Sarah Wasko / Media Matters

Some reporting on so-called abortion reversal fails to call the procedure out as junk science

NY Times reports on abortion reversal without mentioning the junk science behind it. In July, The New York Times Magazine profiled George Delgado, the anti-abortion doctor who originated the sham “abortion reversal” procedure, without noting the dubious nature of his claims. A month later, The New York Times released a video of two women -- one who had undergone an abortion without any regrets, and another who underwent an abortion reversal procedure. In both accounts, the Times presented abortion reversal as an equivalent choice to obtaining an abortion by giving equal weight to claims from doctors for and against the procedure -- despite the large gap of scientific credibility between their positions. The Times, however, did acknowledge that “regret is quite rare when it comes to abortions in general,” but that anti-abortion groups often capitalize on it anyway to promote their agenda. [The New York Times Magazine, 7/18/17; The New York Times, 8/10/17]

Abortion reversal lacks scientific credibility or well-researched support

Doctor who developed procedure relied on extremely small sample size in published study. As Jezebel reported, Dr. George Delgado, the medical director of Culture of Life Family Services in California, and another doctor, Mary Davenport, published a paper in 2012 “that outlined seven cases of women who had taken the first pill” required for a medication abortion, but did not take the second pill. They argued that if doctors injected the women with progesterone instead of having them take the second pill, they would be able to “reverse” the abortion. According to Jezebel, Delgado and Davenport claimed that “abortion reversal was successful in four of the seven cases. Two of the women aborted and one could not be located.” Based on this small sample, Delgado began promoting abortion reversal, including setting up a hotline that he claims averages 600 calls a year and creating a network of doctors who are allegedly willing to perform the procedure. [Jezebel, 7/18/17]

The American Congress of Obstetricians and Gynecologists: “Claims of medication abortion reversal are not supported by the body of scientific evidence.” The American Congress of Obstetricians and Gynecologists (ACOG) submitted a report in 2015 on alleged abortion reversal procedures, stating, “Claims of medication abortion reversal are not supported by the body of scientific evidence, and this approach is not recommended in ACOG’s clinic guidance on medication abortion.” Notably, ACOG found that although anti-abortion advocates promote the efficacy of abortion reversal in halting an abortion procedure, simply failing to take the second pill of two for a medication abortion would yield a similar success rate. ACOG reported that 30 to 50 percent of pregnancies continue in patients who take the first abortion pill only. ACOG also pointed to problems in Delgado’s study, including that it only contained “a handful of experiences, these women received varying regimes of injected progesterone, and this was not a controlled study,” and was conducted without the “oversight of an institutional review board of an ethical review committee.” In addition, ACOG noted the potential side effects of abortion reversal, explaining, “Progesterone, while generally well tolerated, can cause significant cardiovascular, nervous system and endocrine adverse reactions as well as other side effects.” From the American Congress of Obstetricians and Gynecologists:

Reliable evidence is not available.

• A 2012 case series describes six women who took mifepristone and then had a series of progesterone injections. This paper describes a handful of experiences, these women received varying regimens of injected progesterone, and this was not a controlled study. Therefore it does not provide evidence that progesterone was responsible for the reported outcomes. In addition, there was no oversight of an institutional review board or an ethical review committee for this intervention.
• Taking mifepristone (without misoprostol) will not always cause abortion by itself, so no intervention may lead to the same result as this case series.

[...]

What the evidence suggests:

• Available research seems to indicate that in the rare situation where a woman takes mifepristone and then changes her mind, doing nothing and waiting to see what happens is just as effective as intervening with a course of progesterone.
• Progesterone, while generally well tolerated, can cause significant cardiovascular, nervous system and endocrine adverse reactions as well as other side effects. [ACOG, accessed August 2017]

Five outlets debunk the junk science behind the abortion reversal scam

Rewire: Abortion reversal “is foremost a story of how an unsubstantiated medical claim becomes health policy.” Rewire’s Sofia Resnick reported that abortion reversal “is foremost a story of how an unsubstantiated medical claim becomes health policy.” She explained that false claims about the efficacy of the procedure had resulted in several state legislatures introducing or passing laws requiring practitioners to provide patients with information about abortion reversal -- as if it were a credible medical option -- before an abortion is performed. As Resnick detailed, abortion reversal is a tactic employed by anti-choice extremists to push the myth that abortion is fundamentally linked to regret over the decision in order to eliminate abortion access. To debunk claims that abortion reversal procedures are effective, Resnick spoke to abortion provider Gabrielle Goodrick, who estimated “ that she has seen six patients out of about 10,000 who did not want to continue their medication abortions after initiating the process” in the 16 years she has been a provider. Instead of problems with abortion regret, Goodrick instead pointed to “an uptick in women trying to self-induce abortions by various means” -- a more concerning trend reflecting greater difficulties accessing abortion care following increasingly severe state restrictions. From Rewire’s March 21 piece:

[Anti-abortion] groups often claim that many women experience frequent and extreme abortion regret, something that is contradicted by studies that show women who go through the rigorous informed-consent processes required before an abortion rarely change their minds.

Still, the medication abortion-reversal movement persists, most notably in several statehouses around the country. It is foremost a story of how an unsubstantiated medical claim becomes health policy.

[...]

[Dr. George] Delgado and [Dr. Mary] Davenport’s paper circulated among anti-choice groups for a few years, until in 2015, two states—Arizona and Arkansas—amended their mandatory counseling abortion laws to require doctors to tell patients seeking abortions via medication that the procedure can be reversed if they don’t take the second drug and if they act quickly to follow the reversal protocol.

South Dakota followed suit the following year. Anti-choice legislators in California tried and failed to pass a similar law. Louisiana lawmakers entertained a similar policy, but instead passed a resolution calling for the state health department to study the same question Delgado and Davenport presumed to answer in their 2012 paper. A spokesperson for the Louisiana Department of Health told Rewire in an email that this report is still in the draft stages and not yet ready for release. Also in 2016, Arizona repealed its law after the state failed to defend the policy on scientific grounds in a lawsuit.

Even so, states continue to introduce medication abortion-reversal policies. Colorado‘s attempt earlier this year failed to pass, but legislatures are still considering similar bills in Georgia, Idaho, Indiana, North Carolina, and Utah.

[...]

While it is not unheard of for people to change their minds after initiating an abortion, in reality, it is very rare, says Arizona-based OB-family practitioner and abortion provider Gabrielle Goodrick.

In 16 years of providing abortions, Goodrick estimates that she has seen six patients out of about 10,000 who did not want to continue their medication abortions after initiating the process. Goodrick says in these cases she has told the patients not to take the second drug, and about half the time their pregnancies continued to healthy pregnancies.

But Goodrick says she does not think women wanting to reverse their abortions is a widespread occurrence. On the contrary, she says she’s seeing an uptick in women trying to self-induce abortions by various means, as a result of increasingly onerous abortion restrictions in her state.

Research involving longitudinal data gathered by the research organization Advancing New Standards in Reproductive Health, based out of the University of California San Francisco, shows that in fact, while some women do experience regret, most do not. [Rewire, 3/21/17]

The Guardian: “Evidence from published research indicates that most women are very sure of their decision.” Renee Bracey Sherman of the National Network of Abortion Funds and Daniel Grossman of Advancing New Standards in Reproductive Health wrote a piece in The Guardian discussing the extensive flaws of Delgado and Davenport’s abortion reversal claims. In particular, Bracey Sherman and Grossman noted that Delgado and Davenport’s paper included “the experience of just six women who underwent this therapy,” and that it “was not done with the oversight of an ethical review committee, which is standard for this kind of research.” They also noted that the premise of so-called abortion regret is false, as “published research indicates that most women are very sure of their decision” to have an abortion. One such patient, Kelsea McLain, “immediately knew she wanted an abortion” and “there was no hesitation or pause.” McLain, who now works at an abortion clinic, also reported that in the five years she’s worked at the clinic, “she has seen only one patient express remorse immediately after swallowing the abortion pill.” While McLain and the other clinic providers helped the patient vomit up the medication, the patient later scheduled a surgical abortion. From the August 2 Guardian piece:

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.

[...]

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.

[...]

Many abortion patients would recognize themselves in Kelsea McLain, who first realized she was pregnant in 2010. She immediately knew she wanted an 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.

[...]

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.

[...]

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. [The Guardian, 8/2/17]

Marie Claire: Experts say abortion reversal is tantamount to “experimenting on women” and lacks scientific credibility due to Delgado’s “ideological agenda.” In Marie Claire, Breena Kerr debunked Delgado and Davenport’s study by citing the opinions and findings of medical experts that have conducted credible, peer-reviewed research. For example, Dr. Diane J. Horvath-Cosper said the study "used inappropriate comparison groups, was too small to support scientific conclusions, and used data collection that was unverified, inappropriate, inaccurate, results-oriented, and without appropriate ethical safeguards necessary for human research.” Horvath-Cosper also explained, as Marie Claire described it, that “the problem with Delgado's science is that it was done backwards, with a desired result in mind—one that would support an ideological agenda” against abortion. Kerr also included pertinent details about Delgado’s nonmedical religious beliefs, including discussing an incident in which Delgado told a caller on a radio show during a 2013 guest appearance that even though the caller had AIDS, “it wasn’t acceptable to use condoms ever.” Dr. Daniel Grossman told Kerr that Delgado is “experimenting on women” with the abortion reversal procedure. From the July 12 Marie Claire piece:

[Delgado’s] case series, published in The Annals of Pharmacotherapy, included just six women. They had all begun medical abortions, changed their minds, found Delgado, and received his treatment. Four of the six delivered healthy babies. According to Delgado, those four successful pregnancies verified his claims.

Many members of the medical community disagree. They assert that the case series doesn't constitute credible, medically accepted evidence—for one, it skipped the standard protocol of a control group. It also “used inappropriate comparison groups, was too small to support scientific conclusions, and used data collection that was unverified, inappropriate, inaccurate, results-oriented, and without appropriate ethical safeguards necessary for human research,” says Diane J. Horvath-Cosper, M.D., a reproductive health advocacy fellow at Physicians for Reproductive Health. “So-called abortion reversal has not been tested for safety, effectiveness, or the likelihood of side effects.” Although progesterone is generally well tolerated, it can cause “significant cardiovascular, nervous system, and endocrine adverse reactions as well as other side effects,” according to the American Congress of Obstetricians and Gynecologists (ACOG).

David Grimes, M.D., former chief of the abortion surveillance branch at the Centers for Disease Control and Prevention, called the article little more than a “collection of anecdotes from Catholic physicians” and accused Delgado of making “numerous scientific errors” and “violating the essence of the scientific method.”

[...]

Horvath-Cosper, the health advocacy fellow, told me she thinks that the problem with Delgado's science is that it was done backwards, with a desired result in mind—one that would support an ideological agenda. “It's not unusual to have strong views,” she says. But, she argues, “high-quality science starts with a testable hypothesis; Delgado starts with his personal opposition to abortion.”

Delgado has called abortions “a scourge and a plague on our society.” He's also opposed to basic and common forms of contraception like condoms; he refers to contraception itself as “evil.” In a 2013 appearance on Catholic Answers Radio, where he has been a guest dozens of times, a caller asked Delgado if it was morally permissible for a man with AIDS to wear a condom to protect his wife from becoming infected during sex. Delgado replied that it wasn't acceptable to use condoms ever. “Contraception [puts] a barrier between he and his wife,” Delgado said. “The conjugal embrace is no longer a total gift of one to the other.”

It's one of many such beliefs Delgado has expressed during his radio appearances that go against the advice of the medical community. He is also opposed to a woman having her tubes tied (“tying tubes is only for the expressed purpose of stopping fertility”), disagrees with in-vitro fertilization (“the whole sexuality of the husband and wife is torn asunder”...“instead of a husband impregnating his wife, it is a technician”), and believes that birth control and euthanasia are intrinsically linked.

[...]

“Essentially, he's experimenting on women,” Dr. Daniel Grossman, professor in the department of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco, says of Delgado, adding that he's concerned the women who got APR couldn't really know what they were agreeing to because the treatment's promises aren't proven. Grossman says he's willing to look at Delgado's forthcoming studies, but questions whether they'll be unbiased: The journal where Delgado plans to publish at least one study on which he is a co-author is partially funded by an organization that focuses on anti-choice issues. [Marie Claire, 7/12/17]

PopSugar: Arguments in favor of abortion reversal rely “on anecdotes and scare tactics rather than actual statistics or facts.” As Lindsay Miller argued in PopSugar, Delgado’s study is “wildly flawed from both an ethical and scientific standpoint” in that “it was a survey of only seven women total, being treated by a number of different doctors, and there was no control group.” In addition, “Delgado’s own motivations also cast a shadow over the study; he is openly anti-abortion himself” and started the study only after a call from an anti-abortion group. Aside from the multiple ethical and scientific concerns, Miller noted that the pseudoscience of abortion reversal is “condescending to grown women who have the ability — and the right — to make informed decisions about their own health care.” It also “plays into a common fear-mongering narrative about regret that anti-activists often perpetuate,” despite multiple credible studies finding that most people are confident about the decision to have an abortion. Miller concluded that “the argument in favor of ‘abortion reversal’ fails in the same way research on the method did: by relying on anecdotes and scare tactics rather than actual statistics or facts.” From the August 17 PopSugar piece:

The concept of abortion reversal has its roots in a 2012 report coauthored by San Diego physician George Delgado, who has continued to espouse his theory in the years since. The study was wildly flawed from both an ethical and scientific standpoint: it was a survey of only seven women total, being treated by a number of different doctors, and there was no control group. Delgado's own motivations also cast a shadow over the study; he is openly antiabortion himself. He says the impetus for the research was a call he got from LifeSavers Ministries, an antiabortion group, asking for advice from a young woman who reportedly changed her mind after taking the abortion pill.

[...]

Medical abortions are safe, legal procedures. Serious complications from RU486 are extremely rare, impacting fewer than one percent of women. Laws that promote junk science and force medical doctors to lie to women undermine patient rights, are unethical, and are condescending to grown women who have the ability — and the right — to make informed decisions about their own health care.

Doctors have widely pushed back against these unethical, unfounded laws. But there's a broader story the “abortion reversal” movement tends to ignore: as multiple studies have shown, the “problem” of women who choose to terminate a pregnancy being filled with regret and immediately seeking to “undo” an abortion is an extreme rarity. It plays into a common fear-mongering narrative about regret that antiabortion activists often perpetuate. In fact, recent research bears out that women who choose to abort feel “overwhelmingly” confident about the decision not only in the very short term, but also several years later. Unsurprisingly, the argument in favor of “abortion reversal” fails in the same way research on the method did: by relying on anecdotes and scare tactics rather than actual statistics or facts. [PopSugar, 8/17/17]

Mother Jones: Abortion reversal is “very experimental,” says OB-GYN, and “could do more harm than good” as states pass laws requiring its provision. Mother Jones’ Nina Liss-Shultz explored how Delgado’s claims spread from unfounded theory to state law around the country. After anti-choice lawmakers learned of “Delgado’s technique,” the anti-abortion group Americans United for Life drafted “model legislation for abortion pill reversal” bills for states to use. So far, Arizona, Arkansas, and South Dakota have all passed abortion reversal counseling laws, and “four more states introduced similar bills” in 2017. Liss-Shultz highlighted testimony from a doctor who noted that it’s necessary “to determine whether or not someone is feeling ambivalent” when providing abortion care. The provider also expressed concern that the abortion reversal procedure could be harmful since “it’s very experimental and it’s completely inappropriate to recommend it.” From the June 9 Mother Jones piece:

Word of [Dr. George] Delgado’s technique soon spread to lawmakers. Americans United for Life, the influential anti-abortion advocacy group, wrote model legislation for abortion pill reversal.

[...]

Arizona became the first state to pass an abortion-pill reversal law requiring physicians who offer medication abortion to tell their patients that, should they come to regret their decisions, they might be able to undo them. Arkansas followed suit with a similar law. In 2016, South Dakota enacted an abortion reversal law, and this year, four more states introduced similar bills.

[...]

“Everyone I know who provides abortion would try to determine whether or not someone is feeling ambivalent—that’s a critical part of providing good care,” says Karen Meckstroth, an OB-GYN at an abortion clinic in San Francisco.

[...]

Anti-abortion advocates are not giving up on lobbying lawmakers—and in the meantime Meckstroth fears the procedure could do more harm than good. “It’s very experimental and it’s completely inappropriate to recommend it,” says Meckstroth. “For it to become law or a recommendation with no research is unfair to women.” [Mother Jones, 6/9/17]