The American antiabortion movement is on a full-court press to remake the nation in its image. In June, its decades-long campaign to install sympathetic Supreme Court justices paid off with the Dobbs v. Jackson Women’s Health decision, which stripped away the constitutional right to abortion. Now, the movement is pushing for draconian personhood laws (legislation granting fetuses the same rights as people) in an effort to make abortion murder.
In some states, the push is already working. In Georgia, for example, a new law allows expecting parents to claim fetuses as dependents on their tax returns. These victories are the result of a shrewd, ambitious strategy. The rise of an experimental treatment known as abortion pill “reversal” is part of this plan. Although it might appear a peripheral concern—hardly anyone actually seeks out this treatment—it’s a distinctly revealing pet project. The story of the rise of abortion pill reversal contains the antiabortion movement’s blueprint within it.
The first time I heard about it, I didn’t understand why abortion pill reversal was a flashpoint in this culture war. It sounds like the rare thing pro-choice and antiabortion people could wholeheartedly agree on, a choice to not have an abortion. Win, win. It sounded pretty straightforward, too: Medication abortion, which is now the predominant method of terminating a pregnancy in the United States, usually uses two pills. The first, mifepristone, blocks progesterone, a hormone necessary for pregnancy. The second pill, misoprostol, is usually taken one or two days after the first. It causes the uterus to contract, triggering a deliberate miscarriage. In an abortion pill reversal, if someone begins an abortion by taking the mifepristone and then changes their mind, they are given a course of progesterone as soon as possible, in order to counteract the mifepristone’s effects in the hopes of halting the abortion process. The reversal process is aimed at an extremely specific type of patient: someone who has decided to begin a medication abortion and who has taken the first pill but not the second.
The treatment was invented by a family medicine physician named George Delgado, minting him as one of the movement’s golden boys. According to a 2017 New York Times Magazine article, Delgado had used progesterone to help patients with fertility issues for years before hearing about a pregnant woman who was looking for a chance to halt a medication abortion she’d already started by taking mifepristone through his antiabortion activist circles. He found a doctor willing to administer progesterone to the woman, and then followed what happened: The pregnancy continued. Encouraged by this result, Delgado continued to offer the protocol when he found an opportunity, setting up a hotline to attract potential patients.
He first published a small case study showing how he tested it on six women in 2012, and then a 2018 larger case series following 547 patients as they underwent the process (taking mifepristone, then changing their mind and taking doses of progesterone rather than completing the abortion pill regime) as evidence that the treatment works. Almost half the women delivered healthy babies, with the highest success rate for patients who were further along in their pregnancies. The patients selected had taken mifepristone within 72 hours or less, and were in varying stages of gestation. There was no control group, so it was a limited study, something the paper makes clear. “A placebo-controlled trial in the population of women who regret their abortion and want to save the pregnancy would be unethical,” Delgado writes. Still, the paper’s conclusion is sweeping: It says the protocol is both effective and safe.
Abortion pill reversal has become a central talking point for the movement. Evangelists for the treatment include the antiabortion association Heartbeat International, which supports the largest network of crisis pregnancy centers in the country. Many of these centers are deliberately located near abortion clinics, and put up signs advertising abortion pill reversals to catch the eyes of people heading to terminate their pregnancies. The Ohio-based organization also operates the Abortion Pill Rescue Network, which connects pregnant people to hundreds of medical professionals who will offer the reversal protocol. They’re very good at SEO—Google “abortion pill reversal,” and that’ll be the first result. Heartbeat International claims that, since 2012, more than 3,000 babies have been born after someone took this progesterone treatment to reverse their abortions. Its president, Jor-El Godsey, tells WIRED that the number of women given the reversal protocol has been rising in recent years. Heartbeat International claims 1,091 women used the Abortion Pill Rescue Network to successfully reverse abortions in 2021, but the organization does not share demographic or geographic breakdowns of who is getting it, or whether there are complications with those who aren’t successful. There is no outside organization or research group currently monitoring and sharing data on how many abortion pill reversals are completed.
Christina Francis, an ob-gyn based in Fort Wayne, Indiana, has personally prescribed the reversal protocol to patients, often connecting with them through the Abortion Pill Rescue Network. She views it as both safe and scientifically sound. “There’s no increased risk of complications to mom and no increased risk of birth defects for baby,” she says, stressing that progesterone is often given to pregnant women for a variety of reasons in attempts to keep their pregnancies healthy. Francis’ zeal for the treatment is shared by her fellow antiabortion activists.
Most PopularThe End of Airbnb in New YorkBusiness
But abortion pill reversal is not promoted by mainstream medical organizations. It has never been approved by the FDA, nor has it been tested in a randomized controlled trial. Many doctors worry that this treatment has simply not been studied enough to be safe to prescribe. In fact, the American College of Obstetricians and Gynecologists—the most prominent professional association for ob-gyns in the United States, with over 60,000 members—explicitly rejects abortion pill reversal. Its official stance is that the protocol is both unproven and unethical. Francis, meanwhile, disagrees with ACOG. “Their claim that it’s not supported by the science is completely false,” she says. (She is on the board of the American Association of Pro-Life Obstretricians and Gynecologists, AAPLOG, a much smaller association founded in opposition to ACOG’s support of abortion as health care.)
When I contacted ACOG to learn more about their stance, the organization encouraged me to talk to Mitchell Creinin, the ob-gyn at the University of California, Davis, who led the only randomized clinical study thus far into the efficacy of abortion pill reversal. He enrolled pregnant patients who planned to have surgical abortions to first go through the reversal protocol to see whether it would, in fact, maintain the pregnancy. Participants took mifepristone and were then given progesterone the next day and for several days after. As a control, some were given a placebo instead of progesterone. After their role in the study was finished, they terminated their pregnancies as intended. Creinin’s research was intended to offer the first clinical setting to investigate the antiabortion movement’s claims about abortion pill reversal. But the 2020 study had to be stopped early when three women (two who took the placebo, and one who took the progesterone) experienced bleeding heavy enough to send them to the emergency room.
There has not been another attempt to clinically test the reversal process since, and Creinin does not believe it should be offered as a treatment without sufficient evidence. “There are no studies that prove that this works,” he says. He calls Delgado’s 2018 case series “bogus crap.” As it didn’t have a control group or an ethics review committee, he says it doesn’t meet basic clinical research standards. What’s more, the journal Delgado published the study in, Issues in Law and Medicine, is known to push an antiabortion agenda. It is cosponsored by the Watson Bowles Research Institute, which is part of the fervently antiabortion AAPLOG. It’s akin to publishing a study about the dangers of chocolate consumption in Chocolate-Haters Quarterly, funded by the vanilla industry.
Daniel Grossman, the director of the University of California, San Francisco’s Advancing New Standards in Reproductive Health, is another outspoken critic of abortion pill reversal. Like Creinin, his objection is to the lack of clinical research indicating that taking a progesterone course can actually safely mitigate the effects of mifepristone. Especially as Creinin’s study suggests that heavy bleeding may occur after taking progesterone, and Delgado did not publish data on the safety outcomes for all of his study’s participants, he does not think it should be recommended to patients without more research.
Most PopularThe End of Airbnb in New YorkBusiness
Grossman says if a patient came to him after taking mifepristone and had decided they wanted to continue their pregnancy, he would recommend simply not taking the misoprostol, as mifepristone often does not end a pregnancy on its own. He also isn’t sure whether the high success rate that Delgado claims stands up to scrutiny. In a paper critiquing Delgado’s study, Grossman noted that some women originally participating were then excluded if ultrasonography showed their embryos had died, or if they were not able to follow up with them, which he suggests may have artificially inflated the numbers. “We know mifepristone is not very effective by itself,” he says. “This is a situation where we don’t know whether the treatment is better than no treatment.” (Delgado did not respond to requests to be interviewed or to fact-checking questions.)
Nobody is saying that if there is a safe way to offer abortion pill reversal, that it shouldn’t be offered, even if demand is exceedingly scant. The issue is the lack of clinical evidence. “Essentially, the consensus is that this is quack medicine,” says Oregon-based ob-gyn Michele Quinn. “Basically garbage.” Like Grossman, Quinn would counsel a patient who changed their mind that the best course of action was to not take the second pill, and to wait and see. She has not had to offer such counsel in practice, though. “I’ve never had a single patient ask me about this,” she says.
In some states, though, patients have had to hear about it whether they asked or not. That’s because legislators have passed laws forcing health care workers in 14 states to tell patients planning to get medical abortions that abortion pill reversal is an option, despite the lack of actual evidence that it is safe or effective. (In five of those states, the laws are not in effect because of lawsuits.) Their laws are often framed in the language of female empowerment. Wisconsin’s version of the bill, for example, was called “A Woman’s Right to Know.” Yet they hogtie doctors into violating their Hippocratic oaths and misinforming women. “Requiring medical practitioners to provide counseling on something that is at best experimental, it goes against the basic tenets of being a healthcare provider, of first doing no harm,” says Lauren Thaxton, an ob-gyn and assistant professor in the Dell Medical School Department of Women’s Health at the University of Texas at Austin. She sees this command to misinform patients as something that causes moral injury to doctors, in addition to potential physical injury to patients receiving an unproven treatment. These laws rob physicians of their ability to offer the most accurate and safe treatment options, instead forcing them to parrot political talking points. In a time when trust in medicine is already shaky, meddling with the doctor-patient relationship is an especially corrosive move.
Still, these laws continue to be a right-wing priority. In 2022, legislators introduced 16 new bills that would force health care workers to tell patients about this experimental treatment. What is quack medicine to the healthcare mainstream is, nonetheless, getting enshrined as a treatment option by antiabortion activist lawmakers.
Most PopularThe End of Airbnb in New YorkBusiness
More than 900,000 people have abortions per year in the United States, and no two people have an identical experience. Some people do regret their abortions, even mid-abortion. Some people don’t. Others still have mixed emotions. But overall, people who have abortions are not more indecisive about them than they are about other medical treatments. Lauren Ralph, an epidemiologist who has studied abortion certainty, found that people are as certain or more certain of the choice to have an abortion as they are to undergo many other common procedures, including amniocentesis and some cancer treatments. “I think our findings do challenge the narrative that decisionmaking on abortion is is somehow exceptional to other health care decisions, and requires additional protections such as mandatory waiting periods,” she says. Do some people regret amniocentesis? Yes. Of course. But there’s no “Amniocentesis Rescue Network.”
Based on the most recently available data on the number of abortions performed and the number of abortion pill reversals taking place, only .11 percent of pregnant people who get abortions per year in the United States have gone on to successfully take the abortion pill reversal treatment. Even adjusting the number to three times that size to account for those who didn’t succeed in their attempt to stop their abortion, this would still mean that roughly 99.7 percent of people who had abortions didn’t change their mind halfway through. So why all the focus on such an incredibly niche procedure hardly anybody wants?
Some doctors who support reproductive rights suspect that this is a rhetorical move above all else. “They’re peddling this narrative of regret to generate outrage,” Quinn says. She sees similarities in how the antiabortion movement discusses abortion pill reversal and the way it has fearmongered about third-trimester abortions, falsely suggesting that healthy babies are killed weeks before delivery and ignoring the sad reality of the infrequent but awful medical circumstances that necessitate ending a pregnancy at that stage. By promoting the idea that abortion regret is a common problem, one which needs be solved with an experimental treatment, the antiabortion movement is shaping the larger conversation. The campaign to popularize abortion pill reversal casts abortion as a uniquely harrowing, calamitous occurrence to be rescued from, instead of a routine reproductive health treatment which is often necessary or desired. The more abortion pill reversal goes mainstream as the idea of an alternative to completing abortion—even as it remains rarely asked-for—the more this idea of deep uncertainty in the minds of people who have abortions will persist, no matter the reality.
This is a more subtle way to sow doubt about abortion than, say, gory posters of infanticide imagery waved outside of a Planned Parenthood. Rather than going for shock value, the antiabortion movement is now playing a slippery psychological mind game by recasting medical abortions as something people frequently beg to be saved from having. Even the ardently pro-choice can easily overestimate how many people want this treatment based on how prominently it’s advertised on crisis pregnancy center and antiabortion organization websites—and, depending on the state, the fact that their doctor may have had to inform them about it as an option. Misleading people is the point. After all, there are so many more people to mislead than there are people who want to take this experimental treatment.
Most PopularThe End of Airbnb in New YorkBusiness
This is why the enthusiasm for this fringe procedure explains the playbook for the movement at large. It’s a spin campaign. More than promoting an actual treatment—which, again, is barely ever requested—abortion pill reversal advertisements promote the idea that abortions are something people regularly need to be saved from having. It casts a rare circumstance as tragically commonplace in order to dismantle the status quo, to strong-arm the majority into life under minority natalist-fundamentalist rule. This is the same play the antiabortion movement runs when it tells people abortions cause infertility and cancer and widespread mental health issues.
Democratic legislators are pushing back against the state laws forcing doctors to spread misleading information about abortion pill reversal. In Congress, the Stop Anti-Abortion Disinformation Act has a shot at making regulators crack down on crisis pregnancy centers peddling antiabortion propaganda as medical recommendations, from the myths that abortions increase cancer risk to treating abortion pill reversal as though it’s an established treatment. People are fighting against the cruelties unleashed by the Dobbs decision. In red-state Kansas, a recent state referendum upheld abortion rights in a landslide, highlighting just how unpopular the views held by the antiabortion movement are. This movement is never going to stop telling whatever stories it thinks it will take to get people on its side. But no one has to listen.
Updated 9-6-22, 1:15 pm EST: This story was updated to correct the name of the American College of Obstetricians and Gynecologists.