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Public Health

New Bill Pits Anti-Abortion Groups Against The Health Department Over Controversial ‘Abortion Reversal’

abortion pill
Robin Marty
/
Creative Commons
Mifeprex, a progesterone blocker used to end a pregnancy that is less than 10 weeks along.

It’s been a record year for anti-abortion laws introduced in state legislatures, and in Louisiana, the latest battle is over a procedure not backed by scientific consensus — and that could potentially harm women.

Abortions are common in Louisiana, where about 8,000 are performed every year. Medication abortions, in which women take pills rather than undergo a surgical procedure, make up two of every five abortions in the state.

They’re deemed safe and effective by the U.S. Food and Drug Administration (FDA) and the American College of Obstetricians and Gynecologists (ACOG).

But under a new bill making its way through the state legislature, doctors and the Louisiana Department of Health would be forced to tell patients of a controversial and potentially dangerous method intended to reverse their abortion.

That has Dr. Joseph Kanter, the state health officer, worried.

“The bill as it's written now is a concern for us,” Kanter said. “It's not supported by expert consensus and it's not standard of practice. And it might give women, particularly vulnerable women in one of the most vulnerable points of their life, the wrong and potentially dangerous information.”

He pointed to a small randomized control trial begun in 2019 investigating whether the process, dubbed “abortion reversal,” works. The trial had to be stopped because three women — including one abortion reversal patient — hemorrhaged.

“A number of the women bled out and had to go to the emergency department,” Kanter said. “So when that happens in the trial, it's a real unavoidable signal that there's a safety concern.”

The Origins Of HB 578

When Louisiana politicians seek to pass laws aimed at abortion, they find themselves in the House Health and Welfare Committee.

Earlier this month, Rep. Beryl Amedee, a Republican from Houma and the author of House Bill 578, outlined her proposed law. Under it, physicians prescribing medication for an abortion would have to give their patients a written statement saying that it is possible to cancel the effects of the medication by taking the hormone progesterone.

The law also requires the Louisiana Department of Health to post identical language on its website.

Amedee called it “a simple consumer protection bill.”

In medication abortions, patients take two pills. The first, mifepristone, blocks the hormone progesterone, which is needed for a pregnancy to continue. Twenty-four hours later, they take misoprostol, which causes contractions and the cervix to soften. What patients experience as a result of the two drugs is a process akin to a miscarriage.

Under the abortion reversal process, women take progesterone instead of the second abortion pill.

The group behind the law, Louisiana Right to Life, says reversals are safe and lead to a greater chance of keeping a pregnancy. There’s a national network of doctors who promote and prescribe the abortion reversal protocol, including some in Louisiana who testified at the hearing.

A staff member from the Women’s New Life Clinic in New Orleans, an anti-abortion pregnancy center, told lawmakers that six of their patients gave birth after reversing their abortions last year.

Louisiana Right to Life Associate Director Angie Thomas was formerly the pregnancy center’s chief executive officer. She said the proposed law is “just not controversial.”

“This is just about information that is given to women in case they need it, in case they find themselves in regret,” she said.

Fourteen other states have introduced similar legislation requiring doctors to tell their patients about the possibility of reversing a medication abortion. Six states already enforce some kind of notice on abortion reversal. Three states have had such policies enjoined by courts, and Indiana is being sued over its similar bill passed this year.

What’s not clear is whether any other state laws also require a state health department to promote abortion reversals on their website, as HB 578 would mandate.

The Lack Of Scientific Consensus

ACOG does not recommend abortion reversals. It says the practice is not supported by science, that it does not meet clinical standards, and that it’s potentially dangerous.

Dr. Daniel Grossman is an OB-GYN and professor at the University of California San Francisco and the director of a reproductive health research group called ANSIRH. He’s spent years investigating abortion reversal and is a promient critic.

“It's one thing if a state is telling doctors to give information to abortion patients that might be biased,” he said. “But this kind of goes an extra step by actually advocating a treatment that is unproven, and essentially forcing patients to participate in an unmonitored research experiment.”

Grossman noted that the most substantial research seeking to prove that abortion reversal works had no control group — a cornerstone of the best quality research. Instead, the study followed about 500 patients who had viable pregnancies after taking the first abortion pill.

Those patients were given progesterone, and the study concluded the hormone helped roughly half of those pregnancies continue. But without a control group, Grossman said, it’s impossible to determine whether those pregnancies might have progressed without the progesterone.

Kanter, the state health officer, said abortion reversal “might be established down the road as an effective therapy for women that do change their mind.”

“But we're not there yet,” he said. “And it would be a mistake to counsel women otherwise.”

Abortions And The Question Of Regret

The proposed law is intended to help women who begin their abortions and immediately regret them. Thomas, of Louisiana Right to Life, said the fact that even a handful of patients have kept their pregnancies after undergoing abortion reversals is proof the law is needed in Louisiana.

But a substantive, years-long study has found abortion regret in the U.S. is exceedingly rare.

Dr. Corinne Rocca is an epidemiologist at ANSIRH and of the researchers of the Turnaway Study, which followed roughly 1,000 women over five years who were either provided with, or denied, an abortion.

For those who underwent an abortion, “the biggest finding that we found is that 95 percent of women felt that the abortion was the right decision for them at all times over five years,” she said.

“We didn't see any type of sort of emerging regret.”

The study found some women expressed more ambiguity and mixed emotions immediately after an abortion, but that those feelings lessened in intensity over time, she said. The findings suggest that some of that small group who do regret their abortions might do so in part due to anti-abortion stigma.

To legislate for that five percent who do regret their abortions, Rocca said, “is a really blunt tool.”

Medication Abortion And The Push For Telemedicine

For Grossman, one solution to help those patients could be to allow them to bring abortion medication home with them, to take when and if they are ready.

But current Louisiana law prohibits that by requiring patients take the first pill in the presence of the prescribing doctor. It’s the same law that effectively prohibits telemedicine for medication abortions.

ACOG says there is no evidence to suggest that taking the first abortion pill in the presence of a doctor has any impact on the safety of medication abortion. It supports telemedicine and even sued the FDA last year seeking to end federal restrictions that require mifepristone to be dispensed in a hospital, clinic, or medical office.

Reproductive rights groups argue restrictions on mifepristone are intended to increase barriers for people seeking abortion.

Where The Abortion Reversal Bill Stands

HB 578 passed the Louisiana House easily earlier this month, by a vote of 71 to 27.

Still, Michelle Erenberg, the executive director of the reproductive rights lobbying group Lift Louisiana, said that represented progress for her movement: It earned more “no” votes than even the state’s highly controversial six-week abortion ban passed in 2019.

“The House members that voted against it, I think, see this for what it is, which is junk science that puts the patient's health at risk,” Erenberg said.

The bill is awaiting a possible hearing in the Senate’s Health and Welfare Committee, and if it’s advanced, a vote on the Senate floor. The legislative session adjourns on June 10, leaving just over a week for the law to pass these last hurdles.

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