Is ‘Reversing’ An Abortion Really A Good Idea?

His name is Gabriel, and according to the press conferences, he’s not supposed to be here. His mother, Andrea Minichini, said she was at a clinic and told the provider she wanted an abortion, but changed her mind as she held the first dose of the medication abortion regime in her hand. Allegedly feeling pressured by staff, she took the pill anyway, then took herself to a hospital where she was told she would need to take the rest of the protocol or put the fetus at risk of deformities. Rather than follow their advice, she Googled until she found a website with a number to call, and after that call received the name of a doctor who would “reverse” her abortion.

Now, Minichini is the mother of a beautiful, healthy baby, and she’s not alone. According to the press conference at the National Press Club, 223 reversals were attempted between May 2012 and December 2014, and of those 78 resulted in live births with another 51 pregnancies still ongoing.

Despite the discomfort around the idea of “reversing” an abortion, this is actually good news for those who support reproductive rights. To begin with, it is never a good thing when someone who wanted to be pregnant undergoes an abortion, and if these patients decided that they wanted to continue the pregnancy, it’s great news that they not only were able to do so but that no harm came to themselves or the babies they eventually birthed.

The “reversals” also show that the ingestion of medication abortion drugs is never a sure thing when it comes to terminating a pregnancy. While anti-abortion activists tout the alleged “high complication rates” of the process, what they conveniently leave out is that the most common complication is that the patient remains pregnant, and that the protocol needs to be followed up with D&C or vacuum aspiration abortion in order to end the pregnancy. That likelihood increases the further into the pregnancy a patient is, leading to the current limit of nine weeks gestation (last menstrual period) in order to maximize success.

Why is the “reversal” apparently so successful then? Primarily it is because those who are trying to continue the pregnancy are already in the midst of a failed medication abortion to start with. The “reversal”—which appears to just be injecting a large amount of progesterone into the pregnant person to counteract the mifepristone, which decreases progesterone production—is not attempted unless a heartbeat can still be detected via ultrasound when the pregnant person finds a doctor who will administer it. In other words, the fact that the embryo still has a heartbeat means that the pregnancy was likely to continue anyway unless more medication or a surgical procedure was undertaken to end it.

“There’s no evidence of any demonstrable effect of the ‘treatment’ these anti-abortion centers are marketing,” Dr. Cheryl Chastine, a provider at South Wind Women’s Center in Wichita, Kansas, said. “The medical literature is quite clear that mifepristone on its own is only about 50 percent effective at ending a pregnancy. That means that even if these doctors were to offer a large dose of purple Skittles, they’d appear to have ‘worked’ to ‘save’ the pregnancy about half the time. Those numbers are consistent with what these people are reporting.”

Dr. Chastine isn’t alone in her assessment. Dr. Dan Grossman, vice president for research at Ibis Reproductive Health, told Iowa Public Radio that the “treatment” was unlikely to be doing anything at all.

“[The abortion pill] binds much more tightly to the progesterone receptor, to block it than progesterone itself does,” Grossman told reporter Sarah Boden. “So there really is not much evidence to indicate, I’m really not aware of anything, that by increasing the amount of progesterone you’re gonna somehow block the effect of this drug.” He then added, “I think this is really outside of standard of care to just begin doing this kind of treatment, without collecting more rigorous studies about its effectiveness.”

What Dr. Grossman brings up is perhaps the most controversial part of the “reversal” protocol, and the part that is the blatantly hypocritical when it comes to the procedure. On the one hand, anti-abortion advocates have hit state houses across the country with bills that forbid telemedicine abortion, require patients to take each part of the medication in the presence of the doctor, follow an outdated FDA protocol that physicians have stated is not as medically sound as the best practices that they have developed, or even mandate an off-label drug ban that has stopped some states from being able to offer medication abortion all together. Meanwhile, these same people are suggesting that patients Google a website, call a hotline, be hooked up with a doctor they have never seen and rush straight to a place to be injected with massive amounts of hormones without any FDA approval of that procedure, long-term studies of the effects, or even much of a testing pool of subjects to draw data from.

The double standard when it comes to how medication should be dispensed when it is an abortion versus a “reversal” isn’t the only objection pro-choice advocates have. There is also a conveniently shifting belief about the inevitability and potency of the medication’s ability to induce a termination, too. According to abortion opponents, when a pregnant person takes an abortion pill while solidly within the optimal gestational range for the drug, it is still viewed as a nonpermanent, reversible medication that a pregnancy could easily survive. However, when a similar medication is allegedly taken far later in gestation, those same advocates believe beyond a reasonable doubt that medicine – not natural miscarriage – has ended the pregnancy.

In the cases of Jennie McCormack and Purvi Patel, both were accused of inducing their own abortions, and in both cases the purchase of medication was the biggest factor of “evidence” to support the charge. Medically, there was no proof that their losses weren’t, in fact, simply late miscarriages, or that the drugs had any effect on the pregnancies at all.

While anti-abortion activists haven’t been able to prove that their “reversal” regime has any actual impact on continuing a pregnancy, they have been able to show that if you take the medication and do not end up aborting, it doesn’t appear to damage the eventual baby—at least so far. They’ve also made it fairly clear how few patients actually seeking a medication abortion change their minds. According to Guttmacher, as of 2011 approximately 23 percent of all abortions were medication abortions, or about 240,000 per year. That means that in the period in which the reversal attempts were happening, there were roughly 600,000 medication abortions overall. Even assuming that patients seeking a reversal didn’t make it into the 223 test cases, the amount of people changing their mind is just a tiny sliver of those who seek out medication abortion.

Is it possible that there could be more? Perhaps. In order to address that question, anti-abortion physicians are pushing for “Emergency Abortion Pill Reversal Kits” to be available in emergency rooms and urgent cares. Their effort once more reiterates the double standard that all abortion care must be done by specialists in specific sites but anyone, anywhere is welcome to experiment on pregnant people if it could result in continuing a pregnancy.

Obviously, any child is born to a parent who wanted to give birth is a good thing. Whether the “reversal” protocol had any effect on the continuing pregnancy or a woman was having a failed abortion already and would have given birth regardless unless someone intervened, it’s wonderful that these patients are getting what they see as their second chance at a motherhood they originally didn’t think they wanted.

But those patients are the exception, not the rule. To portray them as anything else is as hypocritical. So is claiming it is unsafe to let a doctor use an evidence-based protocol for abortion versus an out-of-date FDA protocol, but that it’s fine to inject a person with massive amounts of hormones in an unmandated, unsupervised medical trial.

Maybe next time, just try the purple Skittles.

Robin Marty is a freelance writer, speaker and activist. Her current project, Clinic Stories, focuses on telling the history of legal abortion one clinic at a time. Robin’s articles have appeared at Cosmopolitan.com, Rolling Stone, Politico, Ms. Magazine and other publications.