The Fantastical Flaws of Arizona’s New 'Reverse' Abortion Law

A new law that forces doctors to give their patients misinformation about an untested procedure is just the latest example of how anti-choice restrictions undermine evidence-based medical care. It’s long past time to stop taking abortion opponents’ hypocritical claims of concern for “patient safety” seriously.
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Arizona State Capitol building. (Photo: robeeena/Flickr)

Arizona State Capitol building. (Photo: robeeena/Flickr)

On Monday, Arizona’s Governor Doug Ducey signed into law a provision—added as an amendment to a bill banning insurance plans on the state’s exchange from covering abortion—that requires doctors to tell their patients that “it may be possible to reverse the effects of a medication abortion if the woman changes her mind, but that time is of the essence.”

If you’re surprised to learn that an abortion can be reversed, you’re not alone. Here’s how unsupported that statement is: The typical procedure for a first-trimester medication abortion involves taking two drugs: mifepristone, which blocks the hormone progesterone which is necessary for maintaining an early pregnancy, followed, a couple days later, by misoprostol, which induces uterine contractions. In a 2012 article published in the Annals of Pharmacotherapy, an anti-choice doctor named George Delgado claimed he’d developed a procedure to “reverse” the effects of mifepristone by giving high-dose progesterone injections to six women who hadn’t yet taken the misoprostol dose; four of them went on to give birth. Delgado has since claimed dozens more successful “reversals.”

Despite the fact that the efficacy, safety, and side effects of Delgado’s procedure have not been rigorously studied, the anti-choice movement is already running with the idea. Arizona’s new law is based on a provision included in Americans United for Life’s influential model legislation guide this year, and the American Association of Pro-Life Obstetricians and Gynecologists is pushing for “Emergency Abortion Pill Reversal Kits” to be available in emergency rooms.

At the recent AAPLOG conference, anti-choice doctors boasted about a 57 percent success rate out of 223 attempted “reversals.” That might sound modestly promising—except that mifepristone by itself is only expected to cause a complete abortion up to 60 percent of the time. “That means that even if these doctors were to offer a large dose of purple Skittles, they’d appear to have ‘worked’ to ‘save’ the pregnancy about half the time,” one abortion provider explained. Experts suggest there’s not even a solid theoretical basis to think that flooding the body with progesterone would block mifepristone, since the drug binds more tightly to progesterone receptors than the hormone itself does.

"If ever there is an example of Legislative overreach, this would be it,” wrote Dr. Eric Reuss, treasurer of the Arizona section of the American Congress of Obstetrics and Gynecology, in an op-ed opposing the bill. “There is absolutely no evidence-based data that the process can be reversed. If passed, our state government will force physicians to impart hearsay to their patients."

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Of course, while this may be a particularly outrageous example, plenty of state governments already do exactly that, requiring doctors to make inaccurate claims as part of state-mandated counseling before abortions. According to the Guttmacher Institute, in 12 states, doctors must say that fetuses may feel pain. (The scientific consensus is that they cannot until well into the third trimester.) In four, they must say that an early abortion may cause infertility. In five, they must say that abortion may increase the risk of developing breast cancer. (No and no.) In seven states, they must stress only potential negative emotional responses after an abortion—and in a couple, even warn patients that they may experience suicidal thoughts or the fictional "post-abortion traumatic stress syndrome.” (Most people express relief after an abortion and the procedure has not been linked to mental health problems.)

The main purpose of such misinformation—which, in addition to being forced into doctors’ mouths, is regularly repeated by abortion foes in state legislatures, at crisis pregnancy centers, and outside abortion clinics—is to portray abortion as more dangerous, emotionally and physically, than it actually is. It’s hard to overstate how dependent on this myth the anti-choice movement has become. By relentlessly pushing the idea that women are “victimized” by “the abortion industry,” opponents have been able to rebrand themselves as their “protectors.” And they’ve introduced hundreds of restrictions that, while clearly designed to reduce access to the procedure, are ostensibly justified—however superficially, at times—by concern for “patient safety” or women’s “right to know.”

When such regulations don’t simply shut down clinics, they almost always violate the standards of “quality care” set forth by independent medical authorities like the Institute of Medicine. While biased “misinformed consent” laws that force doctors to outright lie to their patients are probably the most egregious, mandating ultrasounds that aren’t medically required, setting waiting periods that needlessly delay access to a time-sensitive procedure, and prohibiting doctors from using the most up-to-date—and safest—protocol to administer the abortion pill all constitute “bad medicine,” according to a 2014 report by the National Partnership for Women & Children. These restrictions “put providers in the position of having to choose between adhering to their ethical and professional obligations to provide patient-centered, evidence-based care” and following the law.

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Of course, abortion is hardly the only political issue plagued by advocates with little respect for evidence or expert opinion. But the widespread stigma around the choice certainly makes matters worse. Between the silence that surrounds real-life abortion experiences and pop cultural depictions that often reinforce the myth that the procedure is terribly risky, anti-choice misinformation is rarely checked—and has a real effect on the public’s perceptions. A 2014 study of women who had received abortions found that more than 75 percent overestimated the health risks, and almost half overestimated the risk of depression.

It also doesn’t help that the doctors who offer abortions have been marginalized and isolated within the mainstream medical community. It’s impossible to imagine state governments getting away with brazenly infringing on doctors’ ability to provide the best care to their patients when it comes to any other type of health care—at least not without widespread outcry from the medical establishment. Indeed, when Florida passed a law, pushed by the National Rifle Association, in 2011 that forbids doctors from asking their patients if they have firearms at home, multiple physicians’ associations in the state filed a lawsuit, backed by the American Medical Association, claiming that it violated their First Amendment rights.

But when it comes to anti-choice meddling, it often falls to individual abortion providers, or groups like Physicians for Reproductive Health, to push back. The American Congress of Obstetricians and Gynecologists, which has staunchly opposed Arizona’s law, has become more vocal in telling politicians to “get out of our exam rooms” in recent years. In 2012, its former president explained to Salon that it was the increasing attacks on access to contraception that had spurred the organization to take a stronger stand. Meanwhile, general physicians’ associations like the AMA, while officially supportive of legal abortion, tend to choose their moments to wade into reproductive rights battles carefully.

It's understandable that doctors who don’t perform the procedure would be hesitant to jump into the political fray—especially as medical boards in Republican-controlled states are increasingly stacked with abortion opponents. But you don’t have to provide—or even approve of—abortion to be horrified by the way anti-choice laws violate the sanctity of the doctor-patient relationship. The silence of the rest of the medical community reinforces the idea that abortion isn’t a normal part of health care that should be subject to the same standards of ethics and evidence that dictate the whole profession.

To be fair, there’s only so much the medical community can do anyway, so long as lawmakers have no qualms about passing legislation on the basis of politically expedient fantasies, instead of facts. (After all, despite the AMA’s strong stand, Florida’s gag law was upheld and a similar one popped up in Texas just last week.) Indeed, what Arizona’s new law demonstrates, above all, is just how selective and opportunistic the anti-choice movement’s interest in “patient safety” really is, as Robin Marty pointed out at Talking Points Memo.

In 2012, anti-choice lawmakers in Arizona passed a law, also modeled on Americans United for Life legislation, that requires providers to use the Food and Drug Administration’s original protocol for mifepristone, despite the fact that since the drug was first approved, the medical community has established a safer “evidence-based” regime, based on decades of international scientific research. The new protocol, which has been used by the majority of American abortion providers for more than 10 years, allows patients to take a lower dose of the drug, make fewer visits to the clinic, and experience fewer side effects—and it’s effective for longer into the pregnancy. Not incidentally, it makes the procedure more convenient, less costly, and more accessible in areas—like, say, Northern Arizona—where surgical abortions aren’t available.

The Arizona legislature claimed the law was needed to “protect women from the dangerous and potentially deadly off-label use of abortion-inducing drugs.” Now, the very same people who expect us to believe they are genuinely worried about the risks of a procedure with a complication rate of less than 0.25 percent are, as Marty puts it, “suggesting that patients Google a website, call a hotline, be hooked up with a doctor they have never seen and rush straight to a place to be injected with massive amounts of hormones without any FDA approval of that procedure, long-term studies of the effects, or even much of a testing pool of subjects to draw data from.”

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Recently, the media has been grappling with how to responsibly report on the views of another cohort that’s apparently immune to persuasion by overwhelming scientific consensus: climate change deniers. “Claims that climate science is a hoax, or that human action is not a factor are not defensible positions in a political debate,” Jay Rosen wrote last week. “They are ways of saying: hey, the evidence doesn’t matter.” Increasingly, journalists have decided that such beliefs shouldn’t be taken seriously.

Likewise, while being morally opposed to abortion—and advocating strenuously for its criminalization—is a perfectly legitimate political position, claiming to do so on the grounds that abortion harms those who choose it is not. The evidence that legal abortion in the United States is an extremely safe procedure—mentally and physically—is simply settled science. Pretending otherwise—let alone legislating on the basis of such fantasies—is a way of saying “the evidence doesn’t matter” and should be treated by the media as such.

The Gender Gap explores the persisting gender inequalities of the modern age and society’s unwillingness to grapple with them.

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