Critics say an abortion bill signed into law by Gov. Doug Ducey last week subjects Arizona women to bad science by forcing doctors to give them unproven medical advice.
The law, among other things, says that both doctors and the Arizona Department of Health Services must tell women that a medical abortion may be reversible.
But the advice is neither the standard of care nor FDA approved, says Dr. Ilana Addis, the Tucson-based physician who heads the Arizona section of the American Congress of Obstetricians and Gynecologists.
Addis heavily lobbied Ducey not to sign the law, which is set to take effect in the summer. It is unprecedented in the U.S., though other legislatures are considering similar actions, including one currently waiting for the approval of Arkansas Gov. Asa Hutchinson.
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“It makes me sad for Arizona that we have to be precedent-setting this way,” Addis said Friday.
Supporters of the law (SB 1318), including the Phoenix-based Center for Arizona Policy, say it will protect women and babies by adding information that women aren’t currently receiving from providers. They have cited cases where a medical abortion is reversed with high doses of progesterone.
That makes Arizona women guinea pigs for using unproven doses of an unnecessary hormone, according to the law’s opponents, among them the Arizona Public Health Association. Critics say it allows legislators and special-interest groups to dictate medical care.
A medical abortion happens when a woman takes a drug called mifepristone, followed 48 hours later by misoprostol. It is approved only during the first nine weeks of a pregnancy, when women can choose whether they want the surgical or medical procedure.
According to the most recently available data, 13,401 elective abortions were performed in Arizona in 2013. (By comparison, 84,817 live births occurred that same year.) Fewer than one-third of the elective abortions in Arizona in 2013 (3,731) were medical, also called nonsurgical.
Supporters of the reversal advice cite the work of the San Diego-based Abortion Pill Reversal network of doctors headed by Dr. George Delgado, who has said that high doses of progesterone could reverse the effects if a woman changes her mind after taking the mifepristone, but that time is of the essence.
Testifying before the Arizona Senate Health and Human Services Committee in February, Glendale obstetrician and gynecologist Dr. Allan Sawyer spoke in favor of medical abortion reversal with progesterone, arguing that “women who have initiated a medication abortion process and who change their minds, for whatever reason, should not have their baby stolen from them because Planned Parenthood, or any abortionist, withheld lifesaving facts or provided misinformation to these women.”
But the American Congress of Obstetricians and Gynecologists says that progesterone, while generally well-tolerated, can cause significant cardiovascular, nervous system and endocrine adverse reactions, as well as other side effects.
More than 90 percent of board-certified American OB-GYNs are affiliated with ACOG, which does not support medical abortion reversal with progesterone.
Since both the mifepristone and misoprostol are the protocol for a medical abortion, there’s no proof that the progesterone treatment made a difference for the women who took it after taking mifepristone only, the organization says.
Many women will not abort just from using the first medication. Thirty percent to 50 percent of women who take mifepristone alone will continue with the pregnancy, so no intervention may have yielded the same result as the progesterone, ACOG says.
And the rare woman who does regret her choice should not have to be subjected to “junk science,” Addis says, stressing that the progesterone treatment is not FDA approved.
“Is the patient going to bear the cost of this dubious treatment?” Addis wrote Monday in an opinion piece that ran in the Arizona Capitol Times. “Will insurance companies and AHCCCS (the Arizona Health Care Cost Containment System) pay for up to 17 excess office visits and injections that are non-evidenced-based?”
State health officials say they have not yet determined the website visibility, but they say they will “post the information as required by statute” within a 90-day time frame, interim department Director Cory Nelson said.
Planned Parenthood of Arizona spokeswoman Cynde Cerf said it’s too early to say exactly what wording the medical providers will use to tell patients about the abortion reversal.
When asked whether providers could give women the evidence-based information about trying to reverse a medical abortion with progesterone, she said that is something the organization’s lawyers have yet to determine.
Arizona women need to be their own advocates by researching the issue and making their own informed decisions, Cerf says.
“We have legislators who are insistent they know better than we do,” she said.
“As more and more restrictions are put on women’s health care in general, more of the onus is on us to be advocates for our own health.”
