Below is an excerpt from my book, Alarmist Gatekeeping on the issue of women who change their minds after starting a medical abortion. It highlights the position of 'pro-choice' ideology that is not in fact at all interested in women exercising their right to choose any option.

I wrote about this at a time after closing the service and when the first clinical trial was then available to women in Australia.

Calls for this service to be available to Australian women began around the same time as the USA based organisation found themselves fielding calls from many countries where they were unable to provide the service. In 2015, after being contacted by the US team, I established a small network of medical practitioners to provide progesterone for such women. With limited human resources and no funding, the service was not actively marketed or advertised in any way and relied on women who may find the US service to be referred to me. While still in the early stages of establishment I was contacted by a journalist from Australian Doctor.

Australian Doctor is an internet and print magazine described as the “leading independent medical publication, informing, educating and engaging GPs for more than 30 years.” It provides information on a wide variety of issues relevant to the health professions. The journalist wanted to ask me some questions about our service, which I politely declined as we were still navigating how best to provide service and didn’t want promotion to mean a demand that we found difficult to meet. This didn’t stop Australian Doctor from seeking Expert advice about the terrible dangers of what we were embarking on (153).

Headlined with “Warning over medical abortion ‘reversal’ service,” the service is introduced as being “offered by an anti-abortion group” and stated that it “has been condemned as dangerous and irresponsible.

The Expert quoted in the article is an experienced abortion provider and executive on one of the largest professional bodies in Australia for Obstetricians and Gynaecologists. It can therefore reasonably be expected that she has knowledge of the use of progesterone in early pregnancy, the fact that mifepristone does not cause a higher incidence of congenital abnormalities (154)  and that women are often ambivalent about abortion and may change their minds or experience regret (155).

Her comments in the article include aspects of both Alarmism and Disinformation.

"I would think that any Australian doctor who is prescribing a woman synthetic progesterone in this situation is acting very irresponsibly."

"There was no way of knowing what effect progesterone would have in a woman who has recently taken mifepristone."

"There is no evidence that this is an appropriate thing to do."

"It would be highly dangerous to say that a pregnancy would proceed normally after that."

"We don’t have women suddenly changing their minds—this is basically not a problem; this is a furphy."

These statements are also an attempt to Discredit those providing the service and, of course, denies the existence of women who change their minds. Which begs the question, what does it matter if the service exists if there are no women requesting it? Interestingly, there were a number of comments on the article from doctors who were critical of the Expert’s assessment and Alarmism:

"Rather than being self-interested, this website appears to be offering women something for which there is no other option, without any self-reward or guarantee of success. Pity the rest of medicine (or perhaps just RANZCOG) doesn’t want to get behind helping women at a time when they are so vulnerable."

"I find it quite interesting that while pro-abortion supporters champion
“women’s choice,” Royal Australian and New Zealand College of
Obstetricians and Gynaecologists spokeswoman Professor De Costa’s
resistance to allowing doctors to offer the reversal treatment has the
opposite effect of truly providing women free choice by discouraging
their access to this form of treatment."

“highly dangerous”??? RANZCOG is on record for recommending (synthetic!) progesterone in early pregnancy for e.g. threatened miscarriage."

"Totally biased opinion given de Costa helped bring mifepristone to Australia... like asking a butcher if vegetarians get enough iron out of their diet."

"Regardless of how much counselling a woman gets, she is permitted to change her mind. to say that she won’t/can’t is irresponsible and totally paternalistic."

Perhaps unsurprisingly, all the comments have since been deleted from the online version of the article.

In the United States, a number of state governments—Idaho, South Dakota, Arkansas, Utah, and Mississippi (at the time of writing)—have decided the risk versus benefit evidence of progesterone in this setting is convincing enough that they have legislated for women be told they have an option to reverse if they change their minds (156).  There is massive opposition to this intervention from Adherents. The stated major objection is that there is not enough evidence to support the intervention (157).  It is likely, however, that underlying this objection is the concern that such interventions may threaten the Principle of abortion rights. Some of this opposition raises the issue of progesterone to counter mifepristone being a new therapy that does not yet have as strong an evidence base as many widely available medical interventions. However, all new and innovative medical interventions have a starting point, and this particular intervention is both low risk with potentially very high benefit.

While I am convinced that women should have access to such a remedy if they choose it, I am less confident that informing women about the possibility of reversal prior to commencing an abortion has any merit. In fact, such information may encourage anxious, ambivalent women to begin the process believing it can be stopped without fully understanding the risks they are taking.

In 2017, a case study article I had published on women who had accessed the service of Australian Mifepristone Reversal drew criticism from an Adherent who questioned the agenda of the service provision (158).  In a letter to the editor, the International Coordinator of a group called International Campaign for Women’s Right to Safe Abortion called into question not only the peer review process for allowing the article to be published but also the agenda of the service providers (159).  

The author accuses the peer review process of enabling “anti-abortion efforts to dress up their political aims as science” and of “giving credibility of scientific publication when its underlying aim was to promote a way to stop abortion.”

The service providers of Australian Mifepristone Reversal were accused of having the main purpose of finding “a clinical means to stop abortions already in process from taking place” with the suggestion that this is not the woman’s expressed need. She further suggests that women who change their minds may have done so because they may have been exposed to health professionals who condemned them, showed them their ultrasound scan or “nasty visuals of chopped up foetuses.” In Berer’s mind there is no room for the fact that the women may simply have been extremely ambivalent or under pressure and subsequently sought, asked for, and consented to the service offered by Australian Mifepristone Reversal.

The journal’s Editor responded strongly to this letter which was deemed to “level serious accusations at the editor and questions the reviewing process.” (160)  He went on to state that the published paper met all appropriate standards for research and publication and that rejection of it may have been considered to be censorship and suppression.

The Alarmist reaction by Adherents to this service is due to the perceived risk to the principle of abortion rights, yet underpinning that principle is meant to include the ideal that women have the right to full control of their own bodies. This must include the right to change their minds and access different treatments. Discrediting as “anti-choice” those services that provide women with added alternatives typifies the inconsistency and complete abstraction of the Dominant positioning.

Over almost five years of operation, the service has been contacted by close to 70 women who had taken mifepristone and changed their minds. Almost all the women went to great lengths to contact the service, and then only after exhausting all other avenues of seeking help. One woman had visited three separate hospital emergency departments within the space of a few hours and been turned away, with one doctor telling her she should have thought about what she was doing before she did it. Many of these women were distressed and confused about why it was so difficult to find help and why the service isn’t more widely promoted.

"I will always be pro-choice even though I wish I hadn’t done this (started the medical abortion), but for women like me this should be part of our choice, surely?" (Becca)

So far no typical scenario has been identified in women who change their minds and seek support, except for the common phenomena of immediate regret upon ingesting mifepristone. There have been women from every state of Australia who have accessed medical abortion via all means available, in private clinics, GP-prescribed, and by mail order. Every woman describes the moment that she realised she had done the “wrong” thing as a moment of complete clarity and often total panic.

About half of the women decide to proceed to termination after contacting the service. For those that talk about their reasons, they are usually succumbing to the same pressures that led them to abortion in the first place or their fears that mifepristone has damaged the unborn baby, something that is reinforced by abortion providers.

Around 80% of the women had first contacted or attempted to contact the abortion provider for advice. All but one of these was advised that they had no choice but to either continue the medical abortion process or attend the clinic to complete the abortion surgically. All were told that mifepristone would likely harm the unborn baby, which is not consistent with current evidence. Marie Stopes still has the following on the FAQ page on their website (161):  

Q: What happens if I don’t go through with the medical abortion?

A: It is very important that you understand that mifepristone or misoprostol can damage a developing foetus. If you do not want to continue with the medical termination of pregnancy after starting, we strongly recommend that you have a surgical termination of pregnancy rather than continue the pregnancy.

This is not only untrue but provides added pressure for women to continue a process for which they have clearly withdrawn consent. For women whose pregnancies have continued, there is often an expressed disbelief that they could ever have considered aborting their now much-loved babies. For those whose pregnancies don’t continue, the feedback has still been very positive with women expressing how thankful they were to have had an opportunity to “try to take it back.”