As “Abortion Reversal” Laws Spread, Doctors and Scientists are Pushing Back
The abortion drug mifepristone, also known as RU486, is pictured in an abortion clinic. (Phil Walter/Getty Images)
When North Dakota passed its “abortion reversal” law, Tammi Kromenaker geared up for a fight.
This March, North Dakota joined a swell of states requiring doctors to tell patients that they can reverse medical abortions. The bill is based on a contested study that the American College of Obstetricians and Gynecology (ACOG) said doesn’t meet scientific standards.
However, “abortion reversal” laws passed in five states this year.
This isn’t the first time that Kromenaker — the clinical director of the Red River Clinic, North Dakota’s only remaining abortion provider — has seen the state use dubious science to restrict abortion access. In 2013, North Dakota banned abortion after 20 weeks, prompted by a disputed study about fetal pain. It also unsuccessfully tried to end abortions after six weeks based on the idea that a heartbeat can be detected at that time.
This time, though, Kromenaker would have a powerful ally in combatting the law: the American Medical Association, the nation’s leading physicians’ group.
“It really shows how dangerous some of these laws have become when an organization that has not traditionally been involved says, you know, enough is enough,” Kromenaker said.
In June, the Red River Clinic joined the AMA and the Center for Reproductive Rights in a lawsuit challenging the state’s abortion reversal bill and another existing law that requires doctors to tell patients that an abortion terminates “the life of a whole, separate, unique, living human being.”
The AMA said that both laws infringe on doctors’ First Amendment rights and their ability to give sound medical advice to patients.
“North Dakota’s laws undermine the patient-physician relationship, because it requires physicians to mislead and misinform their patients with messages that contradict reality and science,” said Dr. Patrice Harris, the AMA’s president. “This intervention is about freedom of speech.”
As “abortion reversal” laws have spread to eight states despite inconclusive research, scientists and groups like the AMA are pushing back.
Behind the “Science”
Abortion reversal laws can be traced back to the work of Dr. George Delgado, a medical advisor for the Abortion Pill Rescue Network. In 2012, he published a report claiming that progesterone could reverse the effects of mifepristone, the first of two drugs women take in a medical abortion. The study was based on the experiences of seven patients, four of whom ended up giving birth. None of the women took misoprostol, the second drug administered in a medical abortion.
Delgado co-authored a second study in 2018 that tracked 547 women who took progesterone within 72 hours of ingesting mifepristone. Nearly half of the women were able to carry their pregnancies to term. However, the study was far from conclusive on the success of abortion reversal. Like the first study, none of the women took the final drug in the regimen. According to ACOG, there is a 30 to 50 percent chance that a woman will carry her pregnancy to term if she does not take misoprostol.
In both studies, Delgado’s findings failed to meet clinical standards due to several inconsistencies, including a lack of a control group, which Delgado said he couldn’t implement because of ethical concerns. ACOG cited flaws such as small sample sizes and a lack of an ethics review committee, which are needed to meet the scientific standards of clinical research.
Despite these inconsistencies, state lawmakers herald Delgado’s work when lobbying for abortion reversal laws. Aziza Ahmed, a law professor at Northeastern University, explained that his studies are an example of the expansion of “pro-life” science.
“They’ve done their best to legitimize their ideas through traditional means like peer-reviewed journals,” Ahmed said. “It’s almost like they’re using the science to undo the science.”
The Legal Challenge
Typically, the AMA stays out of the fray when it comes to abortion.
According to the organization’s policy, physicians should perform abortions based on good medical judgement and should not be “required to perform any act violative of personally held moral principles.”
The AMA took a controversial stand when it endorsed a ban on “partial-birth abortions” in 1997, involvement that was frequently used to rally support for the legislation. However, investigators hired by the organization later found that the AMA had “blundered” in its handling of the bill, abandoning its previous positions and failing to meet internal criteria.
Since 2000, the AMA has submitted amicus briefs in 14 abortion-related cases, including one challenging Arizona’s abortion reversal law that was later repealed. The AMA is also currently challenging the Trump administration’s restrictions on family planning services under Title X in Oregon.
Some experts see the more aggressive legal stance as a sharp change for the organization.
“A lot of the lawsuits you see related to abortion are from explicitly pro-choice organizations and abortion providers,” said Mary Zeigler, a historian who focuses on reproductive law. “So for the AMA to be on the frontlines like this is very unusual.”
Harris, the AMA’s president, said that the growing number of abortion reversal laws contributed to her organization’s decision to intervene in North Dakota’s reversal law.
“After scanning the environment and seeing the laws in other states, we decided that it was time for AMA to engage,” Harris said. “We will not sit idly when there is any intrusion to the patient-physician relationship or our ability to give our patients that information they trust us to give.”
In the lawsuit, plaintiffs cited a previous Supreme Court ruling about a California law mandating that crisis pregnancy centers disclose information about other options for pregnancy, like abortion. The court ultimately ruled that the government cannot regulate the speech of medical professionals.
North Dakota’s reversal law was set to go into effect on Aug. 1, but the judge was unable to come to a decision in time. The state agreed not to enforce the law until the judge decides on the case in the coming weeks.
Harris said that though she can’t predict how the judge will rule in the North Dakota case, the AMA is committed to protecting the right to sound medical advice.
“We will oppose any law or regulation that interferes with our ability to talk to our patients openly and honestly about evidence that is science-based,” Harris said.
Back in the Lab
As abortion reversal laws become more common, doctors and medical professionals are looking into the science behind them.
“I’m concerned that the proliferation of information about this potential treatment might make patients unsure or less sure of their decision to take the medication, because they think they might be able to reverse it if they change their mind,” said Dr. Daniel Grossman, an OB-GYN and professor at the University of California, San Francisco.
Grossman re-analyzed the data from Delgado’s initial report and could not find evidence that taking progesterone was any better than not taking misoprostol.
“This goes beyond telling a patient about a risk, we’re being forced to tell patients about a treatment that is unproven and experimental,” Grossman said.
Michael Creinin, a medical researcher studying medical abortions at the University of California, Davis, is taking the probe on Delgado’s work a step further by conducting his own study into abortion reversal. Creinin will spend the next year studying whether the treatment holds up in a clinical study, backed by a research grant from the Society of Family Planning.
It will be first clinical study that meets widely-held scientific standards, and will include the use of a control group and double-blind testing to study the effects of progesterone on reversing abortions. The clinical trial has already been approved by UC Davis and registered with the U.S. National Library of Medicine. The findings of the study will be published next year.
“I’m doing this study because even though I may think it doesn’t work, there’s a possibility that it does and the only way to know the answer is to correctly do the study,” Creinin said.