Bill would require Iowa doctors inform patients of medication abortion 'reversal' critics say is unsound

DES MOINES — Health care providers in Iowa would be required to tell patients that it may be possible to reverse the effects of a medication abortion, something reproductive rights advocates and medical groups say is not supported by science.

Republican members of a three-member House subcommittee on Tuesday advanced House Study Bill 186 for consideration by the full House Health and Human Services Committee.

The bill would require medication abortion providers and the Iowa Department of Health and Human Services to publicly post information about “abortion reversals.” It also requires patients to sign paperwork stating that they have received the information abortion-rights advocates say is meant to mislead people into thinking medication abortions are unsafe and reversible.

It is the second bill introduced this session targeting medication abortion. House File 423 would make it unlawful to manufacture or dispense medicine for medication abortions, which account for 74 percent of all abortions in Iowa. Those who violate the law would face a Class C felony, punishable by up to 10 years in prison and a fine of $1,370 to $13,660.

Supporters, including representatives from Iowa Right to Life, The Family Leader and the Iowa Faith and Freedom Coalition, argued for providing detailed information about the risks and alternatives to abortion, citing high complication rates and the potential for reversal.

“Women deserve to know the complications, risks and threats of chemical abortion,” said Kristi Judkins, executive director of Iowa Right to Life. “Women need to be told they may not get rid of the baby. They could experience hemorrhage, infection, ongoing pregnancy and missed ectopic pregnancy, which is a life-threatening condition.”

Opponents, however, note years of rigorous medical research have demonstrated that medication abortion is safe, with low mortality and complication rates for patients.

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Medication abortion involves terminating a pregnancy non-surgically through a combination of two prescription drugs — mifepristone and misoprostol — during the first trimester of pregnancy.

The Food and Drug Administration has found that medication abortion using mifepristone followed by misoprostol is a safe and effective method of pregnancy termination. When taken, medication abortion successfully terminates the pregnancy 92 percent to 99.6 percent of the time, depending on how misoprostol is administered, with a 0.4 percent risk of major complications.

As of Dec. 31, 2024, there have been 36 reported of deaths associated with mifepristone since it was approved in 2000, out of 7.5 million women who have taken mifepristone, according to the FDA. However, “these events cannot with certainty be causally attributed to mifepristone” for various reasons, the FDA says.

The American College of Obstetrician and Gynecologists says claims regarding abortion reversal treatment are not based on science, do not meet clinical standards and are “unproven and unethical.”

Mazie Stilwell, public affairs director for Planned Parenthood Advocates of Iowa, said the bill amounts to “state-mandated misinformation.”

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“Health care decisions, including abortion, should be guided by medicine and science, not determined by politicians arbitrarily choosing how and when a person can access care, or what pseudoscience stands in their way,” Stilwell told lawmakers.

“… These requirements serve no medical purpose and are intended to make abortion more difficult to provide in the hope that fewer providers are willing to comply. These requirements are medically unnecessary, they provide no benefit to patients, and are politically motivated to restrict access to abortion. These laws have the perverse effect of restricting access to health care, and can ultimately jeopardize the health of pregnant Iowans by subjecting them to misinformation and the entire communities that that affects.”

What the bill does

HSB 186 would require physicians who dispense mifepristone to a patient to do so directly in a health care setting and require medical facilities to post signs detailing the risks associated with medication abortions and how to reverse them.

Facilities that perform medication abortions would be required post a sign visible to patients that reads: "Recent developing research has indicated that a medication abortion utilizing an abortion-inducing drug is not always effective in ending a pregnancy. It may be possible to avoid, cease or even to reverse the intended effects of a medication abortion that utilizes an abortion-inducing drug. Please consult with a health care professional immediately."

Except in the case of a medical emergency, Iowa physicians would be prohibited from dispensing abortion-inducing drugs to patients without written certification that they provided the patient information about reversing the drug and its risks. After dispensing a medication abortion drug, a physician would have to write medical discharge instructions that include information about reversal and associated risks.

Women who seek medication abortions in Iowa would also have to sign off after receiving information about reversing the drug and its risks from their physicians.

Physicians who do not comply could face reprimand, probation and suspension or revocation of their medical license.

Study of abortion reversal has ‘methodological and ethical issues’

A 2023 systematic review of progesterone to reverse the effects of mifepristone by a researcher at the Department of Obstetrics and Gynecology at New York Medical College found “based mostly on poor-quality data, it appears the ongoing pregnancy rate in individuals treated with progesterone after mifepristone is not significantly higher compared to that of individuals receiving mifepristone alone.”

The review found “the quality of the evidence in the case series was low due to methodological and ethical issues.”

A 2019 study by researchers at the University of California-Davis was halted early after three of the study’s 12 participants experienced dangerous bleeding and required hospitalization. Dr. Mitchell Creinin, who led the study, said the results raise safety concerns about the effectiveness of using progesterone in reversing a medical abortion.

The medical regimen has not been approved by federal regulators.

Rep. Heather Matson, D-Ankeny, read from an NBC News article quoting UC-Davis’ Creinin, who “said that the protocol hasn’t been studied enough to properly inform patients about possible side effects or complications.

“The fact that progesterone has been approved for other uses, he said, doesn’t mean that it’s safe or effective for use in this application,” Matson said.

Supporters though, point to other research as proof that abortion reversal works. But critics say that study failed to meet key research standards.

“Abortion pill reversal is safe and effective, and it gives babies a second chance at life,” said Maggie DeWitte, executive director of the anti-abortion advocacy group Pulse Life Advocates. “Thousands of women have successfully reversed the abortion pill. It is not phony. My coworker was one of them. You look at her and tell her that her son, who is now alive because of taking this reversal, is somehow phony medicine. … Women deserve to be fully informed of all of their options, and everyone should be in support of that.”

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Reps. Devon Wood, R-New Market, and Shannon Lundgren, R-Peosta, signed off on advancing the bill.

Matson opposed the bill.

“I think the scare tactics and the fear mongering will only hurt patients,” she said. “And I am deeply concerned about hearing earlier from someone (in support of the proposal) that women deserve information that is grounded and truthful. The language in this bill is anything but grounded and truthful.”

Comments: (319) 398-8499; tom.barton@thegazette.com