Search engine results for reproductive healthcare are more likely to turn up an anti-abortion marketing campaign than legitimate medical information. Crisis pregnancy centers, non-medical organizations that primarily operate to dissuade pregnant people from having an abortion, are consistently included among search results for health clinics.

Recently, anti-abortion campaigns have focused efforts towards promoting disinformation about an untested practice to “reverse” medication abortion.

Through sponsored search results, emergency phone lines and social media ads, the theory of reversing medication abortion has become a core talking point in the anti-abortion movement and a critical tool with which to disempower reproductive health decisions.

The experimental practice consists of an individual being given the progesterone hormone after taking the first pill of medication abortion. Anti–abortion advocates claim that this can nullify the effects of abortion medication. More than 30 percent of crisis pregnancy centers (CPCs) promote this untested practice, which they commonly advertise as “abortion pill reversal.”

This proportion holds true in western Massachusetts, where there are at least six known anti-abortion pregnancy centers; Clearway Clinic in Springfield and New Direction Women’s Center in Pittsfield broadly advertise their membership in the Abortion Pill Reversal Network. At the University of Massachusetts, the group Students for Life uses social media to promote this untested theory.

The claim that administering progesterone increases the likelihood that a pregnancy continues is not supported by any strong scientific research.

“There is no medical evidence that [medication abortion reversal] works or is safe,” Dr. Steffanie Wright, licensed OBGYN and complex family planning fellow at Brigham and Women’s Hospital, said.

In 2019, the American Medical Association filed a lawsuit in North Dakota, objecting to a legal mandate that physicians inform their patients that medication abortion can be “reversed.” The American College of Obstetricians and Gynecologists, a renowned physicians association with more than 60,000 members, has stated that they do not endorse the practice.

“We would not endorse or provide [abortion pill reversal] and to do so would be to go against the largest, most respected scientific body in the country, [the ACOG],” Dr. George Corey, medical director of University Health Services at the University of Massachusetts said.

Technology enables misinformation within women’s health sector

Most CPC’s advertising treatments to reverse medication abortion refer individuals to a 24/7 hotline run by the Abortion Pill Rescue Network. The group is sponsored by Heartbeat International, a global corporation affiliated with thousands of CPCs. Heartbeat provides their partners with digital marketing strategies and technology, such as chatbots and data services. In addition, the company collects and stores data, which may include private health information, from user interactions with pregnancy centers and the hotline.

The Center for Countering Digital Hate, a U.K.-based nonprofit, reviewed advertisements promoted by Facebook and Google, finding that on more than 80 percent of searches, Google prioritized misleading ads for reversing medication abortion. Facebook specifically targeted ads claiming to reverse medication abortion to minors. Users aged 13 to 17 years old viewed the ads more than 700,000 times.

Anti-abortion marketing campaigns are often ripe with other medical disinformation, including warnings of the health risks that abortion can pose to individuals, despite these claims having been routinely disproved by medical professionals.

The popularity of the “rescue” hotline has increased in recent years, as noted in a study by the policy coalition Alliance: State Advocates for Women’s Rights & Gender Equality.

This trend corresponds with the expanding presence of CPCs, many of which are not staffed with medical professionals and are not upfront about their anti-abortion ideology. These centers are critical players in promoting the concept of an abortion pill reversal.

Nationally, anti-abortion advocates are lobbying to require that this untested treatment be included in medical conversations and policy decisions. Eight states – Arkansas, Idaho, Kentucky, Louisiana, Nebraska, South Dakota, Utah and West Virginia – require doctors to tell their patients that medication abortion can be reversed. Many more have mandates being introduced in their legislature.

Medication and surgical abortion are safe and effective, a fact affirmed by the majority of licensed medical professionals across the globe. Medication abortion, which consists of two consecutive doses of the drugs mifepristone and misoprostol has been found to be safer than over-the-counter medications, such as Tylenol.

Western Mass. is not immune to disinformation

Throughout the 2022-2023 academic year, University Health Services provided medication abortion as a patient service. UHS had begun preparations to offer this service two summers ago, in compliance with a Massachusetts law that mandates all state universities offer the abortion pill regimen by November 2023.

 “That situation is not a situation that we would foster or that would be likely,” Corey noted regarding whether UHS would ever entertain the theory of abortion reversal.

“Women have no trouble making these decisions,” he said. “Really our [stance] as physicians – who need to speak towards ethics and not just science – is ‘no, don’t let anyone talk you out of what you want to do. You know what you need.’”

The patient-provider relationship is dependent on honest and direct communication, according to Dr. Danielle Roncari, medical director of the Planned Parenthood League of Massachusetts.

Roncari wants her patients, “to make the decision that is going to be the safest for them and for their families. We try hard at Planned Parenthood to do that [for] our patients and to provide them with a standard of care accepted in the medical literature,” Roncari said.

Roncari emphasized that the unproven concept to “reverse” medication abortion does not meet this standard of care.

“Injecting doubt is really not medically ethical”

Medication abortion is a two-part process. The first pill, mifepristone, works by blocking progesterone from the hormone receptor, stopping the pregnancy from growing. Misoprostol, taken about 24 hours after the first, causes the uterus to contract and empty.

The theory of reversing the first pill of a medical abortion treatment was championed by Dr. George Delgado, a family-medicine doctor and medical director of a California clinic, where he practices Catholic-informed anti-abortion medicine. Delgado’s 2012 report and expanded 2018 data has become the primary source cited by the anti-abortion industry.

The theory, whose scientific basis was explained by Wright, suggests giving a pregnant person progesterone after they have taken the first pill, with that hope that the hormone “can flood the receptors and…potentially reverse the effects of mifepristone,” she said.

Delgado’s case report examined six women who took the first abortion pill and then were given 200 milligrams of progesterone via intramuscular injection. Four of the six women continued with their pregnancies.

Individuals who stop after the first abortion pill and do not receive additional hormone therapies have a similar continuation rate. According to a literature review cited by the American College of Obstetricians and Gynecology, “as many as half” of pregnant people who only take mifepristone continue their pregnancy.

The clinical process of medication abortion makes the unproven reversal treatment not medically necessary, noted Roncari. If a pregnant person decides to not complete the medication abortion regimen after taking the first pill, “mifepristone hasn’t been shown to have any adverse effects for the fetus or for the mother,” Roncari said.

In 2018, Delgado published a broader case series that reported observations from 754 patients who were given progesterone after ingesting the first pill of medication abortion. Delgado reported that 64 to 68 percent of pregnancies continued; the variation between these two data points was dependent on whether progesterone was administered intramuscularly or orally.

Neither case series had a control group or randomized trials, standard requirements to prove a treatment’s efficacy within a clinical care setting, according to Roncari. “[Delgado] may be using different anecdotal evidence,” she said, “but nothing has been proven in a scientifically found way.”

ACOG’s statement on these case series asserted that there was no scientific evidence that could be determined from the observations. The statement noted that “case series with no control group are among the weakest forms of medical evidence.”

“The myth of a treatment that can reverse medical abortion remains under-reported and under-researched for a reason,” Roncari said. “There have not been any clinical trials showing safety and in fact, the one trial that was attempted was stopped short because it showed potential harm for patients.”

In 2019, Dr. Mitchell Creinin of University of California, Davis decided to test out the theory via a randomized control trial approved by the University’s institutional review board, “our gold standard for studying different treatments in medicine,” Wright noted.

The study was halted after recruiting only 12 patients because of safety concerns and complications; three patients had severe hemorrhage, requiring emergency medical transport. Of those hospitalized, two were given a placebo and one had been given progesterone.

The researchers were unable to collect enough data to arrive at an evidence-informed conclusion.

“Science aside, it’s far more the ethics of why would you? The person’s made a decision, help them go through with their decision,” Corey said. “It is not ethical for us to feed doubts into their mind about the decision that they made, and that only they could make, and needed to be made. Injecting doubt is really not medically ethical.”

As determined in the Turnaway Study, and confirmed in a 2018 research article, 95 percent of women who have an abortion are confident in their decision and remained consistently confident in their decision throughout the five year period they were studied.

“Not a regulated, not a studied and not a known amount”

Using progesterone in hormone therapies is still undergoing research and risk assessment.

“The ability for physicians to give you the right amount of hormone at the right time and do so over time, it is not our strength,” Corey said.

The endocrine glands that release progesterone are under feedback control so that, “it makes the right amount — not too much, not too little progesterone — in a healthy individual. It is finely tuned. When a doctor gives you a shot of medication, it is not finely tuned,” Corey said.

The hormone treatment suggested in the reversal theory is “not a regulated, not a studied and not a known amount,” he continued. “You would hope to give the right amount of progesterone, at the right time, for the right period of time. None of that is known.”

Progesterone, and other hormones, are safely and routinely administered by physicians for a variety of purposes, such as birth control or alleviating the symptoms of endometriosis. Past experimental hormone therapies, however, had dangerous side-effects that went unknown until decades later.

This was the case for diethylstilbestrol, “a progesterone-acting compound that is not exactly progesterone,” Corey explained. Corey supplied this anecdote as “one extreme of a concern that one might have,” regarding the lack of large-scale clinical trials that would substantiate not only the effectiveness, but the safety of hormone treatment theorized to “reverse” an abortion.

The progesterone-acting compound was widely used during the 1940s-1970s in the United States to help with pregnancy, as a “morning-after pill” emergency contraceptive and to treat symptoms of menstruation and menopause.

Mainstream use of this synthetic hormone dramatically tapered off as it was discovered that those who had been exposed to the compound, both during pregnancy and in-utero, had higher risk of cancer.

“An infusion is no substitute for an endocrine organ functioning. Long story short,” Corey said.

“These are people’s lives we’re affecting”

Despite concerns raised by medical professionals regarding a lack of legitimate scientific data and ethical violations, anti-abortion organizations continue to promote this theory.

On campus, the registered student organization UMass Students for Life, a chapter of a national anti-abortion organization, promotes misinformation about reproductive healthcare. On their social media, posts present the theory of abortion reversal as a legitimate medical treatment and state that medication abortion “harms women.”

The RSO did not respond to requests for comment.

There is no public data regarding how frequently individuals utilize Heartbeat International’s hotline, seeking to reverse their abortions. Regardless, funding and digital marketing infrastructure increasingly continues to be funneled towards this unmonitored and unproven treatment.

“It sounds so simple, but these are people’s lives that we are affecting,” Wright said when discussing the implications of this disinformation. “The part that makes this all so dangerous is that [it] interferes with the patient-clinician relationship and undermines medical care.”

“One of the many reasons I went into medicine is to help people. It’s as simple as that, to help people live full and productive lives,” Wright said. “The role of the physician is to help support people [to] have healthy lives and be able to reach their aspirations and their goals.”

Grace Fiori can be reached at [email protected] and followed on X (formerly known as Twitter) @grace_fiori.