Response to “Progesterone for preventing pregnancy termination after initiation of medical abortion with mifepristone”: what’s the real point here?
22/02/2018 Comments Off on Response to “Progesterone for preventing pregnancy termination after initiation of medical abortion with mifepristone”: what’s the real point here?
Letter to the Editor of the European Journal of Contraception & Reproductive Health Care, by Marge Berer
Received 04 Jan 2018, Accepted 23 Jan 2018, Published online: 19 Feb 2018
In your recently published article “Progesterone for preventing pregnancy termination after initiation of medical abortion with mifepristone”,  the cases of three women who changed their minds about going through with an abortion after taking the mifepristone pill are presented with the aim of encouraging further research as to whether progesterone treatment is effective in reversing the effects of the mifepristone. Interest in the topic has arisen among people who appear to be anti-abortion and whose main purpose appears to be to find a clinical means to stop abortions already in process from taking place. In focusing on efforts to rescue the embryo, however, the authors, the editors and the reviewers all ignored the pregnant women and the reasons for their actions in this situation as well as the behaviour of the health care professionals.
What is striking about all three of the cases described is how quickly, and in two of the three cases, how immediately the women changed their minds and sought “reversal” of the mifepristone. This raises two quite different sets of questions about the behaviour of the health professionals involved that the report does not consider or answer. Firstly, were the providers of the pills not aware of what must have been quite serious ambivalence and conflicting feelings about the abortion in these women, and if not, why not? Surely it is part of their professional remit to ask the woman if she is sure of her decision, and if she is uncertain, advise her to wait to take the pills until she is sure. Secondly, did those same health professionals while they were handing over the pills say or do anything to upset the women, such as condemning them for seeking abortion or showing them their scan or nasty visuals of chopped up fetuses, as anti-abortion people often try to do, in order to discourage them from going ahead, which then led them to change their minds so abruptly?
And what about the women concerned? It is well known that a proportion of women who make a clinic appointment for a surgical/aspiration abortion do not turn up for the procedure because they have changed their minds, and that they may or may not return later. I well recall a now retired Ob-Gyn in the UK saying the proportion was around 10%, though that was many years ago.
In any case, in whatever the proportion of women who do so, wavering and a change of mind about whether to continue or end an unplanned pregnancy is not uncommon and may happen more than once in both directions before a woman ever seeks an appointment. Hence, I would argue that there is a far better way to address the fact that some women may change their minds, which takes into account all the women who opt for medical abortion pills to end a pregnancy. The fact is, women have a right to feel ambivalent and change their minds, and they should therefore be in complete control over whether and when they take the pills – instead of having to take them in front of a health professional at the health professional’s convenience.
In other words, all women opting for medical abortion should be able to use both the mifepristone and the misoprostol pills at home, in their own time, where they can change their minds (or not) as often as they need to, and only use the pills (or not) when they are sure of their decision. Then the search for an antidote to mifepristone would be unnecessary.
The publication of this article also raises issues about the role of editorial and peer review in the face of anti-abortion efforts to dress up their political aims as science. The authors of the paper should not have been allowed to ignore the situation of the women whose histories it presents, or the reasons for their change of mind, or what role the providers of the pills might have played in their doing so and in supplying the progesterone. Allowing these crucial aspects to be ignored was a failure of the editorial and peer review process and resulted in giving the paper the credibility of scientific publication when its underlying aim was to promote a way to stop abortions.
No potential conflict of interest was reported by the author.
- Garratt D, Turer JV. Progesterone for preventing pregnancy termination after initiation of medical abortion with mifepristone. Eur J Contracept Reprod Health Care. 2017;22:472–475.