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“We do help hundreds of women every day in the UK,” said a tired-sounding American woman who spoke to an openDemocracy undercover reporter in the middle of her night. “We’re like the international abortion pill reversal line.”
So-called ‘abortion pill reversal’ (APR) treatment was invented by a controversial anti-abortion doctor in California. It prescribes high doses of progesterone, a hormone, after the first of two pills used for medical abortions.
A US study into APR was cancelled in 2019 after some participants went to hospital with severe haemorrhaging. The lead researcher, Mitchell D Creinin, said it was stopped because “It wasn’t safe for me to expose women to this treatment.”
But anti-abortion groups have continued to promote it in the US and around the world – including in the UK, apparently under the radar of regulators. APR’s proponents claim at least 60 women in the UK requested it in the first half of 2020.
Our reporter called a 24-hour hotline run by a US group called Heartbeat International – and advertised in the UK by the Society for Protection of Unborn Children (SPUC) – and was quickly connected to a local doctor for the ‘treatment’.
She posed as a pregnant woman who had begun a medical abortion, having taken the first pill, and was told by this doctor that the ‘reversal’ treatment is safe and effective – despite the lack of medical evidence to prove this.
“I am shocked that this is taking place in the UK,” said Labour MP Nadia Whittome in response to openDemocacy’s findings. “Women should not be used as guinea pigs by anti-abortion activists. The hotline needs to be shut down immediately.”
“It is completely unacceptable,” added Munira Wilson, MP and Liberal Democrat spokesperson for health and social care. “Regulators must investigate this as a matter of urgency and put a stop to this harmful practice.”
‘Surging’ during COVID-19
During the pandemic, women in the UK have been allowed to have medical abortions at home with remote appointments. A government consultation on whether to make this permanent closed at the end of February.
Meanwhile, the Society for the Protection of Unborn Children (SPUC), which is a UK anti-abortion group, says the APR network’s 24/7 helpline has “surged with emergency calls amidst [the] coronavirus lockdown”. Its website also claims that this US-based network “includes UK based doctors”.
Shortly after our reporter called this hotline, she was emailed a ‘consent form’ stating that APR is an “off-label use of progesterone” and she should “seek emergency medical care immediately” if she feels pain.
A few hours later a UK doctor called her and offered to email a prescription to her local pharmacy. (No prescription was actually issued).
This doctor said she is an obstetric-gynaecologist who supports ‘abortion pill reversal’ outside her normal work hours, which appear to be at an NHS hospital. She also claimed that in the UK “we’ve done about 100 [treatments] now.”
“Put one pessary into the vagina and one pessary into the back passage. Just do that every six hours for four doses. And then go down to three times a day […] and then just once a day,” the UK doctor explained the ‘treatment’ regimen.
When asked about potential health risks of trying to ‘reverse’ an abortion she told our reporter: “At the end of the day, you live in the UK, you’ve got a hospital there and if you were worried about the bleeding, you’d go get help.”
Progesterone in itself is not a dangerous drug but there are concerns including from some health authorities about using it in this ‘treatment’. It is also hard to tell if it is effective because if a woman does not take the second abortion pill within 48 hours of the first, a pregnancy termination is unlikely to happen anyway.
The American College of Obstetricians and Gynecologists says it is based on “unproven, unethical research” and warns it is “dangerous to women’s health”.
The General Medical Council which regulates doctors in the UK said: “We don’t give clinical advice and don’t have a view about the clinical safety and appropriateness of particular approaches to medical abortion.” But, it added: “The allegations raised by your investigation are clearly a serious matter.”
The regulator additionally shared a list of guidance that it says doctors are expected to follow – including prescribing drugs “based on the best available evidence” and only with “adequate knowledge of the patient’s health”.
“It’s not good enough to say ‘if you start bleeding, go to A & E’ – especially in the middle of a pandemic”
Katherine O’Brien, associate director of communications and campaigns at the British Pregnancy Advisory Service (BPAS), said she was “surprised” to learn that a UK doctor offered to prescribe this “dangerous treatment”.
“It’s not good enough to say ‘if you start bleeding, go to A & E’ – especially in the middle of a pandemic,” she added. “The GMC [can] strike off clinicians if they’ve been found to be guilty of malpractice, and I think this is a very serious case.”
A spokesperson for the Royal College of Obstetricians and Gynaecologists referred openDemocracy to the US study that was halted because, they said, the ‘treatment’ was “associated with a high risk of serious bleeding and consequently dangerous for women, as well as ineffective”.
“GMC good practice guidelines state that when prescribing a medicine off-label, a doctor must be satisfied that there is sufficient evidence or experience of using the medicine to demonstrate its safety and efficacy. To our knowledge, the only randomised control trial had to be abandoned due to unsafe outcomes for participants,” the spokesperson added.
In response to questions from openDemocracy, Heartbeat said APR is “a cutting-edge application of a time-tested, FDA-approved treatment used for decades to prevent miscarriage, preterm birth, and support ongoing pregnancy.”
The group suggested that the lead researcher on the US study is biased towards abortion access and claimed his study “actually showed that the abortion pill carries major health risks.” It claimed: “More than 2,000 women have successfully stopped an abortion and saved their children through the life-saving intervention of APR.”
SPUC said it “consulted with medical professionals prior to providing any information directing women to the APR hotline. It is our understanding that APR is safe for both mother and baby”. It also claimed that the cancelled US study was “deeply flawed” and that medical bodies which have cautioned against this ‘treatment’ “are known for taking pro-abortion positions.”
* Additional reporting by Claire Provost.