Canada’s national society of obstetricians and gynaecologists has warned doctors that so-called “abortion pill reversal” treatment is unproven and can cause “serious complications.”
The society’s statement was issued in response to an international investigation by openDemocracy, a global media organization, and The Tyee that revealed this controversial treatment is spreading from the U.S. around the world — including to Canada.
The Society of Obstetricians and Gynaecologists of Canada “does not support prescribing progesterone to stop a medical abortion,” says the statement, the first by a Canadian medical association to address this topic. “The claims regarding so-called abortion ‘reversal’ treatments are not based on scientific evidence.”
Non-surgical abortions that use medications can end pregnancies in the first 10 weeks. They have been available in Canada since 2017. Two drugs (mifepristone, then misoprostol) must be taken within a couple of days of each other.
Abortion pill reversal proponents claim that taking high doses of progesterone after the first pill can reverse the abortion. Progesterone is a naturally occurring hormone that is used in therapies for menopause and for birth control.
But there is no conclusive evidence that the treatment works — or that it is safe.
Geoffroy Legault-Thivierge, media relations officer for Health Canada, said “abortion reversal” is not a Health Canada-approved use for progesterone.
A 2019 U.S. medical trial examining the effectiveness and safety of the treatment was abruptly cancelled after some participants were hospitalized with severe bleeding. Of the three women hospitalized, one had taken progesterone and the other two the placebo.
Because the trial was never completed, efficacy could not be determined, but researchers warned that “patients in early pregnancy who use only mifepristone may be at high risk of significant hemorrhage.”
The American Medical Association has called abortion reversal treatments “patently false and unproven,” while the American College of Obstetricians and Gynecologists describes it as “dangerous to women’s health.”
Despite this, Canadian doctors are prescribing the drug to patients seeking the treatment, some taking referrals from a large U.S. Christian-right group called Heartbeat International. And some Canadian groups are claiming hundreds of women globally are being referred to doctors willing to prescribe the treatment.
As part of the investigation, a reporter in Montreal posed as a woman who had taken the first of two pills for a medical abortion and contacted the Abortion Pill Rescue Network hotline run by Heartbeat International.
She was then connected via a network of nurses and anti-abortion groups to Vancouver family doctor Dr. Will Johnston, a former president of the Canadian Physicians for Life.
Johnston told her he had provided abortion pill reversal treatment to other women in Canada and that he has delivered at least one baby after he helped to reverse a woman’s medical abortion.
“There are no birth defects caused and your future fertility is not affected,” he said. “Every hour counts if you’ve decided to do this.”
Johnston sent a prescription for progesterone to a Quebec pharmacy. When asked why abortion pill reversal isn’t available as an option in clinics that provide medical abortions, he told the reporter posing as a patient that “it’s all to do with the politics.”
“The people that hand out these pills don’t want to admit that women would think badly of taking [them],” he claimed. “It’s unfair to women not to tell them that they’ve got the chance to change their mind.”
Dr. Dustin Costescu, an associate professor and family planning specialist with the department of obstetrics and gynaecology at McMaster University in Hamilton, Ont., said there are risks and patients need to know about them.
“They may go on to miscarry,” Costescu warned. “They may have a higher rate of emergency or complication… compared to somebody who goes on to complete the abortion on their own.”
Dr. Sarah Munro, assistant professor of obstetrics and gynaecology at the University of British Columbia, says there is no evidence that abortion pill reversal works. “Promoting such claims is poor science,” she said.
“It worries me that clinicians are providing care that doesn’t meet any standard of practice in the country without a clear conversation with patients about the fact that this is experimental,” said Costescu. “It brings up a lot of ethical issues.”
Johnston is not alone. The investigation found several Canadian anti-abortion organizations promoting abortion pill reversal on their websites and social media, with some offering to connect patients with doctors.
Ottawa-based RightNow, which campaigns for anti-abortion political candidates across Canada, for example, tweeted last year that “105 mothers started the process of halting their chemical abortions after calling the hotline.”
Also in Ontario, Cambridge Right to Life says local doctors are ready to provide abortion pill reversal and that “550 healthy babies have been born successfully to mothers who underwent the reversal process.”
While the Society of Obstetricians and Gynaecologists of Canada has spoken out against this treatment, members are not bound by its recommendations.
Comment was sought from Johnston’s regulatory body, the College of Physicians and Surgeons of British Columbia.
Communications director Susan Prins said the college endorsed the society’s statement warning against the treatment.
“Registrants are expected to prescribe and treat patients based on scientific evidence of safety and efficacy, to follow the clinical guidance from experts like the SOGC, and avoid unproven and potentially dangerous uses of existing medication, which can lead to serious complications,” said Prins in an email.
In a followup interview, Dr. Johnston defended the practice and challenged the warning from the Society of Obstetricians and Gynaecologists of Canada.
He said he would like to see statistics or studies the society used to support claims of “serious complications.”
“If they have some credible evidence, that means that we have to take precautions that we’re not aware of right now, we are entirely interested in hearing it,” he said.
Johnston said he doesn’t believe he has done anything contrary to the statement from the College of Physicians and Surgeons of B.C. and doesn’t plan to stop offering abortion pill reversal treatment.
“I would like to hear from the college what their evidence is before changing my practice patterns, because, up till now, I haven’t seen any lack of alignment between myself and the college’s objectives.”
Johnston says his promotion of abortion pill reversal is based on giving women as many choices as possible.
“If [pro-choice advocates are] really interested in helping women, all women who are making all possible choices, then they should have a closer look at the safety record of this progesterone regime,” he said.
In response to questions, Heartbeat International defended its role.
“Abortion Pill Reversal is a cutting-edge application of a time-tested, FDA-approved treatment used for decades to prevent miscarriage and preterm birth,” it said in a statement. “More than 2,000 women have successfully stopped an abortion and saved their children through the life-saving intervention of APR.”
But abortion and women’s rights advocates condemned the use of the treatment.
Jill Doctoroff, executive director of the National Abortion Federation Canada, said she believes leadership is needed to stop the spread of misinformation. “Our governments and health bodies need to promote factual information related to health care.”
Joyce Arthur, founder and executive director of the Abortion Rights Coalition of Canada, said it’s irresponsible to promote abortion pill reversal “as if it works, but there’s really no basis for efficacy.”