Legislation requiring doctors to tell their patients that a medication abortion can be reversed is cropping up across the country.
Already in 2017, Colorado, Georgia, Indiana, Idaho, and North Carolina have introduced versions of the so-called abortion reversal legislation. In March, Utah became the latest state to pass a law addressing discontinuation of a medication abortion. Arkansas, South Dakota, and Arizona have similar laws on the books, but a court challenge ultimately led Arizona to amend its law, significantly toning down the language on reversal.
Bill language differs by state. Arkansas, for example, mandates that physicians tell patients it’s possible to reverse the effects of a medically induced abortion and requires that doctors provide resources to help women find professionals to aid the reversal. The Arkansas law is based on a controversial method of stopping the effects of a medication abortion by flooding a woman’s body with progesterone after she has taken mifepristone, the first of two drugs to trigger pregnancy termination.
Utah’s law meanwhile, requires that physicians explain “the options and consequences of aborting a medication-induced abortion” and inform women that mifepristone alone is not always effective in ending a pregnancy. Women who have not yet taken the second drug and who are questioning their decision are encouraged to immediately consult their physician, according to the statute.
Calling the Utah measure an “abortion reversal law” is an inaccurate overreach, said Sen. Curt Bramble (R-Utah) who cosponsored the bill. A previous version included language about the potential of progesterone in reversing a medication abortion, but that section was removed after conferring with local physician groups, Sen. Bramble said.
“The purpose of this bill is to provide the most accurate information for a woman contemplating terminating a pregnancy,” Sen. Bramble said in an interview. “I want to make certain that women, if they decide to take the life of that unborn child, that they’re doing so in light of all the available information. If they take mifepristone, and they have second thoughts, that they’re aware that [the pregnancy may still be viable]. What this bill does is hopefully provide them that information before they make the decision to take the drug.”
The Utah law sounds more reasonable than other state legislation, but the measure could still be problematic for physicians and patients, said Daniel Grossman, MD , a professor at the University of California, San Francisco, and director of the university’s research group, Advancing New Standards in Reproductive Health.
“Generally, when a physician’s going to be providing an abortion, the physician wants to be very sure that the woman is certain about her decision and wants to address any areas of uncertainty and resolve those before moving forward,” Dr. Grossman said in an interview. “[Utah’s law] kind of implies that if you’re not sure, you can still go forward, and you may still have another chance at continuing the pregnancy. It sends a mixed message to women.”
The sudden volume of bills regulating what physicians should say about medically induced abortions is surprising, said Elizabeth Nash , senior state issues manager for the Guttmacher Institute, a reproductive rights research organization.
“Last year, we thought this kind of counseling requirement wasn’t going to be a trend,” Ms. Nash said in an interview. “Yet, there’s been much more energy around these bills this year. Typically, around abortion legislation, you see similar language pop up in various states. In this case, the bills don’t mimic each other at all. I think it’s because some of the bills are trying to account for the fact there is very little scientific evidence to support this idea, so they’re trying different approaches to craft language that could withstand a legal challenge.”
Kristi Hamrick of Americans United for Life , an antiabortion legal organization, said such laws protect women’s rights to know about the chemicals prescribed to them. AUL has developed model legislation on the issue and several states have based their laws on it, according to Ms. Hamrick.
“Anyone who has ever had a surgery or taken a powerful drug knows that it’s common practice to be told all the possible implications and side effects,” Ms. Hamrick said in an interview. “Women should be given all the facts about the drugs sold to them. It’s commonsense, common practice in other settings, and we should trust women with the science.”
She points to AbortionPillReversal.com , a website that assists women in locating physicians trained in the reversal process. San Diego–based family physician George Delgado , MD, who operates the website, said he has a forthcoming research study that will detail 300 successful reversals of mifepristone and that will also show that the success rate using best protocols is between 60% and 70%. The upcoming study builds on a case series he published in 2012 showing that four out of six women who took mifepristone carried their pregnancies to term after receiving 200 mg of intramuscular progesterone ( Ann Pharmacother. 2012 Dec;46[12]:e36 ).
Dr. Delgado said he applauds legislation requiring physicians to tell patients about the reversal option. “My feeling is that any woman who takes mifepristone has the right to know there is an option for reversal if she changes her mind,” Dr. Delgado said. “These state legislatures that have passed these laws are trying to ensure that.”
But the American Congress of Obstetricians and Gynecologists states that claims of medication abortion reversal are not supported by the body of scientific evidence, and the approach is not recommended in ACOG’s clinical guidance on medication abortion. In their fact sheet on the issue, they specifically rebut Dr. Delgado’s evidence, noting that it describes only “a handful of experiences” involving varying regimens of injected progesterone, and that it was not a controlled study.
Further, a 2015 study led by Dr. Grossman found that evidence is insufficient to determine whether treatment with progesterone after mifepristone results in a higher proportion of continuing pregnancies, compared with expectant management ( Contraception. 2015 Sep;92[3]:206-11 ).
“As our paper lays out, there’s really no medical evidence that any kind of treatment given to women after taking mifepristone increases the likelihood that pregnancy will continue,” Dr. Grossman said. “It’s very concerning that these laws are being passed based on nonexistent evidence. It essentially forces doctors to tell patients about an unproven therapy and pushes them toward participating in an unmonitored research study.”
Any law that requires a physician to make false statements to patients creates a barrier between the doctor and the patient, said Sarah Prager, MD , director of the family planning division and family planning fellowship at the University of Washington, Seattle.
“These laws get in the way of a strong doctor-patient relationship and harm doctors’ ability to use their medical judgment and practice evidence-based medicine,” Dr. Prager said in an interview. “It could be difficult for patients to trust their doctors if we are legally required to give them information that has no basis in medical evidence.”
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