Our last couple of blog posts have covered specific observations about our experiences protesting crisis pregnancy centers (CPCs), and the lessons learned from those events have been important in informing our subsequent events. Since our last post, Reproductive Transparency Now (RTN) has held three additional protests, tabled at an event attended by more than 350 people, and spoken at a press conference denouncing the Texas abortion ban (SB 8).
Outside of the RTN sphere, major developments have been brewing with regards to the public’s understanding of CPCs. Most notably, a major study was released at the end of October 2021 which examines the crisis pregnancy center situation in nine states. We are planning to further explore many of the findings in this study, but one specific topic rose to the top of the list: abortion pill reversal. Due to the significant and medical nature of this topic, it is important that we call attention to the following disclaimer:
IMPORTANT DISCLAIMER: Reproductive Transparency Now’s website does not provide medical advice. The content of this website is provided for reference and educational purposes only and is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. This website is not an attempt to practice medicine or provide specific medical advice, and it should not be used to make a diagnosis or to replace or overrule a qualified health care provider's judgment. The content on this website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified and licensed physician or other medical care provider and follow their advice without delay regardless of anything read on this website.
The above disclaimer is extremely important when it comes to discussing healthcare issues, because transparency is crucial when it comes to making important medical decisions. It is worth noting that I have yet to find a disclaimer of this nature on the website for a crisis pregnancy center or one of its affiliates, including the one we will discuss in more detail here. [editor's note, added on 11/17/21: RTN found a brief disclaimer on The Women's Center website after the publication of this blog post. It is a two-line statement at the very bottom of a long webpage filled with lies about abortion. While we regret the oversight, we maintain that the disclaimer is inadequate for informing their audience and placed in an inconspicuous location]
I had some grand ambitions to write a detailed exposé on the promotion of abortion pill reversal, which is also sometimes shortened to “APR”. But frankly, there is so much misleading information and dishonesty to unpack that it cannot be done in a single blog post (nor should it be). Instead, I’m going to focus on a few key findings that I encountered while scouring the internet for basic information.
But first, a primer: "Abortion pill" is a commonly-used term that refers to two medications that are taken sequentially to terminate an early pregnancy. The first medication is called mifepristone (brand name: Mifeprex). The second medication, which is generally taken 24-48 hours later, is called misoprostol (brand name: Cytotec). For a more detailed explanation, visit the Kaiser Family Foundation website or the Planned Parenthood website.
Although the recent mention of abortion pill reversal in the “Designed to Deceive: A Study of the Crisis Pregnancy Center Industry in Nine States”—published just last month by The Alliance: State Advocates for Women’s Rights & Gender Equality—prompted me to make this the topic of today’s blog, I have been aware of the issue for nearly two years. From where did I first hear about abortion pill reversal? This answer probably will not surprise you given our organization’s mission: I learned about it from the anti-abortion protesters standing outside of a local abortion clinic.
One of the go-to messages from these anti-abortion protesters is to say, “It’s not too late to save your baby! Go to AbortionPillReversal.com!” They also hand out printed materials and pamphlets which encourage patients to visit crisis pregnancy center down the street. The card below was handed to us directly by one such frequent anti-abortion protester.
The fact that I have only heard about abortion pill reversal from anti-abortion protesters should be enough of a red flag. But I am naturally curious and wanted to dig a little deeper into the claim that pro-lifers have the “antidote” (yes, that’s a quote from a CPC website) to the first step of a medication abortion. I figured the best place to start would be where these claims are being made—CPC websites.
Over the past month, our organization has held a total of five protests outside of a local CPC called The Women’s Center. I will not be providing a link to their website for obvious reasons, but you will find it interesting to know that their website URL is abortionchoices.com. That’s right, they put “abortion” and “choices” right in their web address. In the top menu of their homepage, you can find a link to a page titled “Abortion Pill Reversal FAQ”.
As of the date of this publication, the webpage contains 19 questions and answers which are attributed to the Abortion Pill Reversal website mentioned earlier (promoted by the clinic protester). We’re only going to touch on two of those questions in this particular post because it will give you enough to chew on for at least the next week.
In the image above, you can see that the very first question on the webpage is “What is abortion pill reversal?” My eye went straight to the three linked citations and my first instinct was to click on them. But proceed with caution: If you click on the actual numbers 1, 2, or 3, you are taken to the website for an organization called Pro Life Ribbon where all the same exact content is listed. Instead, you’ll want to start a fresh Google search for the original sources or use the links provided below.
Citation #1: Mifeprex REMS Study Group. Sixteen Years of Overregulation: Time to Unburden Mifeprex. NEJM 2017; 376:790-4. DOI: 10.1056/NEJMsb1612526
I’ll be the first to admit my shock that a CPC website cited an actual article from the New England Journal of Medicine. But…wait…hold on just a second here. This paper has absolutely NOTHING to do with abortion pill reversal; in fact, the paper argues that mifepristone (the first of two drugs administered for a medication abortion) is very safe and is being over-regulated by the Food & Drug Administration (FDA) via Risk Evaluation and Mitigation Strategies (REMS). The paper takes it a step further, asserting that the unnecessary REMS requirements for the drug cause delays in treatment that may then require the patient to seek a surgical abortion instead.
Bottom line #1: Advocates of abortion pill reversal cite a paper from the New England Journal of Medicine as a way to appear credible, but the information in the paper is completely unrelated (at best) and contradictory (at worst) to the pro-life propaganda on their website.
Citation #2: The “Medical Abortion” page on the Mayo Clinic website (mayoclinic.org)
Again, I was surprised to see a reference to such a reputable source on a CPC website. Mayo Clinic is the real deal. But…wait…hold on. There is absolutely NO MENTION of abortion pill reversal on this Mayo Clinic webpage either. In fact, there is a sentence which specifically states: “You must be certain about your decision before beginning a medical abortion. If you decide to continue the pregnancy after taking medications used in medical abortion, your pregnancy may be at risk of major complications.” I think what bothers me most about this is another FAQ on the CPC website (see below).
Bottom line #2: Abortion pill reversal propaganda encourages people who have taken mifepristone to disregard the medical advice of a licensed medical professional who is treating the patient in favor of following the advice of a questionable pro-life hotline. This is blatantly irresponsible.
Citation #3: Practice Bulletin No. 143: Medical Management of First-Trimester Abortion. Obstetrics & Gynecology 2014; 123:676-92. DOI: 10.1097/01.AOG.0000444454.67279.7d
This one threw me for a loop. Despite being listed on multiple pro-life propaganda websites as of November 7, 2021, this particular document is listed as being “withdrawn or no longer available”. I was able to figure out quickly that there was a good reason for this. It turns out that Practice Bulletin No. 143 was replaced by a revised document in October 2020, Practice Bulletin No. 225: Medication Abortion Up to 70 Days of Gestation. Obstetrics & Gynecology 2020; 136: e31-e47.
You may recall that the first two citations discussed in this post were used in an FAQ about abortion pill reversal even though neither one included any mention of the process. I guess the third time’s the charm because this time, the article does briefly mention the use of progesterone to continue a pregnancy after taking mifepristone.
But…wait…hold on. Go to page e33, near the bottom of the left-hand column. The bulletin states two important points and cites three scientific sources in the process: 1) There is no evidence to suggest that taking progesterone after mifepristone (i.e., “abortion pill reversal”) will increase likelihood of a pregnancy continuing, and 2) The limited evidence available suggests that taking mifepristone without the subsequent dose of misoprostol may be associated with an increased risk of hemorrhage. That second point is supported by the results in this randomized controlled trial, which stopped enrolling patients in 2019 due to safety concerns.
Bottom line #3: The American College of Obstetricians and Gynecologists (ACOG) clearly states that there is no evidence to show that “abortion pill reversal” is effective and, furthermore, that discontinuing a medication abortion before taking misoprostol could lead to increased health risks. Therefore, the claims made by CPCs about abortion pill reversal are disproven by the very same sources that they cite on their own websites.
That was a lot of information, and we are just scratching the surface. Hopefully this information was thought-provoking enough for you to understand more about why those of us in the pro-abortion/pro-choice movement are so disturbed by the crisis pregnancy center industry in the United States (and elsewhere).
We will continue our mission to raise awareness about these centers and, in the meantime, we hope you do NOT purchase any signs for your front yard promoting abortion pill reversal (yes, this is real life).
Seriously, how is this real?
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