50.50: Investigation

Canada doctors group breaks silence on ‘unproven’ abortion ‘reversal’ treatment

openDemocracy’s investigation prompts Canada’s Society of Obstetricians and Gynaecologists to speak out against this controversial ‘treatment’

Joni Hess Annie Burns-Pieper
26 March 2021, 1.40pm
Illustration: Inge Snip

Canada’s national society of obstetricians and gynaecologists has issued a statement warning that so-called ‘abortion pill reversal’ treatment is “unproven” and can also cause “serious complications” for patients.

The statement – the first by a Canadian medical association to address this topic – was issued in response to findings from an openDemocracy investigation that reveals how this controversial ‘treatment’ is spreading from the US around the world.

“The claims regarding so-called abortion ‘reversal’ treatments are not based on scientific evidence,” says the statement from the Society of Obstetricians and Gynaecologists of Canada (SOGC) which says that it “does not support prescribing progesterone to stop a medical abortion”.

Geoffroy Legault-Thivierge, media relations officer for Health Canada added: “‘abortion reversal’ is not a Health Canada-approved indication for progesterone.”

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Medical (as opposed to surgical) abortions, which can end pregnancies up to ten weeks, have been available in Canada since 2017. Two drugs (mifepristone, then misoprostol) must be taken within a couple of days of each other.

‘Abortion pill reversal’ (APR) proponents claim that taking high doses of progesterone after the first pill can ‘reverse’ the abortion. But there is no conclusive evidence that the ‘treatment’ works – or that it is safe.

A previous US medical trial into the effectiveness and safety of APR was abruptly cancelled in 2019 after some participants were hospitalised with severe haemorrhaging. The American Medical Association (AMA) has called abortion ‘reversal’ “patently false and unproven”, while the American College of Obstetricians and Gynecologists describes it as “dangerous to women’s health”.

Until now, no Canadian association had condemned this ‘treatment’, despite evidence that some Canadian doctors are ready and willing to prescribe it – with the help of by a large US Christian Right group called Heartbeat International.

“Every hour counts if you've decided to do this,” a British Columbia doctor said in a phone call to an openDemocracy undercover reporter posing as a woman who had taken the first of two pills for a medical abortion.

The doctor said he had provided APR to multiple other women in Canada and that he has delivered at least one baby after he helped to ‘reverse’ a woman’s medical abortion.

Dustin Costescu, an associate professor and family planning specialist with the department of obstetrics and gynaecology at McMaster University in Hamilton, Ontario, said there are risks and patients need to know about them.

“They may go on to miscarry,” Costescu warned, or “They may have a higher rate of emergency or complication by taking [the ‘treatment’] compared to somebody who goes on to complete the abortion on their own.”

‘Poor science’ and ‘experimental therapy’

openDemocracy’s undercover reporter contacted a 24-hour ‘abortion pill reversal’ hotline run by Heartbeat International and said she had started a medical abortion in Montreal, Quebec.

She was then connected via a network of nurses and anti-abortion groups to a family doctor in British Columbia. Doctors in Canada are regulated by province, so it is unusual to be referred to an out-of-province medic.

This doctor sent a prescription for progesterone to a Quebec pharmacy (which was not picked up). When asked why APR isn’t available as an option in clinics that provide medical abortions, the doctor said “it's all to do with the politics.”

“The people that hand out these [medical abortion] pills don't want to admit that women would think badly of taking [them],” he claimed, adding “it's unfair to women not to tell them that they've got the chance to, change their mind.”

Medical experts disagree. Sarah Munro, assistant professor of obstetrics and gynaecology at the University of British Columbia, says there is no evidence that ‘abortion pill reversal’ works. “Promoting such claims is poor science,” she said.

“It worries me that clinicians are providing care that doesn't meet any standard of practice in the country without a clear conversation with patients about the fact that this is experimental,” said Costescu. “It brings up a lot of ethical issues.”

‘It’s irresponsible to promote this physically dangerous regimen as if it works’

openDemocracy found several Canadian anti-abortion organisations promoting ‘abortion pill reversal’ on their websites and social media.

Ottawa-based RightNow, which campaigns for anti-abortion political candidates across Canada, for example tweeted last year: “105 mothers started the process of halting their chemical abortions after calling the hotline.”

Also in Ontario, Cambridge Right to Life says there are local doctors ready to provide APR and that “550 healthy babies have been born successfully to mothers who underwent the reversal process,” though its website also says “this ‘reversal’ process offers no guarantee of success.”

Abortion and women’s rights advocates condemned the use of APR.

Jill Doctoroff, executive director of the National Abortion Federation Canada, said leadership is needed to stop the spread of misinformation. “Our governments and health bodies need to promote factual information related to health care.”

“It’s irresponsible,” said Joyce Arthur, founder and executive director of the Abortion Rights Coalition of Canada, to promote “this physically dangerous regimen […] as if it works – but there’s really no basis for [its] efficacy”.

She described the spread of APR as “letting your anti-abortion ideology prevail over the health and safety of women. It’s unconscionable.”

Susan Prins, director of communications at the College of Physicians and Surgeons of British Columbia, the body that regulates the doctor our reporter spoke to, said that it also endorses the SOGC statement.

“Registrants are expected to prescribe and treat patients based on scientific evidence of safety and efficacy, to follow the clinical guidance from experts like the SOGC, and avoid unproven and potentially dangerous uses of existing medication, which can lead to serious complications,” she said.

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 Creinin is biased towards abortion access and claimed 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.

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