Reversing medical abortions, and two other abortion bills the Colorado House will probably kill today

Republicans opened the legislative session by saying they wouldn’t back down from their priorities and values, despite Democrats controlling the House and having the backstop of a governor’s veto.
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Republicans opened the legislative session by saying they wouldn't back down from their priorities and values, despite Democrats controlling the House and having the backstop of a governor's veto. That includes trying to pass new abortion restrictions. These three bills are very unlikely to make it out of the state House Health, Insurance and Environment, which is hearing testimony on them starting today at 1:30 p.m. (You can listen to the audio here.)

Update: All three bills were defeated in party line votes.

However, they give some sense of how the legislative piece of the abortion debate is shifting as opponents feel emboldened by a new president and the possibility of new Supreme Court justices and as more women take advantage of medical abortions that happen at home and not in a clinic setting.

Here's the legislation in question:
  • House Bill 1086, the Abortion Pill Reversal Information Act, would require doctors to tell women they can reverse a medical abortion, which involves taking two different types of medication two days apart, halfway through the procedure by taking progesterone shots. Is this true, that abortions can be interrupted in this way? There have been a few documented cases, but the evidence is really limited. The American College of Obstetrics and Gynecology recommends against the procedure described in the bill and says the risk of side effects is too high. I'll explain this more a little further down.
  • House Bill 1085, the Women's Health Protection Act, would require all abortion clinics to submit a registry of abortions to the Attorney General's Office. Women's names wouldn't be included, but it would describe every abortion, the method used and the doctor who performed it. It would also require a special report on any abortion performed over 20 weeks and lists of any babies born as a result of attempted abortions and how that was handled. And it would give the attorney general's office the ability to inspect abortion clinics. Proponents say this is about making sure clinics operate in a safe and legal manner, while opponents point out that no other medical procedure or practice is regulated by the Attorney General's Office.
  • House Bill 1108, the Protect Human Life at Conception Bill, straight up bans all abortion except that performed to save the mother's life. It makes terminating a pregnancy a felony, though the penalty would fall on doctors, not women. If a bill like this were to pass, it would probably be found to be unconstitutional.
Can medical abortions be reversed?

The language of HB 1086 claims that at least 175 babies have been born full-term and healthy after their mothers took the first round of medication for an abortion and then received progesterone to reverse the effects. It also describes women having second thoughts about their abortions, calling their doctors and being told there was nothing they could do. Women should have full and accurate information that would allow them to "preserve the mother-child relationship" if they choose.

The bill would require the Colorado Department of Public Health and Environment to develop a statement about the possibility and effectiveness of abortion reversal and require that doctors provide this statement to their patients 24 hours before they start a medical abortion.

Here's what happens in a medical abortion: A woman takes a dose of mifepristone, which causes the embryo to detach from the uterine wall. A day or two later, she takes a dose of misoprostol, which causes the uterus to contract and expel the embryo. (I'm using "embryo" and not "fetus" because you can have a medical abortion up to 10 weeks of pregnancy, which is when an embryo becomes a fetus.)

Why not give women more information? Ashley Wheeland, policy director for Planned Parenthood of the Rocky Mountains, said the language in the bill significantly overstates the scientific case for abortion reversal, ignores potential side effects and dictates to doctors what medical advice they should give their patients.

The American College of Obstetrics and Gynecology looked at the available studies and said this: "Claims of medication abortion reversal are not supported by the body of scientific evidence, and this approach is not recommended in ACOG’s clinical guidance on medication abortion. There are no ACOG guidelines that support this course of action."

In cases where women take the first pill and not the second, between 30 and 50 percent of pregnancies will continue, ACOG said. It's not clear that taking progesterone makes it more likely for the pregnancy to continue, and it carries some risks, though many women will be fine.

"Available research seems to indicate that in the rare situation where a woman takes mifepristone and then changes her mind, doing nothing and waiting to see what happens is just as effective as intervening with a course of progesterone," ACOG said. "Progesterone, while generally well tolerated, can cause significant cardiovascular, nervous system and endocrine adverse reactions as well as other side effects."

NARAL, a group that advocates for abortion rights, said that language around abortion reversal is part of model legislation suggested by Americans United for Life, often in tandem with legislation that requires ultrasounds and that doctors use certain language in discussing abortion with patients.

As more abortions are performed using medication, opponents who previously focused on clinic regulations have had to update their approach. Usually the first pill is taken in a doctor's office or clinic, but the second pill is taken at home, and that's where the abortion is completed, in a manner very similar to a miscarriage.

Arkansas, Arizona and South Dakota passed similar notification requirements last year, and Utah and Indiana are considering abortion reversal legislation this year.

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