Arun Venugopal:

I'm Arun Venugopal, in for Tanzina Vega, and we're back with The Takeaway.

Arun Venugopal:

Yesterday marked 47 years since the Supreme Court legalized abortion in the landmark case Roe v. Wade. Today the battle over abortion rights has reached a fever pitch. In 2019 the U.S. saw an unprecedented number of laws aimed at limiting people's right to abortion. According to the Guttmacher Institute, 25 new abortion bans were signed into law, primarily in the Midwest and in the South.

Arun Venugopal:

But there's another kind of restriction that's flown under the radar, so-called abortion reversal laws. States including North Dakota, Oklahoma, and Arkansas have passed laws requiring doctors to tell patients seeking medication-based abortions that the procedure can be reversed if they change their minds halfway through the procedure. The medical establishment says that's not true and there's no reliable research supporting these treatments.

Arun Venugopal:

Joining me now is Mary Ziegler, law professor at Florida State University and the author of several books about abortion, including Abortion and the Law in America: Roe v. Wade to the Present, which comes out in March. Mary, thanks for coming on the show.

Mary Ziegler:

Thanks for having me.

Arun Venugopal:

Also with us is Marc Hearron, senior counsel with the Center for Reproductive Rights. Marc, glad you could join us too.

Marc Hearron:

Happy to be here.

Arun Venugopal:

Mary, how does a medication abortion actually work and how are anti-abortion activists claiming it can be reversed?

Mary Ziegler:

Medication abortion usually requires women or patients to take two pills, mifepristone, which helps to detach a pregnancy from the uterine lining, and misoprostol, which causes contractions. So anti-abortion groups that are promoting these abortion pill reversal laws claim that usually if you take only the first pill in the two-pill protocol and then take pretty significant doses of progesterone that an abortion won't be completed.

Arun Venugopal:

So is the idea as far as you can tell that anti-abortion activists are trying to buy time, if you will, in which to allow for someone to have doubts about going through with the procedure?

Mary Ziegler:

I think so, and I think the laws are part of a bigger narrative that anti-abortion groups have promoted, which is that women regret abortions, and so the idea here I think is just to advance that idea and also to suggest that women who feel that way or are encouraged to feel that way by anti-abortion groups that they can change their minds.

Arun Venugopal:

Well, what explains this rise in these "abortion reversal laws?"

Mary Ziegler:

There are two I think primary things that have led to the emphasis put on these laws. The first I think is just an increase in the number of women who are using medication abortion to end their pregnancies and a sense on the part of anti-abortion groups that that number is only going to increase as more states introduce abortion restrictions and as some states if Roe v. Wade is overturned actually ban abortions. It becomes more and more important then for anti-abortion groups to convince women that abortion pills are a bad idea and that abortion pills don't necessarily lead to the end of a pregnancy.

Mary Ziegler:

The other reason these laws have spread is because of a broader strategy to reverse Roe on the theory that abortion hurts women. The Supreme Court when previously deciding not to overturn Roe emphasized the idea that women rely on abortion to attain equal citizenship, whether that's in pursuing economic opportunities or educational opportunities. Anti-abortion groups believe that if the court no longer thinks that, right, if women cannot or should not rely on abortion, then the court will undo Roe. So these abortion pill reversal laws fit into a strategy centered on the idea that abortion is bad for women.

Arun Venugopal:

So Marc, do we have any evidence supporting the claim of these laws that medication abortion can be reversed?

Marc Hearron:

Well, we know that medication abortion, as Mary said, is a two-drug protocol, and if that protocol is followed, it's both extremely safe and extremely effective. It's effective in over 95% of cases and the rate of serious complications is less than 0.4%. We also know that if only the first drug, mifepristone, is taken and not followed up with the second drug that there's a high rate of continued pregnancies, up to 50%. so the claims that are being made is that if you introduce high rates of progesterone after taking the first pill that that somehow counteracts the effects of the first pill, but there's absolutely no credible scientific evidence that the progesterone has any effect whatsoever.

Marc Hearron:

There was a recent study that tried to actually test this reversal theory using rigorous scientific evidence, a double-blinded controlled clinical trial that you would typically see before you would introduce a new treatment, and the researchers there had to stop the study after only 12 women took the treatment because three of the women experienced severe hemorrhaging. So what we're seeing is that this "reversal treatment," not only is there no science showing its efficacy, in fact the American College of Obstetricians and Gynecologists has said that this is not based on credible evidence, but there are serious concerns with safety.

Arun Venugopal:

And the AMA, the American Medical Association, has also actually spoken out about this, correct?

Marc Hearron:

That's correct. The Center for Reproductive Rights is challenging reversal laws in both North Dakota and in Oklahoma. I'm involved in both of those lawsuits, and in our North Dakota case, the American Medical Association has joined as a plaintiff in that case.

Arun Venugopal:

Mary, this narrative underlying all these laws, it rests on the idea that people are going to regret having an abortion. What do we know about that?

Mary Ziegler:

There was just recently a study published suggesting that very few women do regret abortions, but I think unfortunately given the state of the abortion debate, there's really no study that would put those arguments about abortion and regret to rest. So I think there's been a considerable amount of research suggesting that women don't regret abortions, at least for the most part, but anecdotal evidence or questions about what anti-abortion activists would see as bias will mean that arguments about abortion and regret will live on, I think not least of which because they're believed by anti-abortion lawyers to be effective in the courts as a strategy for potentially dismantling abortion rates.

Arun Venugopal:

Marc, I'm also wondering what these laws mean for doctors, especially in an ethical or a legal sense.

Marc Hearron:

The most critical part of a physician-patient relationship is trust. Patients have to believe that their doctors are giving them sound medical advice and it's advice that they can rely on, and physicians have an ethical obligation toward their patients, and these state laws are requiring physicians to tell their patients about a course of treatment that is not only medically unsound in terms of there's no evidence of efficacy, it's also potentially dangerous, and so it really puts doctors in this Hobson's choice.

Marc Hearron:

The Oklahoma law, for example, actually makes it a felony to not tell your patients about this "reversal treatment," and doctors can be fined up to $10,000 a day if they don't post these notices in their waiting rooms. So doctors are now forced, do I risk criminal penalties or do I give my patients false and misleading information and violate my ethical obligations?

Arun Venugopal:

Marc Hearron is senior counsel with the Center for Reproductive Rights and Mary Ziegler is a law professor at Florida State University and the author of the forthcoming book, Abortion and the Law in America: Roe v. Wade to the Present. Thank you both for joining us.

Marc Hearron:

Thanks, Arun.

Mary Ziegler:

Thanks.

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