Unproven, Unethical and Dangerous: Counseling Requirements on Stopping a Medication Abortion Threaten Patients and Providers

Olivia Cappello, Guttmacher Institute
Reproductive rights are under attack. Will you help us fight back with facts?

First published online:

Patients obtaining a medication abortion from a health care provider expect to have a conversation about the pills they need to take for the procedure, a treatment that has been proven safe over 20 years of use and is more than 95% effective. Their provider will tell them about expected side effects and potential complications, which are similar to those of a miscarriage.

But in an increasing number of states, their provider is forced to tell them about medication abortion "reversal"—an unproven and medically unsupported treatment that can allegedly stop a medication abortion after the patient takes the first pill in the abortion regimen, mifepristone. This counseling is mandated under the guise of providing patients with options. In reality, it uses flawed research to undermine personal reproductive health choices.

Counseling about stopping a medication abortion is the latest attempt by antiabortion legislators to co-opt science as a tool to chip away at abortion access. Since 2015, when Arkansas became the first state to mandate preabortion counseling on stopping a medication abortion, five more states have imposed their own such requirements. Advocates expect that more states will attempt to impose the requirement in the coming legislative session, even as these laws face legal challenges.

Lying to Undermine Abortion Care

Antiabortion promoters of reversing a medication abortion claim that counseling about the unproven treatment offers people additional options about their pregnancies. Such claims obscure that this counseling is based on fundamentally defective studies and, as the American Medical Association has stated, "undermines [the provider-patient] relationship…with messages that contradict reality and science."

First, according to the American College of Obstetricians and Gynecologists, the treatment that abortion foes are promoting is unproven, unethical and dangerous. The case studies on which it is based claim that taking progesterone after the first medication abortion pill (mifepristone) stops the abortion if the patient does not take the second pill (misoprostol). However, these case studies have serious ethical and scientific flaws, and it is unclear whether taking progesterone has any effect beyond what would happen if a patient simply failed to take misoprostol.

A recent attempt to test the efficacy of this experimental treatment in a rigorous and ethically designed controlled study was halted due to significant safety concerns for patients. Researchers were therefore unable to draw conclusions about progesterone’s efficacy in stopping a medication abortion. Providers following accepted professional standards would not offer such an unproven treatment to a patient outside of a controlled medical study, yet abortion providers in several states are being required by law to do so.

Second, instead of improving the health care abortion patients receive, requirements to counsel patients about how to stop an abortion cause harm. These counseling requirements force providers to give patients misleading information, compromising the key medical standard of informed consent and patients’ right to high-quality health care. Counseling that is inaccurate and misleading sows mistrust between patients and providers, not only diminishing the quality of care at a given appointment but potentially for the long term.

Finally, counseling abortion patients about abortion "reversal" is a violation of their agency. According to standards of medical ethics, providers must give counseling that is respectful and conscious of the patient’s own interests. By contrast, counseling about how to stop an abortion casts doubt upon the patient’s decision making: It implies that patients will waver, that their provider tacitly doubts them, and that their abortion is a mistake. In reality, nearly all abortion patients are certain of their decision when they go in for their procedure.

Challenging Harmful Requirements in the Courts

Looking ahead, abortion advocates expect that abortion "reversal" will continue to attract attention in the states and in the courts. In 2019, four states added requirements for counseling about how to stop a medication abortion, while governors in two other states vetoed such requirements. Two of the enacted laws, in North Dakota and Oklahoma, have been blocked during ongoing litigation.

Notably, both cases center on the way these requirements force doctors to lie to their patients on behalf of the state, in direct contradiction to medical ethics and free speech rights. In their complaint in North Dakota, the American Medical Association and Red River Women’s Clinic said that physicians are being used to give patients misleading propaganda that violates their obligation to do no harm. Similarly, physicians at the Tulsa Women’s Reproductive Clinic in Oklahoma noted that the state’s requirement forces them to deliver false, non-medical information with which they personally and professionally disagree.

In siding with clinics in these initial decisions, courts have agreed that these state requirements unfairly burden those seeking abortion and their health care providers. These decisions echo a federal case in Arizona, which resulted in that state’s abortion reversal counseling law being repealed in 2016. This litigation will continue as abortion rights are gravely threatened at the U.S. Supreme Court and as antiabortion legislators work to further roll back abortion access.