The progressive state's Board of Registered Nursing has approved training based on a weak study on “abortion reversal,” that could open us up to everything from bad medical advice to worse legislation.
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It was January 2013 the first time I heard the term “abortion reversal.” Abortion opponents were bragging about a new published study that they believed proved that they could allow a person to remain pregnant even after she had begun the process of a medication abortion.
The case study had six subjects. Four of the six gave birth with no complications. It was a number that seemed far more significant until you read on and learned that the “reversal” wasn’t even attempted on anyone who wasn’t still presenting with an embryo that showed a visible heartbeat. In other words, it wasn’t reversing the abortion, it was providing ongoing medical assistance to pregnant people who failed to have a successful termination—something that happens more often when a person doesn’t take the second portion of the RU-486 protocol.
Still, I spoke to a few providers about the study. They all said something similar: It’s not a legitimate study, there were no controls, this is unlikely to be anything significant. I wrote an article that was never published. “No point in drawing attention to this,” was the general consensus. “It will never go mainstream.”
But it didn’t just fade away. Two years later I found myself once again reading up on the “latest breakthroughs” in abortion reversal. The six-person case study had swelled. Now there were 223 attempted reversals. Roughly a third of those were successful live births, and at the time, another 50 people were still healthily pregnant.
The hundreds of cases were significant enough to launch a pro-life public-relations campaign to get mothers who reversed their abortions slots in religious publications or local pro-life fund-raising banquets. But the same scientific shortcomings remained that were there in the previous batch of success stories: Only those who had a heartbeat after an interrupted RU-486 abortion were given the progesterone. There was still no control group for comparison. Without these factors there was still no way to tell if an abortion was really “reversed” as the doctors claimed, or if patients were being flooded with unnecessary progesterone when the reality was they were already in the midst of an incomplete, unsuccessful abortion and would have remained pregnant regardless.-
Mainstream reproductive health experts continued to dismiss the procedure. “Even if these doctors were to offer a large dose of purple Skittles, they’d appear to have ‘worked’ to ‘save’ the pregnancy about half the time,” Dr. Cheryl Chastine told me more than two years ago. The assumption was the same—it may become a part of the pro-life bag of anti-abortion rhetoric, along with so-called “post-abortion syndrome” or the continuing belief that abortion somehow makes you sterile, but there was little chance of it making its way into mainstream medical care.
Then the states got involved. Arizona, Arkansas, South Dakota, and Indiana all introduced bills that put the idea that abortion reversal is a proven, legitimate medical option into their codified informed consent process prior to an abortion. North Carolina legislators even tried to force a person to wait for the Misoprostol portion of RU-486 until after there was no longer an embryonic heartbeat (the bill thankfully failed). The groundswell was alarming, and media began to pay attention, culminating in a New York Times Magazine feature on the process, the players, and the women who successfully—and unsuccessfully—“reversed” their abortions.
Abortion reversal was obtaining status and legitimacy like no one could have ever expected back in January 2013. But still, none of the legitimacy appeared to be endorsed by the medical community.
At least, not until now.
According to a news alert from National Right to Life News, the California Board of Registered Nursing—the largest nursing board in the country—has now “green-lighted” abortion reversal training. “While it continues to be a sore spot for its pro-abortion deniers, the science behind Abortion Pill Reversal is compelling enough to gain the blessing of California’s Board of Registered Nursing, the board announced July 28,” NRLC announced August 11. “Following an audit that lasted well over a year, the board notified pro-life affiliation networks Heartbeat International and National Institutes of Family and Life Advocates (NIFLA) they were each cleared to train nurses on a process that has saved over 300 lives since 2007.”
The NRLC announcement leaves out a lot of very necessary information that would add context to how such a large professional board in a very progressive state came to their decision to allow—then audit—and now approve a “reversal” training despite the fact that there doesn’t appear to be a very significant amount of data to draw any conclusions from. The board itself doesn’t technically approve individual trainings and classes that nurses registered in California are required to take in order to get Continuing Education credits. Instead, they approve the groups that are offering the classes, and once they have approved one class the approved organization can submit additional classes later with far less oversight.
It is this regulatory loophole that Rewire’s Nicole Knight exposed in 2016, and which caused the year long audit of the abortion reversal training session in the first place. And now, according to anti-abortion activists, that audit is over and the training class has passed inspection.
The real question is, what exactly did they show that allowed them to pass, and was the information provided offered after rigorous scientific scrutiny? “Whether it was evidence-based enough for our standards is unclear,” said Monica R. McLemore RN, MPH, Ph.D., an assistant professor for the Family Health Care Nursing Department at University of California, San Francisco.
“Now they say there are 300 people that have used [the protocol], but that paper has not been published, so we can’t evaluate the methods or the caliber of the science,” McLemore told DAME. “I can’t imagine what scientists from the BRN could have read from that which would have offered rigorous vetting. They probably just evaluated whether it met the criteria for existing as a course, not the validity of the science behind it.”
That may seem like hair-splitting, but the distinction is important. By receiving what appears to be a seal of approval from the Board, the anti-abortion groups aren’t just letting nurses take advantage of a pro-life seminar in order to get necessary career training. They are getting a veneer of medical legitimacy to their “abortion reversal” program, despite the fact that the science still remains unclear that there is any real medical benefit to flooding a pregnant person with additional and unnecessary progesterone – or even worse if there are long term adverse effects on the patient. This new professional endorsement then can be used not just to push “reversal” as a legitimate medical practice in more state legislation, but also as a medical protocol to add to the arsenal of crisis pregnancy centers as they reposition themselves as actual medical providers offering a fuller range of reproductive health care (despite still not offering abortion, contraception or accurate medical information on all reproductive healthcare topics).
According to McLemore, what is happening in California is a result of a Board of Nursing that due to changes in legislative control and budget processes no longer has the resources for the type of independent, through vetting necessary to keep trainings evidence-based and scientifically medically sound—and that it is patients who will suffer as a result. “Without access to accurate and evidence-based clinical information—particularly rigorously vetted and scientifically supported information—nurses are now vulnerable to courses and trainings filled with inaccurate information that may harm care,” she said. “Nurses need to have a strong, fully funded independent board to vet evidence and the science behind it. Without that we are opening nurses up to exploitation by these anti-abortion organizations.”
It may have take four years to get there, but it is now clear that “abortion reversal” is not going anywhere, and is currently scrambling for a toe-hold in legitimate, mainstream medicine. The California Board of Nursing is just its first step toward that goal.