50.50: Explainer

Explainer: What is ‘abortion pill reversal’?

The unproven, potentially dangerous use of progesterone to ‘reverse’ a medical abortion is spreading globally, supported by the US Christian Right

Teddy Wilson
Teddy Wilson
27 May 2021, 6.58am
Illustration by Inge Snip

US religious conservatives have claimed for years that a medical abortion can be ‘reversed’ if high doses of the hormone progesterone are taken. 

The problem is that there is no medical evidence to support this claim – and the only trial into the method’s effectiveness and safety was abruptly halted in 2019 after several participants were hospitalised with severe haemorrhaging. 

This year, an openDemocracy investigation revealed that doctors around the world, connected to the US Christian Right group Heartbeat International, are prescribing this ‘treatment’ to women – under the radar of medical regulators and health authorities. In some countries such as the UK it appears to be more widespread; in others, it seems to be taking root now. 

If you haven’t heard of ‘abortion pill reversal’ before, here’s what you need to know. 

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What is abortion pill reversal?

So-called ‘abortion pill reversal’ (APR) is an unproven procedure that is purported to ‘reverse’ a medical abortion through the use of high doses of the hormone progesterone.

What is a medical abortion?

Unlike a surgical abortion, a medical (or chemical) abortion does not require surgical intervention to end a pregnancy. It can be used to terminate a pregnancy up to ten weeks’ gestation. The pregnant individual takes two medications. First, mifepristone, which is intended to prevent the pregnancy from progressing, and then, within a day or two, misoprostol, which induces contractions to empty the uterus. 

How does APR allegedly work? 

The APR protocol prescribes high doses of progesterone, to be used after the first medical abortion drug (the second drug is not taken). The progesterone can be taken as pills, suppositories or injections. 

Who created the APR procedure?

California family doctor and anti-abortion activist Dr. George Delgado first proposed the idea of APR in 2012, when he published a paper that claimed that progesterone had been used to ‘reverse’ a medical abortion. He is an advisor to the ‘Abortion Pill Rescue Network’ (APRN), which he says is “reaching out to more doctors, and more doctors, emergency departments, and clinics are aware of this”.

What is the Abortion Pill Rescue Network? 

APRN is run by the US anti-abortion group Heartbeat International. It operates a 24-hour hotline and online chat service that connects women to providers of APR across the US and internationally. Delgado has said the goal of this network is the “saturation of the world” with “other regions in the world developing their own networks, like Europe and Latin America”.

How many women have tried APR?

Heartbeat International claims that “more than 2,000 women” have successfully ‘reversed’ a medical abortion. Heartbeat’s medical director has claimed that at least 60 women in the UK requested APR in the first half of 2020, while an anti-abortion group in Canada claims that “550 healthy babies have been born successfully to mothers who underwent the reversal process.”

Where in the world is APR provided?

Our investigation revealed that APRN has linked up with doctors in at least a dozen countries on four continents – Europe, North America (including Canada), South America and Africa – to give women APR ‘treatment’. APRN hotline operators will also email women dosage instructions if they can’t make a connection with a doctor. 

Who provides APR?

Doctors around the world, often associated with so-called ‘crisis pregnancy centres’ (CPCs) or Catholic hospital systems, have been recruited to join APRN. 

Is APR safe?

A 2018 article in the New England Journal of Medicine concluded that there is a “lack of medical evidence demonstrating the safety and efficacy of the treatment”. The only medical trial to date, at the University of California, Davis, was halted in 2019 after some participants were hospitalised with severe vaginal bleeding. 

Is APR effective?

The only medical trial to date (mentioned above) was halted in 2019 after some participants were hospitalised with severe vaginal bleeding. The American College of Obstetricians and Gynecologists (ACOG) has stated that claims related to APR are “not based on science and do not meet clinical standards”.

Has APR been approved by health regulators or medical agencies?

Heartbeat International claims that APR is a “time-tested, FDA approved treatment, that’s been used for decades to treat women at risk for early pregnancy loss and preterm delivery”. This is misleading. Progesterone is approved for use to prevent early pregnancy loss and preterm deliveries. However, neither the US Food and Drug Administration (FDA) nor any other medical authorities in the countries covered in our investigation have approved or recommended the APR protocol.

The ACOG has said that APR is “not based on science and does not meet clinical standards”. Following our investigation, the Society of Obstetricians and Gynaecologists of Canada issued a statement saying that it “does not support prescribing progesterone to stop a medical abortion”.

In the UK, following openDemocracy's investigation into 'abortion reversal', a doctor is now subject to "interim conditions" while the General Medical Council investigates further.

* This article was amended on 28 May to clarify that it was not the GMC itself that placed “interim conditions” on the UK doctor, but rather the GMC is investigating the doctor while these conditions are in place.

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