Talking about abortion reversal, which is not evidence-based, could sow more confusion – exactly the intended effect by anti-abortion forces

‘Abortion reversal: there is no evidence that flooding the body with progesterone increases the chance of continuing the pregnancy’.
 ‘Abortion reversal: there is no evidence that flooding the body with progesterone increases the chance of continuing the pregnancy’. Photograph: Rex 

For years, the anti-abortion movement has popularized the myth that patients regret their abortion, or are somehow coerced into having the procedure before they are ready. This falsehood forms the foundation for many restrictive laws that states have enacted in recent years, including requirements to make an extra visit to the clinic before the procedure, or wait up to 72 hours after receiving counseling before the abortion can be performed.

The latest tactic to advance this argument is the so-called abortion reversal – an unproven treatment that supposedly counters the effect of mifepristone, the first pill used in the two-drug regimen of medication abortion. “Reversal” advocates claim this therapy can give patients a “second chance” to keep their baby.

Despite the hype, there is no evidence that flooding the body with progesterone – a hormone pregnant patients already have a lot of – increases the chance of continuing the pregnancy. In fact, in the extremely rare case that a patient changes their mind before taking the second pill, watchful waiting and inaction appears to be just as effective as the “reversal” treatment.

The single published report documenting the experience of just six women who underwent this therapy was not done with the oversight of an ethical review committee, which is standard for this kind of research. Yet due to the advocacy efforts of anti-abortion forces, doctors in Arkansas, South Dakota and Utah are required by law to tell patients seeking abortion about this unproven therapy, essentially encouraging them to participate in an unmonitored research project.

Such laws are a troubling intrusion into the doctor-patient relationship, and are gaining traction in conservative state legislatures.

Despite the stories of indecisiveness and regret around abortion that form the cornerstone of anti-abortion rhetoric, evidence from published research indicates that most women are very sure of their decision. A recent study led by researchers at the University of California at San Francisco found that women seeking abortion had high levels of certainty around their decision as measured by a scale that has been used in other healthcare settings. In fact, patients seeking abortion were more certain than those making decisions about reconstructive knee surgery or prostate cancer treatment.

Many abortion patients would recognize themselves in Kelsea McLain, who first realized she was pregnant in 2010. She immediately knew she wanted an abortion. She called a nearby Florida clinic to schedule a medication abortion, which would give her the ability to terminate safely in the privacy of her own home. But she was unemployed, on a fixed income and couldn’t afford the $500 cost. Her health insurance wouldn’t pay for the abortion.

Afraid to tell her family, McLain looked into other options. On a friend’s suggestion, McLain tried taking vitamin C and dong quai root for a week. “I drank a lot of orange juice and it didn’t do anything except for make me feel like I was destroying my stomach,” she said. She finally turned to family members who helped her pay for the abortion.

When McLain, now 31, became pregnant in 2016, she knew medication abortion was again the right decision for her. “I absolutely knew what I wanted to do both times,” said McLain. “There was no hesitation, or even a pause when I was at the clinic both times. I was eager to take my medication.”

At the core of “abortion reversal” is a desire to undermine the high level of decision certainty among people seeking the service. And let’s not forget who abortion patients are: nationally, three-fourths are low-income and the majority are women of color. Our nation has a shameful history of medical experimentation on poor black and Latina women, and it is particularly concerning that some state governments are promoting another experimental therapy in these same populations.

Additionally, discussing the theoretical option of abortion reversal with patients subverts the counseling process, which is aimed at ensuring that patients will only proceed with abortion once they are certain of their decision. Talking about abortion reversal, which is not evidence-based, could sow more confusion – exactly the intended effect by anti-abortion forces. It is dangerous and unethical.

The anti-abortion movement may also be promoting this spurious science because of its fear of the abortion pill. Use of medication abortion has steadily risen in the US, now representing almost half of all eligible procedures. It has the potential to radically transform the way patients access and experience abortion by moving it out of a clinic and more directly into the hands of the user. It also challenges the anti-abortion movement’s longstanding strategy of demonizing clinicians who perform surgical abortion and the instruments they use.

Inspired by the care she says she received during her first abortion, McLain began volunteering and now works at a North Carolina independent abortion clinic where she counsels their 20-40 medication abortion patients a week. “Medication abortion is really a magical solution for a lot of people,” McLain said. “Medication reversal is just another tool used to confuse and manipulate people.”

Over the past five years working at the clinic, she has seen only one patient express remorse immediately after swallowing the abortion pill. McLain and the clinic staff helped the young woman to vomit the medication and counseled her on what to do if she began to abort.

McLain says she did hear from the patient again: one week later when she came back to the clinic for a surgical abortion.

https://www.theguardian.com/commentisfree/2017/aug/02/abortion-pill-reversal-anti-choice-activism?utm_source=nar.al&utm_medium=urlshortener&utm_campaign=FB