, one had taken progesterone.
The study concluded that patients who take mifepristone on its own, regardless of whether they use progesterone afterward, could be at “high risk of significant hemorrhage.”
“We don’t have any evidence that disproves the possibility that abortion reversal exists,” the study’s lead researcher, Mitchell Creinin, told VICE. “But I do have evidence that not completing the regimen as it’s designed is dangerous.”
South Dakota Republican Rep. Fred Deutsch said he still supported his state’s law, which mandates that doctors give patients a statement telling them that it may be possible to “discontinue” an abortion after taking mifepristone.
“I think it’s part of informed consent,” Deutsch told VICE News in a phone interview. “We have a whole list of items that we require physicians to provide women. For example, a woman must be informed that an abortion will terminate the life of a whole, separate, unique human being.”
In response to a question about the research he had relied on when deciding to support South Dakota’s law, Deutsch emailed links to studies that examined the efficacy and safety of misoprostol — the second drug typically taken in a medication abortion, and the drug that women who may wish to “discontinue” their abortions are not supposed to take. (Multiple studies have found that misoprostol taken alone can effectively and safely induce an abortion early in pregnancy. Using mifepristone in combination with misoprostol is more effective and generally has fewer side effects.)
“We reviewed a host of studies pertaining to both drugs. I provided you links to the drug you apparently weren't inquiring about,” Deutsch told VICE News via email when asked why he felt misoprostol’s safety was relevant to whether doctors should tell patients about a drug regimen that doesn’t involve it.
Deutsch did not reply to a request for the studies he’d looked at involving mifepristone.
Of the legislators who backed an abortion reversal bill and returned VICE News’ inquiries, only Utah state Rep. Timothy Hawkes, a Republican, said that he would be open to revisiting his state’s law. In Utah, abortion patients must receive a printed statement on how mifepristone may not end a pregnancy. While the UC Davis study “raises concerns,” Hawkes said, he still wants to do more research into this issue.
Instead of repealing the abortion reversal law entirely, Hawkes suggested amending it to include information about the potential dangers of attempting the regimen.
“We would want a woman in that situation to have access to all of that information. Is it reversible, if the science supports it? Yes, that’s good information for the woman to have,” Hawks said. “Does it raise a risk of severe vaginal bleeding that could lead to other complications? Well, that would be good information to have as well.”
“I’m no expert on the state of the medical research on this issue, either way,” he went on.
The UC Davis study has already triggered at least one attempt to repeal an abortion reversal law: Nebraska Democratic state Sen. Megan Hunt has announced that she plans to author legislation that will roll back her state’s measure when the legislature opens for its 2020 session in January.
“When we talk about procedures that are experimental, untested, we’re not talking about the morality of life,” Hunt said. “It’s possible to be an anti-abortion, Christian, right-wing conservative and oppose this bill because it’s not really about saving a child. It ends up being about hurting a mother.”
Cover: The abortion drug Mifepristone, also known as RU486, is pictured in an abortion clinic February 17, 2006 in Auckland, New Zealand. (Photo by Phil Walter/Getty Images)