“You are the first client I personally have worked with in Germany, but we have assisted many women all over Europe,” a US-based nurse told an openDemocracy undercover reporter, posing as a woman who had taken the first, but not the second, pill required to have a medical abortion.

The nurse then emailed this reporter instructions on how to take a controversial ‘treatment’ that claims to be able to ‘reverse’ abortions. Our reporter subsequently received dosage information to take to a local hospital or pharmacy in order to get the medication needed.

This medication is progesterone, a hormone, which is not in itself a dangerous drug. However, its use in high doses in this ‘treatment’ has been called “dangerous to women’s health” and based on “unproven, unethical research” by the American College of Obstetricians and Gynecologists.

So-called ‘abortion pill reversal’ (APR) treatment was invented by an anti-abortion doctor in California. The only trial into the ‘treatment’ was halted in 2019 after some participants were hospitalised. The trial’s lead researcher said “it wasn’t safe for me to expose women to this treatment.”

And yet openDemocracy has found evidence that it is spreading worldwide – including in countries where abortion has been legal for generations.

Our undercover reporters on four continents – including eight European countries (Armenia, Italy, Lithuania, Portugal, Romania, Spain, the UK and Ukraine) – were connected by US activists to local doctors who were willing to offer prescriptions or instructions for this ‘treatment’ by phone or email.

In Belgium, Croatia, Germany and Russia, where US-based nurses could not connect reporters directly to local providers of APR, they emailed them instructions to take to a local hospital or pharmacy to get the medicine.

Women’s health and rights activists called for urgent action in response to these “horrific” findings – especially during the coronavirus pandemic when it’s particularly important for people to trust healthcare providers.

“There is no evidence to support that it works and telling women that it does is misleading and wrong,” Margit Endler, an obstetrician gynaecologist and researcher in the field of global maternal health, told openDemocracy.

European and British parliamentarians condemned openDemocracy’s findings about the promotion of ‘abortion pill reversal’ as “completely unacceptable” and “deeply worrying” and said these activities must be “shut down”.

Petra Bayr, president of the European Parliamentary Forum for Sexual and Reproductive Rights (EPF) and an Austrian MP, condemned the doctors who are involved in these activities as “irresponsible charlatans [who] misuse women as medical guinea pigs”.

openDemocracy’s findings, Bayr said, “need a clear political reaction that immediately stops these threats for women globally”.

‘It will do you a lot of good’

Each of our undercover reporters contacted the 24-hour ‘abortion pill reversal’ hotline – run by the US Christian Right group Heartbeat International – either by telephone or by using the online chat function on the hotline’s website.

This group is among dozens of US Christian Right organisations that have spent millions of dollars in ‘dark money’ globally, including in Europe.

In Spain, our reporter was emailed a prescription by a local doctor who said it has “no risks” and, in fact, “it will do you a lot of good.” In Romania, our reporter was also emailed a prescription by a local doctor.

In only one European country, Serbia, were local contacts unwilling to provide APR. In that case the reporter spoke to a local NGO which said this ‘treatment’ is not regulated by local legislation and is not completely safe.

In Portugal, the doctor our reporter spoke to offered a prescription, though he said there is “no consensus” around the method’s effectiveness.

‘A miracle of nature’

In eastern Europe, our reporters were also connected to local doctors who gave them instructions on how to take this ‘treatment’.

In Lithuania, our reporter was connected to a local doctor who introduced himself as a ‘general practitioner.’ He assured her that progesterone is “safe if a woman is healthy” and was willing to prescribe her the hormone.

Another reporter was connected to a sex therapist in Armenia, who told her that ‘abortion pill reversal’ is safe; that women who have previously undergone it “did not have any problems”; and that “all the medical risks together can’t stop the development of this miracle of nature”.

In Ukraine, the doctor who contacted our reporter explained how to get the required pills from a local pharmacy (a prescription is not required for progesterone in the country). This doctor recommended a colleague who could help in case of problems, but said “there should be no problems at all.”

In Russia, a US-based nurse emailed our reporter instructions to take to a local hospital or pharmacy to get the medication.

US hotline operators sent each of our undercover reporters versions of the same ‘consent form’ – produced by Heartbeat – stating that they understand APR is an “off-label use of progesterone” and that they should “seek emergency medical care immediately” if they experience pain.

It is unclear how many women have tried APR globally. In some countries, it appears more established; in others, it seems to be just getting started, with doctors more recently involved.

In addition to safety concerns, health experts explain it’s unlikely that high doses of progesterone work to ‘reverse’ a medical abortion. If a woman does not take the second pill (misoprostol) within 24-48 hours of the first (mifepristone), a medical abortion will happen in only 8-46% of cases.

Last year, openDemocracy revealed how Heartbeat International affiliates and grantees around the world are providing women with misinformation about their rights and health – prompting calls for action from policymakers and officials in Europe, Africa and Latin America.

Other journalistic investigations have previously found evidence of APR being promoted by anti-abortion activists and doctors in Ireland and the Netherlands.

Cătălin Teniță, a Romanian parliamentarian in the Chamber of Deputies, said APR’s promotion in Europe “with scientifically unproven effects and no substantial studies proving the lack of risks is a highly worrying issue”.

He added: “The doctors and nurses who participate in it violate the deontological principles of their profession.”

In response to questions from openDemocracy, Heartbeat International said APR is “a cutting-edge application of a time-tested, FDA-approved treatment used for decades to prevent miscarriage, preterm birth, and support ongoing pregnancy.”

The group suggested that the lead researcher on the trial that was cancelled in 2019 is biased towards abortion access and claimed that his study “actually showed that the abortion pill carries major health risks”.

“More than 2,000 women have successfully stopped an abortion and saved their children through the life-saving intervention of APR,” it claimed.

* Additional reporting by Claudia Torrisi, Zeynep Sentek, Diana Cariboni, Tatiana Kozak, Ana Curic, Jelena Prtoric, Eva Hoffmann, Katerina Fomina, Nino Kaishauri, and Bella Dally-Steele