Idaho Joins Other States With Informed Consent For 'Abortion Reversal' Procedures
SARAH MCCAMMON, HOST:
Idaho has become the latest of a handful of states to pass a law promoting a medically-controversial technique called abortion reversal. Idaho doctors who prescribe medication to end a pregnancy must now inform patients the procedure can be stopped if they change their mind. Here's State Senator Lori Den Hartog, a sponsor.
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LORI DEN HARTOG: It simply enhances our informed consent language to allow pregnant mothers to be aware of and provided information about potential lifesaving opportunities for their unborn child if they have changed their mind after the initiation of a drug-induced abortion.
MCCAMMON: Many medical groups have come out against the procedure. One opponent is Dr. Daniel Grossman of the University of California, San Francisco. I asked him to explain how medication abortion works.
DANIEL GROSSMAN: A medication abortion involves the use of two drugs - first, Mifepristone, which blocks the progesterone receptor, and then a second medication, Misoprostol, which is given to open the cervix and cause uterine contractions. These medications are very effective. It's used up to about 10 weeks of pregnancy. And a growing number of women are choosing this as an option. The latest data are about 45 percent of all eligible abortions end up with medication abortion.
MCCAMMON: And this is different - right? - from the morning after pill, for instance. This is actually ending a pregnancy once it's begun?
MCCAMMON: So granting that this is not a well-established procedure at this point, what is the typical protocol like for women who ask for an abortion reversal?
GROSSMAN: They all involve progesterone of some sort, either given by injection or vaginal administration or by pills. And the thought there is that because Misoprostol - the first pill of medication abortion - blocks the progesterone receptor, if you just then flood the body with progesterone, you could somehow limit the effect or reverse the effect of that first pill. And that kind of makes sense on some level. At the same time, it's important to recognize that in a normal pregnancy, the body is already flooded with progesterone, and it's unclear that adding more progesterone would actually make a difference. So if, you know, there's a case where a woman - in a very rare case - that a woman decides to change her mind after taking the first medication, really, the standard of care now would be just to watch and wait and see what happens after taking the first medication.
MCCAMMON: And you've looked closely at this research that examines the effectiveness of abortion reversal. What stood out to you from that analysis?
GROSSMAN: There's just very little data that's been published in the literature. There is one case series of seven women who received this treatment, one of whom was lost to follow-up. And there's just a lot of missing information from this report. The most concerning thing to me is that there's no evidence that this research - which, it really was research - there's no evidence that it was conducted under the supervision of an institutional review board or some sort of ethical review panel to make sure that patients received informed consent and that they were aware of the potential risks and that they were participating in research. And there's really no evidence to indicate that some sort of treatment will increase the likelihood that the pregnancy will continue.
MCCAMMON: But there are doctors who will do this - right? - who will give women progesterone in an effort to stop medication abortion. What, if any, risks does that entail?
GROSSMAN: Well, because this hasn't been studied, we don't know what the risks are.
MCCAMMON: Do you suspect that there would be risks to the fetus, you know, trying to terminate a pregnancy and then reversing that?
GROSSMAN: The best evidence that we have indicates that Mifepristone by itself does not increase the risk of the baby having a birth defect if the pregnancy continues. So I don't have a lot of concerns about the fetal risks, but I think it really needs to be studied. And I'm very concerned that this is now being advocated and, you know, really being put forward by state legislatures with so little evidence.
MCCAMMON: What are the ethical implications of requiring doctors to tell women that this abortion reversal procedure is available?
GROSSMAN: Well, I find this very concerning. I mean, for a long time, states have been forcing abortion providers to give women inaccurate information about the risks of abortion. Women have to be told in some states about potential association with breast cancer.
MCCAMMON: Which the American Cancer Society says is not an actual risk, correct?
GROSSMAN: Exactly. It's not an actual risk. But I find this next level with these laws requiring providers to give information about this so-called abortion reversal even more concerning because now it's state forcing doctors to tell their patients about a treatment that is completely unproven and experimental. I think this is particularly concerning because, you know, the majority of abortion patients are women of color and low-income women. And our country really has a very dark history of experimentation on people of color. And I'm concerned that these patients are not being adequately informed that this is really research.
MCCAMMON: Dr. Daniel Grossman is a professor of gynecology and reproductive sciences at the University of California, San Francisco. He joined us from our member station KQED in San Francisco. Dr. Grossman, thank you.
GROSSMAN: Thank you.
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