George Delgado made his first attempt at reversing an abortion in 2009.
He got a call from Terri Palmquist, a missionary at the evangelical group LifeSavers Ministries who ran in the same California anti-abortion circles he did. Palmquist said she’d gotten a call from a young woman in El Paso, Texas, who had taken the abortion pill, a common method for ending a pregnancy, but changed her mind. The woman wanted to know if there was any way to reverse the effects of the pill. Palmquist turned to Delgado, a family practice doctor in San Diego, seeking advice.
Delgado had never heard of anyone “reversing” a medical abortion before, but he had an idea for how to try. A medical abortion comes in the form of two pills: Mifepristone, the first, works by blocking the hormone progesterone and preventing a pregnancy from continuing. Misoprostol, the second pill, is taken 24 to 48 hours later to cause contractions that empty the uterus.
Delgado fixed on progesterone, which is critical for sustaining pregnancy. Progesterone is cheap and widely covered by insurance. It’s often used to boost fertility and given to women at risk for miscarriage. Delgado thought that a woman who had taken mifepristone could increase the chance of continuing the pregnancy by first skipping the misoprostol and then taking a lot of progesterone — multiple times a week throughout her first trimester to overpower the mifepristone. The idea was less of a reversal, really, than a halt.
Delgado searched for a sympathetic doctor in the El Paso area who would be willing to do an experiment. He found one through a fertility care website, and she agreed to give it a go. “The abortion was reversed, the baby was born and is now over 5 years old,” Delgado told me in an interview in April. “That was my first success.”
I couldn’t verify Delgado’s account of this story — that is, whether the El Paso woman in fact went on to give birth. He put me in touch with another woman who followed his treatment after taking mifepristone and later gave birth, but she wasn’t the first. Delgado says he has gone on to prescribe the progesterone protocol to 880 women nationwide since 2012 and claims to have “successfully reversed” 350 medical abortions.
These successes are likely an accident of statistics rather than medicine. According to the American Congress of Obstetricians and Gynecologists, a woman who takes the first pill in the medical abortion protocol but not the second can expect her pregnancy to continue up to half the time, whether she floods her body with progesterone or not. ACOG and the American Medical Association say Delgado’s method of “abortion reversal” lacks credible scientific evidence and do not recommend it as a clinical approach.
But the way Delgado tells it, his hunch was confirmed on the first try. Word quickly spread in the vocal anti-abortion community. He received a few more calls from women who wanted to reverse their abortions and he helped locate nearby doctors who were willing to try the protocol. The response pushed him to evangelize the method further, and he built a website, founded a hotline staffed by nurses, and recruited a more formal network of doctors under the name Abortion Pill Reversal, or APR.
In raw numbers, APR’s impact has been quite small. Around 287,000 medication abortions were performed in the U.S. in 2014. In five years, Delgado’s hotline has taken just 1,200 calls — likely because, as studies show, an overwhelming majority of women are confident about their decision going into an abortion and do not regret it afterwards.
APR’s publicity gains, however, have been enormous. Early on, Delgado caught the attention of the powerful anti-abortion lobbying group Americans United for Life, which pushed lawmakers in statehouses across the country to promote his unverified method through laws requiring abortion providers to share information about reversal with patients.
Governors in four states — Arkansas, South Dakota, Utah, and Arizona — have signed abortion reversal “informed consent” laws in the last few years. (At the objection of civil rights and women’s health groups, Arizona’s was blocked by a judge before it went into effect.) State lawmakers have also proposed abortion reversal legislation in Indiana, Colorado, Georgia, Idaho, California, and North Carolina. In Louisiana, a measure floundered after a report from the state health department concluded there was “insufficient evidence to suggest that there is a sound method to reverse a medication-induced abortion.”
Abortion rights advocates and most medical professionals say the spread of the reversal narrative is yet another example of junk science’s outsize impact on the abortion debate. Laws requiring providers to tell women that reversing an abortion is possible are like laws requiring doctors to tell women abortion leads to breast cancer or that dictate the width of a clinic’s hallways — restrictions that simply lack a foundation in scientific evidence.
Yet the idea that a medication abortion can be reversed also works on a second level, one that lays bare the shifting tactics and priorities of the anti-abortion movement. Medical abortion now makes up about half of all abortions before nine weeks. Fewer than 1 in every 100,000 women dies from medical abortion, making it as unlikely as death by penicillin and 28 times safer than childbirth. A procedure as simple as swallowing a couple of pills undercuts the notion that abortion is a dramatic, cruel, and gruesome undertaking — and that puts abortion opponents in a tough spot.
Promoting the idea that an abortion can be reversed offers another way for anti-abortion doctors, activists, and legislators to inject myth, shame and doubt into the process of accessing abortion care, with the goal of steering women away from it entirely. More than pushing untested medicine on vulnerable patients, this rhetorical crusade may prove to be abortion reversal’s biggest risk.
Not long after his experience with the El Paso woman in 2009, Delgado learned that another doctor in North Carolina had tried a similar protocol a few years earlier and the woman ended up giving birth to a healthy girl. Delgado felt validated by this story, like he’d hit on something significant. Opposing abortion has been a big part of his family medicine practice for two decades, and he thought that women needed to know about this exciting new possibility.
“All of us, when we make profound decisions in our lives, have times when we second-guess and moments when we change course,” he told me. “Taking mifepristone is no different. It’s my belief that any woman who takes mifepristone should have the right to know that reversal is an option for her. Women should be told the truth.”
Delgado wanted abortion pill reversal to become standard practice, accepted by doctors and readily available to women, which meant he needed it to be scientifically tested. He tracked every patient he knew of who received the protocol between 2006 and 2011 and wrote an article for a medical journal with his findings. The case study was published in the Annals of Pharmacotherapy at the end of 2012. The sample was extremely small, and the evidence far from conclusive.
Delgado’s paper detailed seven patients of six different doctors, including one he treated himself. One of the patients was “lost to follow-up,” but of the six remaining who took mifepristone followed by a regimen of progesterone, four carried their pregnancies to term with no neonatal complications or birth defects noted. He said this sample, however small, implied a 66 percent success rate. “The experience of these patients suggests that medical abortion can be arrested,” he wrote.
Anti-abortion doctors prefer a handful of sympathetic medical journals to publish their research. A look through the Annals of Pharmacology archives yields a spate of articles with titles unlikely to appear in a mainstream journal focused on women’s health: Is Vaccination Complicit with Abortion?; Breast Cancer: Its Link to Abortion and the Birth Control Pill; and Analysis of Severe Adverse Events Related to the Use of Mifepristone as an Abortifacient. (The current editor of the Annals said he was not involved in the decision to publish Delgado’s paper and that the journal no longer publishes case studies.)
After publishing his paper, Delgado attracted some publicity and more interest from other doctors who wanted to try his protocol with their patients. But he needed more recruits. He and his team at his family practice, Culture of Life Family Services, set out to build the formalized national network APR.
To join the network, doctors are screened to ensure they have a clear record and participate in an hourlong online training. Many are affiliated with crisis pregnancy centers, which have been accused of posing as abortion clinics in order to provide misinformation and pressure women into choosing not to have an abortion. But in theory, any doctor could administer the protocol — it’s super basic — and it doesn’t have to be an OB or a family medicine doctor. Compare that to the extensive training abortion providers have to undergo, not to mention the stringent regulations imposed on abortion clinics. It’s far easier to “reverse” an abortion under these conditions than it is to provide one.
Soon after Delgado’s paper appeared, Rebekah Buell got pregnant the second time.
Buell’s first pregnancy came when she was 17, the summer before her senior year of high school. She wanted to keep the baby — her devout Baptist upbringing told her the pregnancy was a gift, and her parents, a pharmacy technician and stay-at-home mom, could help support her. She was also determined to keep living her life. Over the next nine months, she graduated from high school, started college, and married her boyfriend. She gave birth to her son, Elias, on March 14, 2012, just a week after she turned 18.
The second time was that winter. She was halfway through her freshman year at Sacramento State University, a 30-minute drive from her parents’ house in Roseville. She’d been married only nine months, but she already knew she wanted to end it. As she considered the prospect of divorce, she decided to take a pregnancy test — she wasn’t experiencing any symptoms, but she wanted to make sure there were no loose ends.
“It was unreal,” Buell told me, remembering the panic and despair she felt as the lines appeared on the little white stick. Elias wasn’t even a year old yet. She didn’t want another baby, not now, and not with her soon to be ex-husband. “The first time around, I thought, ‘OK, I can do this. It will be really hard, but I will prove all the mean things people said about me wrong, make a good life for myself, and take care of my baby.’ The second time around, absolutely not. I thought there was no way I could do this.”
Despite her religious beliefs, Buell scheduled an appointment for a medication abortion. When she went back to the exam room, the doctor handed her a dixie cup containing a single dose of mifepristone.
“We were sitting there and the doctor said, ‘Are you sure you want to take this?’” Buell remembers. “I nodded, but she said I had to give her more than that. It was emotional and hard for me. I was sad and tearing up, and she said, ‘Just because you are sad doesn’t mean you are making the wrong decision.’ At the time, I thought that was the best thing she could have said.’”
Buell swallowed the pill, made a follow-up appointment, and left with a brown paper bag containing a second pill, misoprostol, which she was told to take 24 hours later. The clinician said Buell could expect cramping and bleeding, but when used together, the combined regimen was more than 95 percent effective and exceptionally safe.
By the time she reached her car, Buell had started to panic. The following day was March 14 — Elias’ first birthday. She couldn’t shake the idea that she would always remember that day as bringing one child into the world and another out of it. “I don’t know why I didn’t see it before, but it took me taking the pill to freak out and reconsider what I just did,” Buell recalled. “I knew for me personally, not for every woman, but for me, I knew that this was the worst decision I’d ever made.”
She sat in her car praying and then tried various searches on her phone: “I took abortion pill and changed mind” and “I took mifepristone and don’t want to take second set of pills.” After reading through a slew of outdated forum posts, she found abortionpillreversal.com. The site claimed it might not be too late to reverse the effects of the mifepristone. And it had a phone number.
The nurse who answered talked with her for 30 minutes, calming her down, explaining the way the abortion reversal regimen was supposed to work. Her insurance would cover the prescription for progesterone. There was no guarantee it would succeed, but Buell wanted to try.
The nurse struggled to find a doctor nearby who was willing to administer the protocol. Finally, she located one about 65 miles away, in Colusa, California. The doctor was Julian Delgado — George Delgado’s brother.
Buell drove to his office the next morning, where another doctor at the practice gave her an injection of progesterone in the back of her hip. For the rest of her first trimester, she received progesterone injections twice a week and took vaginal suppositories of progesterone on the other days.
On Oct. 20, 2013, she gave birth to her second son, Zachariah. She said APR is the reason she has her “perfectly healthy, thriving, kind of crazy sometimes” son. Abortion reversal, she said, “was the best decision for me. I can’t say that for everyone, but it was the best decision for me, for sure.”
In 2015, as the idea of abortion reversal began to circulate beyond Delgado’s network, the mainstream medical community caught on with concern. A group of seven doctors from leading university research hospitals came together to refute Delgado’s paper and APR’s claims. They published their own paper in the journal Contraception asserting that Delgado’s study “was of poor quality” and lacked clear information around who the patients were and how and why they were selected. Moreover, they wrote, there was no evidence that his progesterone protocol was anything more than a placebo.
In his study, they said, Delgado didn’t provide sufficient evidence as to whether the subjects’ pregnancies continued because of the progesterone or would have continued anyway without it. Basically, if a woman took mifepristone, but not misoprostol, and did not undergo APR, the “success” rates could look the same.
Delgado shrugged off the critiques. He said there is always wariness around new treatments, but physicians regularly rely on judgment and analogy in their practices. Delgado said more research is coming soon that includes a larger sample of abortion reversal patients. He also shared an article published by a team at the Kobe University School of Medicine in Japan that found progesterone could arrest the effects of mifepristone in rats.
“We certainly didn’t try this out willy-nilly in a cavalier fashion,” Delgado said. “I knew progesterone had a 50-year track record of use in pregnancy and is very, very safe. Having that experience using it and knowing its history of safety, I felt very confident, and other doctors did too, that it was a safe thing to do.”
It’s true that progesterone is not harmful. The hormone is routinely given to pregnant women, but just because it does no harm does not mean it’s good medical practice. Absent solid medical evidence, we don’t know if it’s any more effective than snake oil.
Daniel Grossman, an OB/GYN and the director of Advancing New Standards in Reproductive Health at the University of California, San Francisco, said that in a normal healthy pregnancy, progesterone levels are already very high, so it’s unclear that adding more progesterone to that system would accomplish anything.
“I agree there is biological plausibility for this, but there are other reasons why it may not work,” Grossman said. “It’s not a totally crazy idea, but that’s not the way medicine works. We don’t just come up with a good idea and start administering that therapy to a patient.”
Grossman called Delgado’s actions “irresponsible medicine.” If a woman took the first pill and began to question her decision, Grossman said the standard of care would be to talk to her, try to understand what changed, and help her to make the right decision — whatever that happened to be. If she wanted to try and continue the pregnancy, the best course of action would be to simply forego the second pill, rather than gamble with an experimental protocol.
In the meantime, Delgado continues to promote APR through word of mouth. He is a board member of the American Association of Pro-life Obstetricians and Gynecologists and a regular speaker and participant at events, such as the Catholic Medical Association Conference, the National Right to Life Convention, and the Walk for Life.
Heartbeat International, one of the three major umbrella organizations behind the 2,500 crisis pregnancy centers in the U.S., has helped promote and spread the word about APR. Many centers and people who picket abortion clinics now carry signs advertising APR, hoping to catch women after their appointments. “To me, it’s amazing to see the way it’s grown with very little effort,” said Sara Littlefield, who serves as APR’s director.
Rebekah Buell started speaking publicly about her experiences with APR in 2015. She had transferred from Sacramento State to a private Christian college and met with the director of Californians for Life on campus. Buell mentioned she had taken the abortion pill and changed her mind, and the woman asked if she would speak at a banquet. From there, invitations to speak at other events started flowing in.
Buell believes speaking about APR is important to let women know it’s an option, but she also hopes that by sharing her own experience, she can inspire more-nuanced discussions about abortion.
“People need to hear real-life examples, because so often what I hear from pro-life people is, ‘I just don’t get it? How women could choose abortion? That is the most selfish thing,’” Buell said. “They don’t understand what an unplanned pregnancy does to someone. I think that’s why I have agreed to speaking, so people can understand what it’s like to be in that type of situation.”
Littlefield said these events help inject the abortion reversal idea into the national policy conversation. Prominent groups such as Students for Life of America and National Right to Life have highlighted APR, as has Priests for Life, where Delgado serves as a medical adviser. In 2015, Priests for Life co-sponsored a press conference at the National Press Club in Washington, D.C., to call attention to abortion reversal.
Americans United for Life, which bills itself as “the nation’s premier pro-life legal team,” seized on abortion reversal as soon as Delgado presented his method at the American Association of Pro-life Obstetricians and Gynecologists conference a few years ago.
AUL claims credit for one-third of the hundreds of laws restricting abortion that have been passed since 2010 through model legislation for state lawmakers. Its “Abortion Pill Reversal Information Act” expresses concern that the increase in medical abortion represents a “willful disregard of women’s health and safety” and has become a “cash cow” for abortion providers. It also cites Delgado’s “peer-reviewed study.”
In 2015, Arizona became the first state to pass a law, based on AUL’s template, requiring providers to tell women that medical abortions can potentially be reversed if they act quickly. The Center for Reproductive Rights, Planned Parenthood, and the American Civil Liberties Union worked with Arizona healthcare providers to file a lawsuit challenging the law. They argued that there was no credible evidence to support the claim that medical abortions can be reversed and that it violated the First Amendment by forcing physicians to essentially lie to patients.
“This narrative does a real disservice to two different things,” said Amanda Allen, a lawyer for the Center for Reproductive Rights. “It promotes this idea that women aren’t moral, autonomous agents capable of making complex and difficult decisions on their own, and it turns the informed consent process on its head.”
Moreover, it’s foolish to expect that some real number of women will suddenly want to take back a decision that very few make lightly, she said. “Women know what an abortion is, and a vast majority of women in a clinic seeking care have already made up their minds.”
A judge blocked the law from going into effect and Arizona’s governor ended up repealing it in May 2016. That didn’t stop AUL, which pushed its draft legislation in other states and easily found lawmakers willing to sponsor a version of it. Arkansas passed an abortion reversal law in 2015, and in 2016 South Dakota passed one requiring the state’s informed consent process to include information about abortion “discontinuation.”
It’s one thing for the anti- abortion movement to promote misinformation about the abortion pill and its effects, but abortion reversal and its supporters want more. They want politicians to write the idea into law. They also want the public to believe that women regret their abortions; that choosing to have an abortion is always an agonizing decision; that to have an abortion is a misstep, a slip, a mistake that can and should be remedied.
“We felt this was an important enough innovation that women needed to be given access to the information,” Denise Burke, who works in legal affairs for AUL, said on the phone. “Chemical abortion has been an area of great concern of legislators for years. The abortion industry is increasingly relying on chemical abortion. Legislators want to make sure that they are properly responsive to this growing business segment of the abortion industry.”
Abortion rights advocates suspect this is what makes the idea of abortion reversal so appealing — and necessary — as propaganda for the other side.
“We know that medication abortion is extremely safe, simple, and effective, and women are taking advantage of it more and more because of the privacy it affords,” Allen said. “I think the level of self-determination is a real threat to anti-abortion groups.”
Rebecca Grant is a freelance journalist based in Brooklyn. She writes about reproductive rights.