North Carolina Republican legislators appear to have found a new way to interfere with women’s reproductive rights – this time potentially eliminating the option of a non-invasive abortion for women during the first trimester of pregnancy.
House Bill 62 would require doctors to tell women seeking a non-invasive medical abortion that they could reverse the process halfway through – advice that is medically unproven.
The bill is even more restrictive than legislation in other states by requiring medical proof of fetal death before a woman can continue the second step of a non-surgical abortion.
It would increase the number of visits a woman would be required to make to her doctor (which also increases the cost), increase the number of steps doctors would be required to take and could potentially require multiple vaginal ultrasounds, which increases a woman’s risk of infection.
A medical abortion is typically used within the first nine weeks of a pregnancy and involves taking two pills, Mifepristone and Misoprostol.
Mifepristone is administered in a clinical setting by a medical professional. It blocks progesterone, a hormone needed to sustain pregnancy. Misoprostol is taken 24 to 48 hours later and works to expel the embryo from the woman’s body. It’s recommended she take the pill in a comfortable place because the process can begin as soon as 30 minutes after taking it.
Legislators want to require that women return to the doctor for the second pill. The bill would force doctors to provide a woman with medical proof that fetal death occurred before she could be given the second medication.
Mifepristone on its own has about a 50 percent success rate for terminating pregnancy, according to Kelsea McLain, with Carolina Abortion Fund, a nonprofit that works to protect and expand abortion access.
Because the bill isn’t written with clear instructions, it’s unknown how doctors would be required to provide medical proof of fetal demise. It’s also not clear what protocol would be followed if fetal demise did not occur with the first pill.
The four legislators who sponsored the bill – Rep. Larry Pittman (R-Cabarrus); House Speaker Pro Tem Sarah Stevens (R-Surry, Wilkes); Rep. Beverly Boswell (R-Beaufort, Dare, Hyde, Washington); and Rep. Michael Speciale (R-Beaufort, Craven, Pamlico) – refused to comment on HB 62 after multiple phone and email messages.
The two medical abortion pills taken together have a 92 to 97 percent success rate of terminating pregnancy. If the first pill is not successful and a woman is denied the second pill, she could be forced to seek a surgical abortion or carry the pregnancy to term – in which case, McLain said, there’s no guarantee the pregnancy would be healthy or the fetus would be free of abnormalities.
“I do know that we’re shutting down the process of sustaining pregnancy for a few days during a really crucial part of development, which is the first eight weeks,” she said. “It’s very possible that inhibiting that process could result in complications during delivery or some sort of developmental delay with the developing child.”
Requiring proof of fetal demise would require that a woman return to the clinic after the first visit. Without knowing how legislators would want doctors to provide medical proof of fetal death, McLain guessed it might involve searching for heart tones, which that early in a pregnancy could only be done with a vaginal ultrasound.
“I’m worried that it would possibly require multiple vaginal ultrasounds because if the patient comes in and fetal demise has not occurred and she still wants to take the pill, she may have to wait a few hours and then do another ultrasound,” McLain said.
Amy Bryant, an OBGYN with University of North Carolina Medical Center who provides abortions, called the bill “complete nonsense.”
“At the early stages of pregnancy when these abortions are done, you can’t even tell necessarily whether there’s a living pregnancy or not,” she said. “It’s essentially putting up another barrier for women who want to choose a safe abortion.”
She said the bill is based on one small case series that showed some women were able to continue pregnancy after taking the first pill and then adding doses of progesterone, and that it’s not enough evidence to warrant giving abortion reversal advice to patients.
“I feel that it’s truly unethical to give someone medically unproven information,” Bryant said. “We counsel women carefully and women think hard about whether they want to have an abortion or not, and when they choose to have one, they should be allowed to.”
Matthew Harrison, a Charlotte-area doctor, created an abortion reversal kit and helped Pittman with some of the wording of HB 62, he said.
“I think it is a strong bill that will give women important information about their procedure and that if they change their mind, there might be a possibility to save their pregnancy,” he said. “This bill should set the medical standard because to this point, we consistently see women being told inaccurate and coercive information, scaring them into continuing an abortion that they do not want.”
Harrison added that he believes the bill will separate pro-abortion legislators from pro-choice legislators because it supports a “woman’s right to choose to save their baby’s life.”
If a woman chooses abortion reversal after taking Mifepristone, she would meet with a provider who performs the procedure. The provider would confirm the pregnancy is viable, educate the woman about the reversal process and then she would either be given a progesterone injection or capsules or suppositories, Harrison said.
“She follows the protocol guided by the practitioner and continues replacement until the end of the first trimester at 13 weeks,” he added. “She is given prenatal care or referred to a prenatal clinic. She is also usually plugged into many other resources such as baby showers, job counseling, housing and Medicaid approval.”
There is an abortion reversal hotline staffed 24 hours a day, seven days a week, and Harrison said there are over 300 abortion reversal sites in 44 states across the nation and in 15 different countries.
He agreed that physicians should be skeptical of new protocols, as he is, but said the science behind the bill “is solid”
He claims the reversal process makes logical, scientific sense and said that animal studies in Japan showed that rats that were given Mifepristone had its effects reversed when given progesterone. He also pointed to a study published in 2012 in the Annals of Pharmacotherapy that described six case studies where four women had successful reversals and two lost their babies.
The Abortion Pill Reversal network Harrison is part of has attempted over 900 reversals, he said, and delivered 243 babies with no major birth defects. There are currently 120 women going through the protocol.
“These are all retrospective studies because it would be unethical to withhold lifesaving protocols from women seeking to save their children’s’ lives,” he said. “If we design a prospective study with an injection arm and an oral medication arm, these would be the choice of the mother and both have shown very good efficacy.”
But medical experts and organizations including the American Congress of Obstetricians and Gynecologists dispute his claims and say there is no credible, medically accepted evidence that the procedure can be reversed.
“It’s our general understanding that really the way this abortion pill reversal process works has nothing to do with the additional medications that are given and has everything to do with the fact that patients that have taken the first dose of medication with the abortion pill regimen are instructed not to take the second medication,” McLain said.
Arkansas and South Dakota both have abortion reversal laws and legislation has been introduced in Colorado, Utah and Indiana. The ACLU and other groups successfully sued Arizona for a similar bill and it was repealed.
Sarah Gillooly Policy Director of the ACLU of North Carolina said the organization is still looking over and analyzing HB 62 but that it was clearly interferes with the relationship and best medical judgment of a healthcare provider.
“It certainly creates unnecessary interference and hurdles to people’s access to their constitutionally protected healthcare and they’re medically unnecessary hurdles,” she added. “Telling a patient that their decision can be reversed after is has begun is, first of all, medically inaccurate and also interrupts that informed consent process. We don’t want patients beginning a medical procedure believing that they can reverse that medical procedure when that’s inaccurate.”
“HB 62 is just another effort, in a long history of attempts, to make abortion less accessible in North Carolina for those who seek it,” said Tara Romano, NARAL Executive Director. “And like so many of the other restrictions, HB 62 is not based on sound medical evidence or what is best for the patient – it’s based on a political ideology opposed to abortion and the sexist belief that women can’t make up their own minds.”
Alison Kiser, a spokeswoman for Planned Parenthood South Atlantic, said the organization is committed to ensuring that women have medically accurate information about all pregnancy options, not just abortion.
“This bill undermines doctors’ ability to provide the highest quality health care based on their years of training and in keeping with current clinical research and medical best practices,” she said. “The bottom line is that HB 62 has no basis in medical science and is simply another attempt by anti-women’s health politicians to make safe and legal abortion more difficult to access.”
McLain has had a medical abortion and she said the main reason she chose that process was because it was the least invasive and she did not want a vaginal ultrasound.
“[The bill] is completely and totally unnecessary and it’s basically robbing from women what they may be trying to get out of the medication abortion process,” she said.
She and Bryant pointed out that a lot of women seeking abortion are from rural areas and have a long drive to get to a provider. This bill could mean multiple trips and more cost barriers.
Carolina Abortion Fund received at least 100 calls per week from women who need financial help and the organization can only help 5 to 10 percent of them, McLain said.
“We feel like we’re in an epidemic right now with how hard it is for people to afford these procedures and the idea of additional burdens being added to it to increase the cost really makes us nervous about what people might end up doing if they can’t accept this early care,” she said.
McLain and others interviewed for this article fear too that HB 62 could just be the beginning of what will become a more omnibus bill by the end of the session.
Sen. Joyce Krawiec (R-Forsyth, Yadkin) told protesters just last week that she expects a bill to come out of the General Assembly this year involving the concept of personhood for fetuses.
“We’re nervous that this is kind of a testing the waters bill, like maybe they’re floating it out there to see what happens and then they might bring further restrictions in bills later on,” McLain said.
Bryant said there are a very small percentage of women who regret their abortion and that HB 62 is driven by ideology rather than medical advice.
“I think that it just doesn’t make sense for lawmakers to interfere in evidence-based medicine and that physicians should be able to practice based on the highest quality evidence that’s available,” she said. “This law asks physicians to use medical evidence that’s not sound.
If a woman doesn’t want to have a medical abortion, she just shouldn’t take the pill in the first place. She shouldn’t be misled into thinking she can take the medicine but it’s then reversible. We just don’t have the evidence to say that it is.”