PHOENIX — An abortion regulation bill moving through the Legislature is under scrutiny for an amendment requiring doctors to inform patients about “abortion reversals,” for which medical evidence is lacking.
The House Federalism and States Rights Committee approved the amendment to SB 1318 from Rep. Kelly Townsend, R-Gilbert, adding informed consent requirements about medication abortions. SB 1318 prohibits any health exchange in the state from providing abortion coverage and requires doctors admitting privileges be submitted to the Arizona Department of Health Services.
Under the amendment, doctors would be required to inform women seeking abortions that the effects of RU-486, the “abortion pill,” can be reversed. It also requires the information to be accessible on the ADHS website.
“We’ve come to find out that there is an option when women have taken RU-486 and then they have changed their mind and there’s a plan and a way for physicians to help reverse their decision if they act quickly,” said Sen. Nancy Barto, R-Phoenix, the bill’s sponsor.
Opponents of the bill and reproductive health professionals aren’t so sure. They argue that the effectiveness of these abortion reversals is not yet known and it could give women false hope when it may not work.
Dr. Eric Reuss, treasurer of the Arizona Section of the American Congress of Obstetrics and Gynecology, said the information in the amendment can’t be supported by any data or medical evidence.
“In the absence of any evidence, it’s foolhardy for the state to be telling women this information,” Reuss said.
State law already requires doctors to inform women about the medical risks of an abortion, the probable physical features of the fetus and benefits available should they carry the pregnancy to term. Arizona would be the first state to require women seeking abortions to be informed of the possibility of abortion reversals.
Medication abortions require two pills: RU-486, also known as mifepristone, and misoprostol. RU-486 is given within the first seven to nine weeks of a pregnancy and stops the hormone progesterone, which is needed for pregnancy. Misoprostol is taken later and causes the womb to contract to create the effects of miscarriage.
“Reversing” the abortion comes in with giving the woman progesterone after RU-486 is taken to keep the pregnancy going. The SB 1318 amendment states “time is of the essence” when it comes to reversing the abortion.
Dr. Allan Sawyer, immediate past president of the American Association of Pro-life Obstetricians and Gynecologists, testified before the House committee that he had helped a woman save her pregnancy by administering progesterone after that woman had taken RU-486. Other doctors have reported that they have managed to save pregnancies this way.
The Food and Drug Administration does not approve progesterone for this specific use. Administering progesterone is also not widely accepted in obstetrics and gynecology as a way of reversing the effects of a medication abortion.
Dr. Ilana Addis, chair of the Arizona section of the American College of Obstetricians and Gynecologists, said this protocol is not evidence-based.
After RU486 is administered, there is up to a 50 percent chance that the pregnancy will continue anyways if nothing is done, Addis said. This is about the same success percentage as administering progesterone so, she said, it works “about as well as placebo.”
Sawyer said the studies on abortion reversals are ongoing. “This is not a clinical trial, it’s looking at outcomes of pregnancies and … that’s the way those studies are done,” he said.
Addis said the reports on individual cases do not constitute research.
By requiring doctors to tell patients about the medication abortion reversal, Reuss said, they would be forced to practice on the “fringes” of medicine.
Bryan Howard, president of Planned Parenthood Arizona, said this amendment also would remove “moral hazard” for women considering abortions, meaning they could take a risk they wouldn’t otherwise take.
“If we communicate or are required to communicate that she can actually start a process and then change her mind, a woman who is still conflicted could begin that process and risk losing a pregnancy that she could ultimately conclude that she wanted,” Howard said.
“We are sending a mixed message to women and risking their pregnancies,” he said.
Rep. Townsend said informing women about reversing their abortion doesn’t mean that they will assume it is totally effective.
“I think that women are intelligent enough to know that it has been used in the past successfully and there is nothing guaranteeing them that it is going to work,” Townsend said. “The potential for success exists and they deserve to know that.”
Sen. Barto also insists that the evidence on abortion reversal is “all on our side so far.”
The uncertainty of its medical effectiveness could raise legal issues, too.
Tim Fleming, an attorney for the House Rules Committee, said from case law, legislation can add information a doctor be required to give to women seeking abortions. “The test is whether [the information] is truthful and non-misleading,” Fleming said.
Fleming said he isn’t sure whether or not the information in the amendment regarding medication abortion reversal.
“There may be some question about that and that may be the source of litigation perhaps going forward,” he said.
The Senate passed SB 1318 down party lines last month in a 17-12 vote with Republicans in support and Democrats opposed. The Republican-dominated House is set to debate the bill on the floor this week.
Ethan McSweeney is the Bolles Fellow covering the Legislature for Arizona Sonora News, a service provided by the School of Journalism at the University of Arizona. Reach him at firstname.lastname@example.org