Mifepristone antagonization requires real studies to evaluate safety and efficacy

Mifepristone Antagonization with Progesterone to Avert Medication Abortion: A Scoping Review

The safety and efficacy of mifepristone antagonization with progesterone to avert medication abortion, also known as abortion pill rescue, is a subject of vigorous debate. Two prominent medical associations have taken positions that either entirely reject or fully support its use. This scoping review aimed to gain insight into the safety and efficacy of its use. Analysis of 16 studies showed that the continuing pregnancy rate after ingesting mifepristone alone is ≦25 percent for gestational ages ≦49 days. Analysis of four studies showed that two-thirds of the women who changed their minds and received progesterone after initiating their medication abortion with mifepristone could safely continue their pregnancies. There is no increased maternal or fetal risk from using bioidentical progesterone in early pregnancy. If a woman has already taken mifepristone for her medication abortion and then changes her mind, timely supplementation with progesterone may allow her pregnancy to continue. The conclusion that mifepristone antagonization with progesterone is a safe and effective treatment has implications for medication abortion informed consent. Summary: Two-thirds of the women who changed their minds and received progesterone after initiating their medication abortion with mifepristone could safely continue their pregnancies. If a woman has already taken mifepristone for her medication abortion and then changes her mind, timely supplementation with progesterone may allow her pregnancy to continue. Physicians should disclose this treatment option to their patients at the time of informed consent.

The right to choose to abort an abortion: should pro-choice advocates support abortion pill reversal?

Abortion pill reversal (APR) treatment aims to halt an initiated medical abortion, wherein a pregnant woman takes progesterone after having taken the first of the two consecutive abortion pills, typically because she has changed her mind and no longer wants to abort the pregnancy. It is a controversial intervention, generally supported by those identifying as pro-life and opposed by those identifying as pro-choice. This paper examines whether, in principle, those identifying with the pro-choice view should support APR. We firstly examine the commitments of the pro-choice stance. We then briefly outline the evidence supporting the APR. Following this, we discuss potential consequences of APR on women's mental health and its safety. We conclude that those espousing the pro-choice standpoint should be, in principle, committed to supporting the availability of APR, while recognising that data on its efficacy may be difficult to obtain.

Decision rightness and relief predominate over the years following an abortion

A recent analysis from the Turnaway study focused on women who were just under the gestational limit of a clinic and received an abortion and those who had first trimester abortions to examine trends in decisional rightness and negative and positive emotions over 5 years after the abortion. Specifically, Rocca et al. (in press) analyzed these data and found that women were overwhemingly sure of their decision: 95% felt their decision was the right one at each assessment after their abortion, and the predicted probability of abortion being the right decision was 99% at 5 years afterwards. Relief was the most common emotion felt by women, and negative emotions or decision regret did not emerge over time. These results and others from studies conducted globally counter assertions by abortion opponents that women are not certain of their decisions, or that women regret or have mainly negative emotions about their abortions if not in the short run then after a long period of time. This commentary addresses not only these findings but also relevant U.S. abortion policies based on these unsubstantiated claims. Policies should not be based on the notions that women are unsure of their decision, come to regret, it or have negative emotions because there is no evidence to support these claims.