The first time I read about so-called ‘abortion pill reversal’ treatment, fantastical images flashed through my mind. I remember wondering: “Is this about reimplanting aborted foetuses or embryos in someone’s uterus?”
Then I worked on an openDemocracy undercover investigation that revealed the global spread of this so-called ‘treatment’ – and I discovered first-hand that it is a parody of modern medicine that only works in a counterfeit, distorted version of reality.
In this imaginary world, there are many women who begin medical abortions and then change their mind and need to be “rescued” by promoters of this unproven and potentially dangerous ‘reversal’ treatment.
After a six-month openDemocracy investigation, major aid donors and NGOs have said they will investigate anti-LGBT ‘conversion therapy’ at health facilities run by groups they fund.
But unlike the other aid donors, US aid agency PEPFAR has not responded at all.
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‘Abortion pill reversal’ (APR) treatment was invented by an anti-abortion doctor in California. It involves taking high doses of progesterone, a hormone, following the first of two pills used for a medical abortion (mifepristone and misoprostol).
Progesterone isn’t dangerous, but this delusional ‘treatment’ could be. The only high-quality clinical trial into this method, in the US, was halted in 2019 after some participants were hospitalised with severe haemorrhaging.
Along with other openDemocracy reporters across four continents, I contacted a 24-hour APR hotline – run out of the US by the Christian Right group Heartbeat International – while posing as a pregnant woman living in Uruguay.
A US hotline operator emailed me a copy of a ‘consent form’ stating that I understood APR was an “off-label use of progesterone” and that I should “seek emergency medical care immediately” if I experienced pain or heavy bleeding.
Then I was connected to local activists and a doctor in Uruguay. This doctor gave me a progesterone prescription over the phone, and the local activists insisted that they could bring the pills to my home and for free.
No national medical authorities in Uruguay have approved or recommended APR. Despite this, the Uruguayan doctor assured me there was “no reason for fear”. She said that this treatment works, although it is not “standard practice”.
But my pregnancy was fake – as fake as the world in which APR is a ‘treatment’.
The facts about abortion in Latin America
In reality, many women across Latin America struggling with unwanted pregnancies are forced into motherhood or have to go through dramatic ordeals to get abortions. If you are raped and fall pregnant in the Dominican Republic, El Salvador, Honduras, Nicaragua, Paraguay, Peru or Surinam, you are not allowed by law to have an abortion, and you can be jailed for seeking one.
Where abortion is legal in the region – in only five out of 34 countries – counselling, information on adoption and days to “reflect” are usually mandatory. Where abortion is allowed only under certain circumstances, the requirements can be excruciatingly detailed.
Women seeking an abortion can change their mind, and I believe that some do. But after they have already taken the first pill for a medical abortion, as APR promoters claim?
“During my many years of practice, and since abortion became legal , I have never heard of a woman having regrets halfway through the process,” a gynaecologist who works in Uruguay’s public healthcare system (and requested anonymity) told me.
This doctor added: “There is the rare case of a woman returning the medication without having taken it.” This is reflected in medical protocols because “the pills are taken back and discarded [by the healthcare provider], and that fact is registered.”
‘Abortion pill reversal’ is more a political issue, rather than a medical procedure
Mariana Piastri, a doctor and board member of Uruguay’s Society of Gynaecology and Obstetrics, had also never heard of ‘reversing’ an abortion. When I interviewed her, she asked for time to consult other colleagues in the sexual and reproductive health field.
“Most of those who answered,” she told me some days later, “knew about some cases of women regretting [their decisions], though not precisely after the first pill [...] but it’s a very low percentage. And we all agree on the reasons for this low percentage: the way that legal abortion is implemented in Uruguay, [including] a mandatory counselling session with an interdisciplinary team and a five-day reflection period.”
A woman has to take these steps and confirm her decision to have an abortion before can she get the relevant medication. “Nothing happens in a hurry; we offer all the support and information needed by the woman to make up her mind,” Piastri emphasised.
“I doubt that our gynaecologists would be comfortable prescribing a thing like this,” Piastri added, about APR. “This is more a political issue, rather than a medical procedure.”
Indeed, ideology seems to be the only real thing behind APR, the latest, globally coordinated attack on women's reproductive health.
Last year, we exposed a global network of ‘crisis pregnancy centres’, also backed by Heartbeat International, which target vulnerable women with disinformation and “emotional manipulation” about their health, including abortion and contraception.
Many of these centres seemed to pose as ‘neutral’ health facilities, hiding their anti-abortion agendas in order to lure in women seeking information about abortion.
A 2020 study published in the US by the academic journal Social Science & Medicine found that 95% of women do not regret their abortions. The research involved 667 women more than five years after having an abortion, including their emotional responses.
But APR promoters don’t seem to care about such statistics – just as they don’t seem to care about the efficacy or potential health risks of their ‘treatment’.
“I have never done this before, but I know it works,” claimed an anti-abortion advocate with no medical background, while encouraging me to take APR.
It’s particularly disturbing when such delusional behaviour ends up guiding public policies. In several US states, for example, including Arkansas, Kentucky, Nebraska and Tennessee, doctors are required to inform women that ‘abortion pill reversal’ exists.
Our investigation found activists and medical staff providing APR in at least 12 countries around the world – including Uruguay and Mexico in Latin America.
In Ecuador, an operator from the US hotline failed to connect our undercover reporter with a local doctor, but still emailed her a consent form and dosage instructions.
In Chile, our reporter was connected to a local doctor working with an anti-abortion group affiliated to Heartbeat. He, at least, wasn’t prone to fantasy. “No medication in the world can reverse the effect of [mifepristone]. That’s false,” he said.
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