“If you go to a pharmacy and you can get them to call me […] I will prescribe [it] telephonically,” a South African doctor emailed our undercover reporter, who was posing as a young pregnant woman.

The doctor was referring to ‘abortion pill reversal’ (APR), a controversial method to ‘reverse’ a medical abortion (which consist of two pills taken a few days apart).

An online hotline – run from the US by activists from Heartbeat International, a Christian Right anti-abortion group – connects women to doctors around the world who will prescribe APR. Last year, openDemocracy revealed that this group has affiliates globally some of which have provided women with misinformation about their health, including false claims that abortion “causes cancer”.

Our reporter was first connected to a US activist who emailed her a ‘consent form’ produced by Heartbeat. She was then connected to a South African anti-abortion group that gave her contacts of doctors – including the one who offered to prescribe this ‘treatment’ without either meeting or speaking to her.

“There is no evidence to support that it works and telling women that it does is misleading and wrong,” Margit Endler told openDemocracy about APR. Endler is a specialist in postpartum haemorrhage and abortion, and a senior lecturer at the University of Cape Town’s Women’s Health Research Unit.

‘Abortion pill reversal’ procedures were first developed by a controversial California-based family physician, who is now a Heartbeat medical adviser. Its proponents claim that high doses of progesterone, taken after the first pill (mifepristone) recommended for medical abortion, can ‘reverse’ the abortion.

A US trial to test the effectiveness and safety of APR was halted in 2019 after some participants were hospitalised with severe haemorrhaging.

openDemocracy discovered that doctors on four continents – Africa, Europe, South America and North America – are offering women this ‘treatment’.

In the UK, a doctor told our undercover reporter that “about 100 women” had already taken it. In other places, APR seems new and it’s unclear how many women have been involved. No medical authorities in the countries included in openDemocracy’s investigation recognise the procedure.

South African health experts explained that it is unproven – and unlikely – that taking high doses of progesterone is effective in stopping a medical abortion.

If the abortion does not happen, it is probably because the woman hasn’t taken the second abortion pill (misoprostol). If it is not taken within 24-48 hours of the first pill (mifepristone), an abortion will happen in only 8-46% of cases.

Nigeria and Uganda

In Nigeria, another openDemocracy undercover reporter contacted the US group’s activists via its online chat function. She was not connected to a local doctor, however. Two days after signing the ‘consent form’, she heard from one of these US activists: “We are still working hard to find a provider.”

The following day, she received dosage instructions via WhatsApp, contacts for two anti-abortion organisations and the message: “See if they can help or if they know a doctor who could prescribe the progesterone for you.”

Our reporter in Uganda was also sent dosage instructions, by email, and was referred to local ‘crisis pregnancy centres’ for help in accessing the medication.

Doctors for Life, the South African anti-abortion group that contacted our undercover reporter, told openDemocracy that APR is “officially proposed by the American Association of Pro-Life Obstetricians and Gynecologists”, referring to another network of anti-abortion doctors based in the US.

In response to openDemocracy questions, Graeme Birdsey – the South African doctor who offered to prescribe APR to our undercover reporter – sent two emails.

He said that had the woman gone to a pharmacy, he would have spoken to the pharmacist “about the suggested progesterone regimens and the potential problems with it”, and that he would have spoken to the woman to get her details, explain the treatment’s risks and make a follow-up appointment.

In a later email he said “if a woman comes to me wanting help for whatever situation she finds herself in, it is unethical for me to refuse her such help” and “it is time that we all put aside our agendas and try more care for the genuine interest of the person that crosses our path, whatever the desire of that person is.”

He said he wasn’t sure the trial that was halted in 2019 “really holds much proof of anything”, that it was “extremely small” and that haemorrhaging also occurred in patients that did not take the progesterone protocol.

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 of the APR trial that was stopped 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,” the group claimed.

Additional reporting by Kiki Mordi