Abortion Pill Reversal

Addressing Serious Misinformation about Abortion Pill Reversal

Editor’s note. Dr. O’Bannon was asked to testify in Wisconsin back in October on requiring information about APR—abortion pill reversal—for women undergoing chemical abortions. This is the testimony he submitted, edited here for publication.

Randall K.
O’Bannon, Ph.D.
Photo: Lisa Andrusko

I am Dr. Randall K. O’Bannon, the director of research and education for National Right to Life. I have been researching and writing on chemical abortion for over 25 years, from the time when RU-486, or mifepristone, was first tested in the U.S. in 1994, to the current effort by abortion advocates to promote dangerous telemedical and mail-order of these deadly pills.

I am submitting this statement on behalf of Wisconsin’s 2021 Senate Bill 591. I appreciate Chairman Testin and the members of the Senate Committee on Health for considering my written testimony regarding the proposed legislation requiring that women taking the abortion pill mifepristone be informed about the possibility of reversing their chemical abortions and saving the lives of their unborn children.

A brief history of abortion pill reversal.

After a few years of use, those who understood how these pills operate began to suspect that there might be ways to halt or “reverse” these chemical abortions if treatment was given early on, before the abortion process was complete. That process, as you know, involves not one, but two drugs, given over a period of several days, with the abortion taking place hours, if not days after, the second drug.

Mifepristone, the first drug given on day one, begins to compete with the progesterone from the woman’s body, neutralizing its effect by filling and blocking the critical pregnancy hormones’ binding sites. The signal of an active pregnancy blocked, the woman’s body begins to shut down the baby’s life support system, depriving the child and his or her protective cocoon [and] necessary nutrients to continue to grow and thrive. Essentially, the woman’s body receives the message that there has been no conception and initiates the menstrual process and the shedding of the inner uterine lining.

The second drug, the prostaglandin misoprostol, is then given a day or so later to initiate powerful uterine contractions to separate the dead or dying child from the wall of the mother’s uterus, and expel the tiny corpse from her womb.

Misoprostol is not taken with the mifepristone because it takes a while for the first drug to work. And by itself, mifepristone is not always fully effective. Thus the unborn child may still be alive for several hours or even a couple of days after that first drug has been administered.

Independently, in the last half of the 2000s, two doctors, George Delgado of California, and Matthew Harrison of North Carolina, theorized that they might be able to counteract the effects of mifepristone by flooding the body with additional progesterone, to “outcompete” mifepristone at the body’s hormone binding sites. Each encountered a woman who had taken the first drug mifepristone, but then decided not to take the second drug misoprostol, each hoping they could somehow save their babies. Delgado and Harrison gave each woman a boost of progesterone and their babies survived.

Delgado published a case study of six cases of attempted abortion pill “reversal” in 2012, sharing results of four successful reversals. Abortion pill advocates dismissed this as statistically insignificant, but Delgado was merely trying test the principle. A much larger study by Delgado and colleagues, published in 2018, involving more than five hundred eligible cases, demonstrated wide scale effectiveness, particularly with repeated high oral or intramuscular doses of progesterone, offering reversal rates of 64-68%.  

Despite this record of success, several myths have persisted about abortion pill reversal, typically peddled by abortion pill advocates and their media allies. As you consider this bill, please do not be swayed by their disinformation campaign.

Myth #1: Abortion pill reversal doesn’t work.

One of the weakest but most persistent claims about abortion pill reversal is that it doesn’t work, or more specifically, that it doesn’t work any better than doing nothing.

Everyone recognizes that these abortifacient pills do not always work, and particularly that mifepristone alone is not always enough to bring about a complete abortion. The dispute is over the relative effectiveness of intervention over non-intervention.

We have been told by the FDA that the failure or incompletion rate for mifepristone-misoprostol abortions is between 2-7%. Claims have been made by abortion pill advocates that the failure rate for mifepristone alone (taking mifepristone but not the follow up misoprostol) is somewhere between 20-50%. Though this upper limit is itself highly questionable, it is important to remember that even this high rate is not a claim that half of the babies survive, but that 50% of those abortions are incomplete, that material of some sort is still present in the womb, that bleeding still continues, etc. The baby may be dead in the womb, but if all the pregnancy tissue has not passed, the abortion is incomplete, and the pill has been ineffective.

More careful estimates based on actual studies place the embryo survival rate after just a single dose of mifepristone at 10-23.3%, considerably lower than the 50% proposed by abortion pill advocates.  

[The] 64-68% successful reversals reported by Delgado are [obviously] higher than even the 50% abortion pill promoters have put forward [but are even more striking with more careful definitions and data. The] two-thirds successful reversals and embryo survival rates found with the progesterone boosts are obviously significantly higher than even the maximal embryo survival rates of less than a quarter found in the medical literature for mifepristone alone, that is, simply giving the mifepristone and doing nothing.

It isn’t just that doctors offering abortion pill reversal can point to an isolated case here or there where a child survived, but that they can share literally hundreds of cases where this aggressive progesterone protocol has resulted in happy mothers and healthy births.  

Myth #2: Attempted abortion pill reversals are dangerous.

One of the most insidious myths is that the progesterone boosts used by doctors to try and reverse chemical abortions may somehow pose a danger to the women to choose to receive them.  

This ignores decades of use of progesterone by doctors to try and avert threatened miscarriage.  Though there are still debates in the medical literature about the efficacy of this treatment, there has never been any indication that these progesterone boosts posed any danger to these mothers or their babies.

Recent misinformation related to the safety of this treatment may be related to study performed by abortion researcher Mitchell Creinin in 2019, supposedly done to test the efficacy of reversal. 

Creinin began a study of abortion pill reversal in December of 2018, planning to test progesterone boosts on forty pregnant women who had taken mifepristone. Half were to get the boost, the other half a placebo (so that they would reflect the results of taking just the mifepristone and doing nothing).

Creinin halted the trial early because three of his first twelve patients ended up in the hospital with bleeding issues, with the long-time abortion advocate saying he just could not continue to expose women to that sort of safety risk.

Most media accounts failed to note that two of those three women – the ones who had the most severe reactions and required surgery – were in Creinin’s placebo group, those who did not receive the progesterone boost. The one of the trio who did receive the progesterone did, in fact, have bleeding – as does nearly every woman who takes mifepristone – but she did not require the surgery and transfusion needed by the other two from the placebo group.

If anything, the truncated results show that it is the taking of the mifepristone, skipping the misoprostol, and just waiting to see what happens (what some of the abortion pill advocates have advocated as just as good as attempting reversal with progesterone), that is the course that is dangerous, not attempted reversal. 

Creinin’s data, limited though it was, actually showed that of the ten patients who went through the full two weeks of his study, four of the five (80%) receiving the progesterone boost were still pregnant at the end of the study period, versus just two of the five (40%) who took only the mifepristone.

Though the media have repeatedly cited Creinin’s study as proof of abortion pill reversal’s lack of safety, his actual results affirm the safety and effectiveness of progesterone to counter the effects of mifepristone, with the danger being association with doing nothing. 

Myth #3: Women are not interested in abortion pill reversals.

One final claim often made by abortion advocates is that women aren’t interested in reversing their chemical abortions — that once they’ve considered their options and made the decision to take the pills to abort their babies, they are committed to their course and have no interest in having legislators second guessing their choices.

No one is claiming that upon taking the abortion pill, all or even most women regret or wish to reverse their decisions. But some clearly do.

According to the Abortion Pill Rescue network, more than 2,500 preborn lives have been saved, indicative not only of a significant level of interest, but the effectiveness of this option. More than 150 women contact the Abortion Pill Rescue network each month expressing regret for their decisions to take the abortion pill and seeking information as to whether it is too late for them to do something to reverse the process.

Abortion pill reversal isn’t what every woman wants, but clearly some women do. And if there are safe, effective options out there to reverse their abortions, women need to be told that, and told where to find help in their community, rather than be fed lies from the abortion industry that calls this desire unreasonable, and claims reversals are just a dangerous fantasy.

Give those women who want accurate information about abortion pill reversal an opportunity to try and save their babies. Pass Senate Bill 591.

Thank you for your time and consideration.

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