Medical abortion in the spotlight

In the past ten days our office has been contacted by two women desperately seeking information about reversing a medical abortion process they had just started. Whilst there is a protocol available for attempting to reverse the damaging effects of Mifepristone, it is not widely known or practised and the success rate in the US where it is more widely used sits at around 55%. This may not seem like a high success rate, but for a woman feeling desperate to undo an abortion process it is significant hope.

These women are not the first to contact us, and not the first to seek treatment in Australia, with a small number of women successfully continuing a pregnancy after treatment. We receive a number of emails and phone calls from women who want to share their stories of grief or regret after abortion and we have a website where they can submit their stories if they choose. The women's stories often highlight issues of coercion, lack of support or resources, inadequate informed consent processes or not enough time to consider their decisions.

With medical abortion, a new layer of consent and information-giving is being brought to light which raises some serious ethical and professional issues about coercive tactics of abortion providers and the misinformation being provided to women.

Both of these are significant infringements of both the obligation to adequately inform women, and the rights of women to freely withdraw consent from a medical process and determine the action they choose to take with their pregnancy.

Mifepristone is the first drug given to a woman as part of a medical abortion process. The action of this drug is to compete with progesterone receptors in the body. Progesterone is an essential hormone to maintain healthy pregnancy. When progesterone is unable to be effectively utilised in the body, as when the Mifepristone takes its place, the foetus is starved of essential nutrients and dies in many cases.

The completion of a medical abortion regime requires that a woman then take a further drug, Misoprostol, which causes uterine contractions in order to expel the foetus and placenta. Misoprostol is generally taken 24-48 hours after the Mifepristone.

The pregnancy does not always end with the ingestion of Mifepristone alone, and in fact there is solid evidence that pregnancies can continue and end with the live birth of a healthy baby even in cases where both drugs have been taken.

There is also another option being offered to women in the United States, and to a lesser extent here in Australia; abortion pill reversal through the use of progesterone therapy. This is an experimental treatment which is reasonably low risk and which has so far demonstrated a 55% success rate in the US, with the births of 115 healthy babies and almost as many women currently continuing pregnancies

Because the reversal of Mifepristone is a relatively new treatment which uses a protocol of progesterone therapy during the first trimester of pregnancy, it is possible that abortion providers are not all familiar with it. However there is no legitimate excuse for the advice that we know at least some women are receiving when they contact their abortion provider to say they have changed their minds. Mifepristone product information sheet states, 'Should the patient wish to continue with her pregnancy, the available data are too limited to justify a systematic termination of an exposed pregnancy. In that event, careful ultra-sonographic monitoring of the pregnancy should be carried out.'

Anecdotally we know that women are being advised via abortion provider staff that Mifepristone will cause foetal abnormalities and that they must therefore continue the medical abortion process and take the Misoprostol. This abortion provider website makes the claim that there is a 9% chance of foetal abnormality after taking Mifepristone, yet provides no reference for this figure which contradicts other reputable studies. This misinformation breaches the woman's right to withdraw consent by placing pressure on her to continue an abortion process she may no longer want, under the misleading premise of abnormalities occurring.

The evidence that exists about the potential of foetal harm from Mifepristone alone shows that the incidence of harm is extremely small, if it exists at all. This prospective study analysed not only data collected through its own observation, but also looked at data from other studies and determined that the rate of foetal abnormality was only very slightly higher among women who had taken Mifepristone than in those who hadn't, and that causality could not be confirmed. The women in the study were also taking significantly higher doses of Mifepristone than is currently prescribed to women in Australia.

The fact that a number of women do change their minds after taking Mifepristone raises serious questions about the screening and assessment processes women undergo in an abortion facility. The time between the first and second drugs provides an opportunity for evaluation of the path being taken, and it appears that for at least some women, that path is not one they actually want to be on. We have to question not only whether women are receiving enough information about their alternative options, but also whether they are given enough time to consider them.

When a woman consents to a medical abortion she is given the Mifepristone in the abortion provider's office and told to take the Misoprostol according to instructions at home. Whilst she initially consents to this process, she can of course withdraw consent at any time before taking the Misoprostol. In this case, a woman should be provided with accurate information about the effects of Mifepristone, and informed of her alternative options.

Interestingly three of the women who have recently contacted us after seeking abortion in 2 separate abortion facilities in Victoria, all described the process as 'like being in a production line'. Not one of them felt that they had adequate counselling, and 2 denied having, or being offered counselling at all, even though they had expected to. They both felt that it was just presumed they had already decided. One woman was very surprised to find that her partner was allowed into the consulting room with her saying 'I couldn't believe they wouldn't at least want to talk to me alone, I've heard about boyfriends who pressure girls into this'.

It is time that abortion providers were held accountable for their practise in terms of ensuring women are provided with comprehensive and accurate information not only about abortion procedures, but about their alternative options. This is a fundamental expectation of any medical or surgical care. Of the dozens of women we have spoken to regarding both surgical and medical abortions, not one has recalled being screened for any external coercion, domestic violence, or been provided with information about the supports that may be available to her if she continued her pregnancy. All of the women had their abortions on the same day as their first consultation and many of them couldn't recall if they had even spoken to the doctor who actually did their procedure.

The idea that abortion is something that is decided between a woman and her doctor is misleading in the extreme. An abortion provider has usually never seen the woman before and in fact some women don't believe they even saw the doctor at all. At least some women are not being adequately counselled about their options or the adverse effects of procedures, and are then being coerced into completing abortion processes when they clearly state a desire to do otherwise.

The numbers who find and contact our organisation are likely just the tip of the iceberg, indicated as least in part by women who tell us they continued the process despite having second thoughts, but under the assumption there was no turning back. How many more simply follow the misleading information given to them by the abortion provider, or fail to find any person willing to help them when they change their minds, and their stories are not yet known?.

When will the lives and choices of women truly be held in higher regard than an abortion ideology that is clearly not serving them or meeting their needs?