The growing use of abortion pills, often without any counseling, has created a new clinical reality: many women regret their decision after taking mifepristone and seek medical assistance to continue their pregnancies. As physicians, we have an obligation to understand the evidence surrounding abortion pill reversal (APR) so that patients can receive accurate information and informed counseling, as well as this potentially life-saving treatment for their baby should they want it.
Recently, a Houston Chronicle article falsely portrayed APR as unsafe and unsupported by evidence. Unfortunately, articles like this overlook important clinical data and fail to accurately represent the current body of evidence showing that APR is not only safe, but effective.
The APR protocol uses progesterone to counteract the effects of mifepristone, the first drug used in a drug-induced abortion. The goal is simple: to help women who regret taking mifepristone give their babies a second chance at life.
Through the Abortion Pill Rescue Network, operated by Heartbeat International, more than 8,000 babies have been saved after their mothers sought help following a change of heart. These women deserve access to accurate information about their options, not misinformation designed to discourage them from pursuing care.
One of the most troubling aspects of the Houston Chronicle article is its reliance on claims that APR is both ineffective and dangerous. Yet during recent legal proceedings involving the state of California and Heartbeat International, Dr. Mitchell Creinin, a well-known California abortionist, reportedly acknowledged under oath that he cannot say APR does not work and cannot say it is dangerous for women. Publicly, however, he continues to make those claims.
Let’s examine the evidence.
The Study Often Cited Against APR
Organizations such as the American College of Obstetricians and Gynecologists (ACOG) frequently point to a single study led by Dr. Creinin as evidence that APR should not be offered to women.
The study was a very small prospective randomized trial that enrolled only 12 women, with just 10 included in the final analysis. The trial was stopped early due to what researchers described as “safety” concerns.
Supporters of abortion frequently claim those concerns were related to progesterone treatment. However, the study’s own data tells a different story.
Five women received progesterone, while five received a placebo. Three women ultimately sought emergency care.
Only one woman in the progesterone group visited the emergency room. She was found to be completing her abortion, required no additional treatment, and was discharged home.
The other two women who sought emergency care were both in the placebo group and had not received progesterone. Each experienced severe bleeding and required emergency dilation and curettage procedures to complete their abortions. One woman also required a blood transfusion.
In other words, the serious complications occurred among women who did not receive progesterone. The safety concerns raised by the study were associated with mifepristone exposure, not with APR.
What the Study Actually Found
The study’s findings regarding effectiveness are equally important.
At the two-week follow-up, four of the five women who received progesterone still had viable pregnancies. In the placebo group, only two of the five women had ongoing pregnancies.
While the study was far too small to draw statistically significant conclusions, the results suggested that progesterone may help counteract the effects of mifepristone and increase the likelihood of an ongoing pregnancy.
Yet, inexplicably, this same study continues to be cited as proof that APR doesn’t work.
The Growing Evidence Supporting APR
Contrary to claims that APR is based on a single report, multiple prospective cohort studies have examined the use of progesterone following mifepristone exposure.
These studies have found that progesterone treatment can result in successful continuation of pregnancy in up to 68% of cases.
By comparison, studies evaluating women who take mifepristone and then do nothing further show successful continuation of pregnancy less than 25% of the time.
The evidence consistently demonstrates a higher rate of ongoing pregnancies among women who receive progesterone than among those who do not.
Additional support comes from mifepristone’s own development history. During the drug’s development, researchers demonstrated that progesterone could counteract mifepristone’s effects. Animal studies have likewise shown progesterone’s ability to reverse the drug’s action.
This is not a novel or experimental concept. It is rooted in well-established principles of biochemistry and works via the same mechanism as using oxygen to reverse the harmful effects of carbon monoxide.
Women Deserve Accurate Information
Perhaps the most important issue is that women deserve to know all of their options.
Many women experience regret after beginning a drug-induced abortion. Pregnancy resource centers and APR providers hear from these women every day. Some act immediately after taking mifepristone and desperately search for a way to continue their pregnancy.
These women should not be denied information about a treatment that has helped thousands of mothers experience a lifetime of memories with their child rather than carry a lifetime of regrets.
If we truly support informed consent and women having access to care, we should support patients receiving accurate information about APR. Suppressing information about APR does not expand choice. It limits it.
Many of our members know that ACOG and critics of APR misrepresent the evidence or ignore it completely, but it’s important to see how. This Houston Chronicle article, study, and lawsuit from California against Heartbeat International is proof of how APR is falsely relayed to the public. The evidence supporting APR continues to grow, and thousands of families can testify to its impact. Myths surrounding APR abound, but we can respond with facts. See our video to equip yourself with more information.
Women who regret taking mifepristone deserve to know there is still hope. They deserve the opportunity to make a different choice. And they deserve access to accurate information about a treatment that may help save their baby’s life.
