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Abortion rights advocates, doctors take aim at uptick in 'reversal' laws

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Abortion rights advocates, backed by a coalition of medical professionals, are stepping up their fight against "pill reversal" laws they say infringe on medical ethics and free speech amid a slew of increasingly harsh abortion restrictions passed by states over the past year.

Late last month, the Center for Reproductive Rights filed a lawsuit challenging legislation in Oklahoma that they say would deprive doctors of their right to free speech and require them to provide "false, misleading, nonmedical information" to women seeking a medication abortion, a nonsurgical procedure which involves a drug used in the first trimester.

Oklahoma's Senate Bill 614, which is slated to go into effect on Nov. 1, would mandate doctors inform patients 72 hours before administering a medication abortion that "it may be possible to reverse the intended effects" of the drugs, but "time is of the essence." Doctors who violate the law would face felony charges.

The 34-page complaint, submitted on behalf of the Tulsa Women's Reproductive Clinic and its owner, Dr. Alan Braid, charges that the law forces doctors "to violate their ethical obligations to their patients and undermines the establishment of a relationship of trust and confidence between a patient and her physician." The American Medical Association and the American College of Obstetricians and Gynecologists, meanwhile, have publicly opposed medication abortion reversal laws, warning that the reversal procedure is an "experimental and unethical treatment."

Currently, six states — Arkansas, Idaho, Kentucky, Nebraska, Utah and South Dakota — have laws in effect requiring doctors to inform their patients of medication abortion reversal. Three of these states — Arkansas, Kentucky and Nebraska — plus Oklahoma and North Dakota, whose laws are not currently active, have signed medication abortion reversal bills into law within the past year.

Georgia, Kansas, North Carolina, Ohio and Wisconsin have similar bills sitting on their dockets this legislative session. Earlier this year, U.S. Rep. Mike Conaway, R-Texas, proposed the "Second Chance at Life Act," introducing a medication abortion reversal bill at the federal level.

According to Center for Reproductive Rights attorney Gail Deady, the abortion rights organization chose to target Oklahoma's law because it contains the "most severe penalty" against doctors found in similar medication abortion "reversal" laws around the country.

"The law in Oklahoma is a particularly troubling version of what is a trend across the country," Deady said. "We are seeing a trend of lawmakers using doctors as mouthpieces for the state or silencing them with rules."

Anti-abortion public interest law firm Americans United for Life penned the model legislation adopted by these states — a bill they refer to as the "Women's Right to Know Act." They argue that such laws are necessary in order to ensure that women can give informed consent to an abortion.

"Many women who seek abortion do so because they feel they don't have options," said Steve Aden, the chief legal officer and general counsel for AUL. "This is just an option — a common sense, straightforward, medically appropriate option."

The American College of Obstetricians and Gynecologists, however, has condemned the case series that supports medication abortion reversal as "among the weakest forms of medical evidence."

To terminate a pregnancy with medication, women take two pills: mifepristone, which blocks the hormone progesterone and prevents further growth of the embryo, and misoprostol, which causes the uterus to contract and expel the embryo.

Proponents of the so-called "pill reversal" contend that if a woman does not take the second pill and instead receives injections of progesterone, the abortion can be "reversed" and the pregnancy can be carried to term.

Dr. Ilana Addis, former chair of the Arizona section of ACOG, said that the existing studies alleging the efficacy of "abortion pill reversal" amount to "junk science." She claims that such reports do not indicate the effectiveness of progesterone injections, but mifepristone's failure rate if taken alone.

"What we know is that even if you don't do anything — if you gave out, say, purple Skittles — then [the pregnancy] would still be up to 50 percent successful if you don't take the misoprostol," Addis said.

In 2016, a joint lawsuit filed by Planned Parenthood, the American Civil Liberties Union and the Center for Reproductive Rights resulted in the repeal of a medication abortion reversal law in Arizona. Earlier this month, a district court in North Dakota blocked another "compelled reversal mandate" after the American Medical Association sued the state.

Medora Nagle, executive director of the North Dakota Right for Life, called the court's ruling a "disservice to women" and said she hopes that North Dakota Attorney General Wayne Stenehjem would appeal the decision.

Rebecca Tong, the director of development at the Trust Women Foundation, which operates an abortion clinic in Oklahoma City, noted that this is not the first time that state laws have mandated doctors to disseminate information about abortion that they disagree with. Referencing another Oklahoma law that requires doctors to warn of unconfirmed side effects of abortion, including breast cancer, Tong said that this can give rise to "awkward" conversations with patients.

"After we say the state-mandated language, we would say, 'This is not true, but we're required to tell you this by the state.' And we've had cases where our patients were upset by this," Tong said. "[The doctors] took an oath to give factual information to their patients and to give them the best advice possible — this law is in direct conflict with that."

Aden said that he believes that the "protests by the abortion industry" will prove "unavailing."

Tamya Cox-Touré, the regional director of public policy and organizing at Planned Parenthood Great Plains Votes, stressed the significance of the upcoming hearing in Oklahoma amid the battle over abortion rights.

"So-called abortion pill reversal sets a dangerous precedent for patients and is simply another politically motivated attempt to restrict access to safe, legal abortion in Oklahoma," Cox-Touré, whose lobbying and advocacy branch of Planned Parenthood operates in multiple states, said. "Women must be able to make their own health care decisions with the advice and expertise of their health care provider — not politicians."

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