Planned Parenthood
and the
Center for Reproductive Rights
are
suing
the state of
Kansas
to block the implementation of new legislation that requires informing abortion patients of the potential to stop a medication abortion using a high dose of the hormone progesterone, also known as “abortion reversal.”
After a protracted fight in the state legislature, Republican lawmakers overrode Gov. Laura Kelly’s (D-KS) veto on April 26, and the law is slated to take effect on July 1.
CONGRESS CAN DO MORE TO PREVENT MEGAFIRES
Abortion in
Kansas
is legal up to 22 weeks of gestation unless the pregnancy beyond this point threatens the life of the mother. There were
7,845
abortions conducted in the state in 2021, 68% of which were mifepristone-induced. Kansas citizens accounted for only 50% of in-state abortions. Approximately 44% of abortion-seekers in Kansas were residents of Missouri, which prohibits all abortion except for saving a mother’s life.
Here’s what to know about the scientific claims within the political context of this case.
What is the lawsuit about?
Planned Parenthood and the Center for Reproductive Rights
claim
that requiring clinicians to discuss abortion reversal with their patients undermines the principle of “decisional autonomy” that undergirds informed consent, saying it makes healthcare providers “mouthpieces for the State’s ideological message in favor of childbirth.”
The plaintiffs also argue that informed consent on abortion reversal requires “providers to force potentially traumatizing information on their patients,” who may experience psychological harm by hearing new information after having decided to terminate their pregnancies.
Although the progesterone abortion reversal has not been approved by the Food and Drug Administration,
proponents
of the procedure cite anecdotal evidence that a reversal is safe and effective in a majority of cases. Advocates also note that it provides an option to women who experience regret after the first step in the mifepristone abortion process.
How does a medication abortion work?
A medication abortion is typically
facilitated
in a two-step process using mifepristone and misoprostol. Although it is uncommon,
misoprostol
alone can be administered as an abortion agent.
In the two-step process, mifepristone blocks a woman’s progesterone receptors. Because progesterone is necessary for fetal development, mifepristone is designed to stop the child’s growth in the womb. Within 48 hours after taking mifepristone, the abortion patient is instructed to take misoprostol to induce uterine contractions to expel the pregnancy.
The FDA
approved
the brand name of mifepristone, Mifeprex, in 2000 and approved the generic version of the drug in 2019. The drug is approved for use up to 10 weeks’ gestation, or 70 days after the patient’s last period.
Planned Parenthood describes both the two-agent and single-agent medication abortion process as “similar to an early miscarriage,” with cramping and bleeding lasting between four and five hours or more.
What is the role of progesterone in abortion reversal?
Taking a high dose of progesterone within 24 hours of taking mifepristone can
counteract
the effects of the first agent by essentially overloading the patient’s progesterone receptors. This minimizes the effects of the mifepristone and raises the patient’s progesterone levels.
Because of the relationship between progesterone and mifepristone, reversing a medication abortion with progesterone treatment is only possible after taking the first medication in the two-step process. Progesterone abortion reversal would be ineffective after taking misoprostol in the two-agent process or a misoprostol-only abortion because of the chemical causal mechanism of the drug.
The American Association of Pro-Life Obstetricians and Gynecologists
notes
that, of documented cases, there is a 68% survival rate when mothers choose to take progesterone as an abortion reversal after the first dose of mifepristone. AAPLOG also says no birth defects have been reported after a child survives either a failed mifepristone abortion or a successful abortion reversal.
Several studies published in medical journals have shown a
positive
result of progesterone stopping a
mifepristone
abortion, but they consist of case studies with very small sample sizes. As such, they are not necessarily representative of the entire population and are not under the same scientific control mechanisms as typical medical analyses.
Although using progesterone after taking mifepristone may need more quantitative scrutiny, progesterone is recommended by physicians to help stop early natural miscarriages.
The National Institute of Health and Care Excellence
recommends
increasing progesterone intake for women who have a history of miscarriage and are experiencing bleeding during the early stages of pregnancy. Although each patient and set of circumstances is different, the recommended
doses
for preventing early miscarriage are similar to the recommendations for stopping a mifepristone abortion.
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How prevalent is medication abortion nationally?
A preliminary estimate from the Guttmacher Institute, a pro-abortion think tank, is that
54%
of all abortions in the United States as of February 2022 were conducted via medication abortion. In 2020, 53% of all facility-based abortions were conducted using either the two-agent or single-agent medication abortion process.
A total of
620,327
abortions were reported to the
Centers for Disease Control and Prevention
in 2020. Guttmacher Institute data estimate that
930,160
were conducted in 2020. These figures are significantly
lower
than their peaks in 1990, when between 1.4 million and 1.6 million abortions were reported by the CDC and Guttmacher Institute, respectively.
