Australian Doctor magazine, an online publication for health professionals published an article this week on our new project, Australian Mifepristone Reversal. The 'expert' they chose to quote on this service to women is a prominent abortion provider and advocate Professor Caroline de Costa. Not surprisingly her opinion of mifepristone reversal was both scathing, inaccurate and very dismissive of the experiences of women who might seek the service.
Professor de Costa stooped so far as to suggest that women seeking reversal simply do not exist, as they are all well informed and given time to make a decision. She further states that, "We don't have women suddenly changing their minds - this is basically not a problem, this is a furphy."
She described the use of progesterone in this setting as 'highly dangerous' and participation in providing this service to women as 'irresponsible'. This is in spite of the fact that the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) support the use of progesterone in early pregnancy for other reasons, including artificial reproductive technologies.
While de Costa expresses her opinion that 'It would be highly dangerous to say that a pregnancy would proceed normally after that', more than 130 mothers of healthy babies born after reversal in the United States would disagree.
Unfortunately, although the author did seek to ask me some questions prior to the publication of this article, at which time I invited them to contact me in the New Year when we were more established, they have so far chosen not to publish my comment to the article on their site. (amended, that they did later publish my comment)
While I submitted a slightly abbreviated version to them, in order to fit their commenting guidelines, below is my full response.
Progesterone is relatively low risk and commonly used in early pregnancy in the setting of threatened miscarriage and in artificial reproductive technologies. Using progesterone in an attempt to reverse the effects of mifepristone, a competitor for progesterone receptors is considered experimental, however it has been offered in the United States for a number of years and resulted in the births of more than 130 healthy babies to date. There have been no recorded instances of adverse effects of the progesterone therapy itself.
If Professor de Costa truly believes that all women are well informed, given time to make a decision and don’t change their minds, then surely concern over the establishment of this service wouldn’t need to exist as there will be no reason for women to contact us. However, given that our establishment has occurred only in response to women that de Costa states are non-existent, there may well be some issues with consent or information giving to at least some women.
Five women in ten weeks who attended four different abortion clinics in three different states found us and requested reversal after leaving the abortion clinic and conducting an internet search, desperately looking for a way to undo what they had done. Three of the women contacted us before our website was live, and no marketing or promotion of the service has been undertaken. Two of them were directed to us when they found the US website.
Three of the women have related stories of absolute coercion in the abortion clinic itself and we will be publishing these case studies in the near future. Of course this must raise some questions about how many other women are feeling pressured inside abortion clinics to take mifepristone when they clearly don’t want to and how many simply fail to find any help when they seek it.
Given the relatively low risk, and the potentially great hope offered to these women, how can those who advocate choice suggest that women should only have the choice of taking drugs to procure abortion, not drugs to stop abortion? Given the risks that we know exist for women undergoing medical abortion, I am not sure on what basis Professor de Costa expresses concern that progesterone could be more dangerous for her than misoprostol after taking mifepristone.
While I appreciate the publicity you may generate for our work through your article, perhaps a more evidence based, less sensationalised and obviously ideologically biased approach would contribute more fully to expanding the range of reproductive available choices available to women.