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Medical groups voice concern over medication abortion 'reversal' laws

Several states have passed legislation requiring abortion providers to tell women seeking medication abortion the medically unfounded claim that the abortion can be reversed, spurring concerns from medical groups, STAT News reports.

A medication abortion is a two-step process in which a woman first ingests mifepristone and then, a few days later, takes a second drug called misoprostol (Graham, STAT News, 4/21). Last month, FDA approved a new label for the medication abortion drug Mifeprex that better aligns it with scientifically proven, evidence-based medicine (Women's Health Policy Report, 3/31).

'Abortion reversal' claims

George Delgado, medical director of an antiabortion-rights clinic, over the last few years has promulgated an unproven process in which women who want to stop a medication abortion after ingesting the first drug receive multiple injections of progesterone. Delgado's clinic works with 300 physicians throughout the United States to offer this process to women.

Delgado based his claim on a 2012 study involving only seven pregnant women who received progesterone injections after ingesting the first medication abortion drug. The pregnancies of two women ended shortly thereafter, one woman was lost to follow up and four women delivered healthy infants. According to STAT News, the study authors concluded that their process could be "standard of care" for women who did not want to complete the medication abortion process, even though the study had exhibited multiple serious flaws, including the extremely small sample size, the incomplete data and the lack of a control group.

However, a 2015 study published in Contraception found that only 53 to 88 percent of women who take only the first drug in a medication abortion complete the abortion, meaning that a woman who does not take the second drug in a medication abortion might keep her pregnancy regardless of whether she receives progesterone injections. According to STAT News, women often must take the second drug, misoprostol, to complete the abortion.

Conservative states adopt medication abortion 'reversal' laws

An antiabortion-rights group has crafted model legislation to require physicians to tell women seeking medication abortion about this process, STAT News reports. States that have adopted such legislation include Arizona, Arkansas and South Dakota. The courts have temporarily blocked the law (SB 1318) in Arizona.

According to STAT News, medication abortion 'reversal' laws are one of several types of restrictions abortion-rights opponents are using to target medication abortion access. The efforts come in conjunction with increasing state restrictions on clinics offering surgical abortion services.

Medical groups voice concern

The American Medical Association and the American Congress of Obstetricians and Gynecologists have voiced concerns about the medication abortion "reversal" process, stating that "there is no credible, medical evidence" supporting its efficacy.

Daniel Grossman -- a professor of obstetrics and gynecology at the University of California-San Francisco and co-author of the 2015 study -- also expressed concerns, saying, "As physicians, we can't just experiment on patients willy-nilly." He explained that physicians offering to reverse a medication abortion are "essentially testing an unproven, experimental protocol on pregnant women."

Sarah Stoesz, president of Planned Parenthood Minnesota, North Dakota, South Dakota, said because the medication abortion "reversal" process lacks scientific evidence, requiring a physician to tell a woman seeking a medication abortion about it violates a patient's right to receive sound medical information.

Separately, Beverly Winikoff, a physician and president of Gynuity Health Projects, said, "It looks like progesterone may not do anything, but we can't really know because we'd need to compare women who got mifepristone alone with women who got mifepristone and progesterone, and that study hasn't been done."

Courtney Schreiber, an associate professor of obstetrics and gynecology at the University of Pennsylvania's Perelman School of Medicine, cited the possible, though uncommon, side effects of progesterone, including maternal depression and hypertension. Schreiber, who testified against the Arizona law, also noted that there is currently no research on how the combination of mifepristone and progesterone could affect fetal development (STAT News, 4/21).