A New Front in the War Over Reproductive Rights: ‘Abortion-Pill Reversal’

When the abortion pill became available in the United States in 2000, 12 years after it was approved in France, activists on both sides of the debate predicted that what was then called RU-486 would revolutionize the abortion landscape. One Planned Parenthood medical director told a journalist in the late 1990s that he expected medication abortions to make up 30 percent of all abortions within three or four years. Anti-abortion leaders, meanwhile, foresaw the procedure’s becoming effectively invisible, and therefore difficult to confront directly. George W. Bush, then the Republican nominee for president, said he feared the new protocol would ‘‘make abortions more and more common.’’

.. In 2014, the number of abortions in the United States dropped below one million for the first time since 1975.

.. A decade after RU-486’s arrival in the United States, fewer than 18 percent of abortions took place via medication

.. Even among women whose pregnancies were eligible for the abortion pill — at the time, eight weeks’ gestation or less — almost three-quarters underwent surgery instead.

.. As public discussion about abortions has focused on surgical abortions, the anti-abortion movement has notched victory after victory, chipping away at abortion access through a constellation of state laws that heavily regulate clinics, starve providers of funds and require women to undergo ‘‘counseling’’ or waiting periods before procuring the procedure. As a result, at least 162 abortion providers closed or stopped offering the service between 2011 and 2016

.. In the Midwest and the South, more than half of all women live in counties with no abortion provider at all.

.. But today, 17 years after RU-486 was approved, medication abortion is approaching its initial promise — or threat, depending on your point of view. American women now end their pregnancies with medication almost as often as they do with surgery

.. The experience of taking a few pills in private is on the cusp of becoming what we mean when we say ‘‘abortion.’’

.. This steady rise of medication abortion, or what the anti-abortion movement calls chemical abortion, presents the movement with a significant challenge, one that has turned out to be more complicated than the fear that abortion would become more common.

.. Medication abortions take place relatively early in pregnancy, and they are eliminating many of the images and narratives — the abortionist’s instruments, the impersonal clinic — that have historically served as persuasive scare tactics.

  • .. What the anti-abortion movement has thought through carefully is how to tell stories about abortion’s impact. Early activists, who were mostly Catholics, were almost solely concerned with saving the life of the fetus.
  • Feminists arguing for choice, in turn, made a convincing case for their own rights — and accused people opposed to abortion of not caring about women at all.

.. By the 1990s, emphasizing abortion’s supposed harms to women had become a full-fledged strategy, one that changed both the public face of the anti-abortion movement and its self-identity. Today many young anti-abortion activists frame their work as feminist

.. Promoting abortions as murder had always carried the uncomfortable implication that the women who procured them were killers. In the revised narrative, ‘‘the women are viewed as essentially victims,’’ Williams says. ‘‘The argument is always that they didn’t have the knowledge they really needed.’’

.. And ‘‘abortion pill reversal’’ implies exactly that — that a woman made an uninformed decision and has now thought better of it. The brainchild of a San Diego doctor named George Delgado, ‘‘reversal’’ is a medical protocol that floods a woman’s body with progesterone, the so-called pregnancy hormone, within hours after she has taken mifepristone, the drug that begins a medication abortion. ‘‘If you have something that’s poisoned a specific spot in your body and we know what the antidote is, then you just take the antidote,’’

.. For all the challenges that the abortion pill poses to the anti-abortion movement, it turns out to have at least one unexpected benefit: The hours between the two doses of medication represent an extra decision point to interrupt and redeem. ‘‘With a surgical abortion, once the instrument enters the uterus, then it’s over,’’ Delgado says. Medication abortion, by contrast, gives women ‘‘a second chance at choice.’’

.. Natural Procreative Technology, a Catholic-friendly approach to women’s reproductive health. Developed by an anti-abortion OB-GYN named Thomas Hilgers who was also inspired by ‘‘Humanae Vitae,’’ ‘‘NaProTechnology’’ eschews most forms of birth control and fertility treatments and relies instead on tracking widely used ‘‘biomarkers’’ like cervical mucus and body temperature.

..  he knew that mifepristone, the first drug in the abortion-pill protocol, works by blocking progesterone from the uterus. Couldn’t an extra dose of progesterone overcome the mifepristone? Within hours, he sketched out a plan to inject the woman with 200 milligrams of progesterone and to con­tinue giving the progesterone until the end of the first trimester.

.. Delgado later found out that a doctor in North Carolina, Matthew Harrison, had received a similar call from a crisis pregnancy center in 2006 and independently made the same guess about progesterone counteracting the effects of the mifepristone. That fetus, too, survived, after the mother received progesterone injections through her 26th week of pregnancy.

.. They soon published a small case series in the journal Annals of Pharmacotherapy. The article, just four pages long, describes seven pregnancies treated with progesterone after mifepristone. Two of the abortions completed, but four of the fetuses survived.

.. Delgado’s hotline received just 28 calls in all of 2012. But the volume increased over the years: 200 calls in 2013, more than 400 in 2014 and more than 600 for each of the last two years

.. When a call comes into the hotline, the nurse’s job is to connect the caller as quickly as possible with a local doctor willing to administer the reversal protocol. The program has a network of about 350 doctors

.. If the caller doesn’t live within driving range of one of those providers, the hotline nurse immediately starts calling local doctors and hospitals to explain what reversal is, hoping to find a sympathetic provider. Catholic hospitals are usually a good place to start.

.. One fan gave Harrison a T-shirt that read ‘‘Reversed RU-486. Now reverse Roe vs Wade.’’

.. A vanishingly small percentage of women decide they want to reverse a medication abortion halfway through. In fact, regret is quite rare when it comes to abortions in general. A 2013 study found that although women experienced a wide range of often conflicting responses to the procedure, relief was the most common emotion one week after. A later study found that women who had abortions were also confident in their decisions beforehand — more confident than people who decide to get reconstructive knee surgery, for example.

.. ‘Most women are certain of their decision when they present for care,’’ says the study’s lead author, Lauren Ralph, an epidemiologist at the Univer­sity of California, San Francisco. Their certainty is largely unchanged by waiting periods and mandated counseling, which suggests ‘‘women do not change their minds.’’

.. Ralph also found that women who do experience uncer­tainty are more likely to already believe a myth about abortion, such as that it causes breast cancer.

.. In Cynthia’s memory, it wasn’t the pressure from a priest, a doctor, her mother and her boyfriend that changed her mind. It was the ultrasound. ‘‘When I saw the heartbeat, I mean, truly everything changed,

.. Women who regret their abortions, and are willing to speak publicly about it, have long been valued spokeswomen for the anti-abortion message. But reversal offers a twist to those stories: a happy ending.

It also represents a concrete action that women can take to atone for their initial mistake.

.. While Delgado claims that flooding a woman’s body with progesterone saves the fetus, other doctors say that in many cases the fetus would have survived if the woman simply declined to take the second pill, misoprostol, after the initial dose of mifepristone.

.. The American Congress of Obstetricians and Gynecologists issued a strongly worded statement against reversal in 2015 that said the fetus would survive 30 to 50 percent of the time.

.. The question, in other words, is whether the progesterone protocol is effectively just a placebo. ‘‘There’s no evidence that any kind of treatment is better than doing nothing,’’

.. Delgado and Davenport are also preparing a larger case series for publication later this year, which they say will include about 350 women. Delgado says it shows that the most effective progesterone protocol results in an embryo survival rate between 60 and 70 percent.

.. Critics say that even if those numbers are valid, they aren’t what they seem. Many women who decide to take progesterone undergo an ultrasound first, to see if the pregnancy remains viable; those whose fetuses have died do not go forward with reversal, which means the initial pool of subjects is skewed toward women whose pregnancies had a good chance of continuing even without progesterone.

.. The protocol, however, has attracted almost no interest from the mainstream medical community, in part because the presumed audience is so small.

.. Since 2015, legislators in 10 states have introduced bills requiring doctors to inform women procuring the abortion pill that they can change their minds after taking the first dose. ‘‘These laws are essentially forcing physicians to tell their patients about a treatment that is unproven and essentially kind of encouraging them to participate in an unmonitored research experiment,’’

.. The anti-abortion movement has effectively promoted the idea that many women regret their abortions. Supreme Court Justice Anthony M. Kennedy, considered a wild card on abortion questions, waxed eloquent on the topic in his ruling in Gonzales v. Carhart, a 2007 case that upheld the ban on ‘‘partial-birth’’ abortion. ‘‘It seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained,’’ he wrote in the majority opinion. ‘‘The state has an interest in ensuring so grave a choice is well informed.’’ That assumption undergirds huge swaths of contemporary abortion law: waiting periods, mandatory ultrasounds and requirements that doctors give women more (sometimes dubious) information about the procedure and its effects. The idea seems to be that many women understand what an abortion is only after they have one.

.. Stories from individual women who struggle with remorse remain a powerful weapon in the anti-abortion arsenal, and the abortion rights movement has often stumbled in its attempts to respond.

.. Just raising the question of uncertainty and regret affects the abortion pill’s reputation. ‘‘You’re changing cultural norms about what people think about this kind of abortion,’’ she says. ‘‘You can do that regardless of what the research ultimately shows.’’

Abortion, Civility, and Rule Breaking

We probably disagree on this, but as I see it, people like Putin, Duterte, and Trump are not actually restoring law and order. I don’t think that is what authoritarian leaders do, it is what they promise. Remember that Nixon was the “law and order president”. As I see it, they are making a mockery of law and order, turning it into a tool that an authoritarian leader can use to advance his own interests, hound his enemies, protect his friends, hide his own actions, and enrich himself. I am extremely concerned about law and order, I just want to make sure that it applies to the president as well. I have some examples in mind, I want to avoid giving them now simply because I want to avoid putting hot-button issues into a post at this point of the conversation. We may well disagree on my examples, I would like to find a calm way to discuss them in order to be able to discuss and learn together.

In the long run, if I’m right and this becomes obvious to people, then they may judge both Christianity and the pro-life movement as political pawns with little moral authority if we are fiercely loyal to them. I think that’s what happened in Europe as the children of Germans realized that their Christian parents had generally supported the Nazis. I think the same might well have happened in the United States if Christians of all races had not marched together against racist laws.

I think it is really important to have some moral distance from any political leader. I’m probably a lot more concerned about Trump than you are.

.. I don’t think democracy “works” and I don’t think it’s stable in the long run. I don’t really sit around worrying about “how to make democracy work”, either.

.. I guess the difference is I’m not part of the “we” of trying to make political change happen – instead, I think political change happens because God is ultimately orchestrating the affairs of men. If men don’t voluntarily choose to stop doing a grievous sin like abortion (or world wars, or the Holocaust, or all manner of other evil), God eventually intervenes. And I don’t think God is constrained by the democratic process.

.. Ending abortion, or dealing with roving drug gangs, is definitely restoring some kind of law and order. It’s not an ideal, but it’s improvement in the right direction. And I think it’s a consequence of us more progressive-minded people being so obsessed with laws and rules that we end up letting criminals get away with turning cities into war zones because we were so fixated on the rights of criminals to due process and so forth.

.. I do pray that God will intervene, but I worry about American Christians anointing a strongman who promises to beat up our enemies. I see some religious leaders treating Trump as “God’s anointed”, sent to save America from our sins. The Trump Prophecy and many things coming out of Liberty University seem to approach idolatry, as does the billboard Jeremy mentioned.

.. If I were to advise Christians, I’d tell then to follow the Bible, which necessarily means not voting, not fighting in wars, not killing people, and so on. Regardless, abortion will only be ended through force. God is in charge of using that force. Persuasion doesn’t stop murder.

.. I think abortion will not be ended by force, unless you mean the return of Christ as an act of force. Abortion pills are too easy to transport, even if they were to become illegal.

A change of heart, that is conversion (not persuasion, although that too will help), is the best way to end abortions. Meanwhile, we can reduce abortions with easy free access to birth control, free prenatal care, free birthing centers, and reducing other financial barriers to parenthood.

Newt Gingrich Didn’t Break American Politics

The Times podcast focuses less on Gingrich’s style and more on his use of so-called “wedge issues.” Times columnist Jennifer Senior interviews Republican former congressman Vin Weber about how the GOP “exploited” American differences on cultural issues such as partial-birth abortion and gay marriage to help hand them their first majority in two generations.

But it turns out that “wedge issue” is just another word for “popular position.” In the early 1990s, there wasn’t a meaningful electoral constituency for gay marriage. There wasn’t much public support for partial-birth abortion. By bringing up cultural issues, the Republicans not only gave voice to millions of Americans who had deep concerns about the cultural direction of the country, but also exposed divisions in the Democratic coalition.

Gingrich’s Contract with America (you can read it here) was extensively poll-tested to present only promises that had overwhelming public support. Gingrich was a political street fighter, yes, but he was playing a very strong political hand. Congress was overdue for serious change.

.. it’s hard to argue that he “broke politics” when the GOP House and the Clinton administration worked together to enact significant legislation.

.. What? The president of the United States (a man who is almost certainly a sexual predator, by the way) had an affair with an intern in the Oval Office and lied about it under oath. He lied to the American people. He conducted a systematic smear campaign against his accusers and his investigators. None of this was Newt Gingrich’s fault.

.. It is absolutely worth profiling Gingrich and considering his role in American politics — including the undeniable part he’s played in American polarization. Some of his tactics have absolutely been destructive. But the diagnosis here is just fundamentally wrong.

.. Did Newt Gingrich “break” American politics more than Roe v. Wade did? Do progressives know or care about the shock waves Ted Kennedy’s “Bork’s America” speech sent rippling through conservative America? Lest you need reminding, here is the key part of that vile text:

Robert Bork’s America is a land in which women would be forced into back-alley abortions, blacks would sit at segregated lunch counters, rogue police could break down citizens’ doors in midnight raids, schoolchildren could not be taught about evolution, writers and artists would be censored at the whim of government, and the doors of the federal courts would be shut on the fingers of millions of citizens for whom the judiciary is often the only protector of the individual rights that are the heart of our democracy.

But for progressives, Roe is good and Bork is bad, and so a bit of sloppy judicial reasoning or rhetorical excess is but a trifling compared to the worth of the broader cause. It’s the arc of history bending towards justice, and that’s not always neat or clean.

.. There’s no question that Newt Gingrich was an important figure, but he was an inevitable important figure. If Gingrich hadn’t ended Democratic dominance of the House, someone else would have. There were tensions in the Democratic coalition that could not be avoided. The Democratic hammerlock on the House was out of step with the composition of the American electorate. The tidal forces of cultural conflicts launched decades before were going to tear apart Congress in the same way they’d torn apart campuses and caused conflict at kitchen tables.So, no, Gingrich didn’t break American politics. But he did help break a progressive monopoly on the House, which the GOP has controlled 20 of the 24 years since. And given the aggression and incivility they overlook on their own side, it’s clear that for many commentators on the left, ending Democratic dominance is Gingrich’s truly enduring sin.

Beto O’Rourke May Benefit From an Unlikely Support Group: White Evangelical Women

In the Senate race, one of the most unexpectedly tight in the nation, any small shift among evangelical voters — long a stable base for Republicans — could be a significant loss for Mr. Cruz, who, like President Trump, has made white evangelicals the bulwark of his support.

To Democrats nationwide, who have largely written off white evangelical voters, it also sends a signal — not just for the midterms but also for the 2020 presidential campaign — that there are female, religious voters who are open to some of their party’s candidates.

.. The women, who are all in their 30s, described Mr. O’Rourke as providing a stark moral contrast to Mr. Trump, whose policies and behavior they see as fundamentally anti-Christian, especially separating immigrant children from their parents at the border, banning many Muslim refugees and disrespecting women.

“I care as much about babies at the border as I do about babies in the womb,” said Tess Clarke

.. confessing that she was “mortified” at how she used to vote, because she had only considered abortion policy. “We’ve been asleep. Now, we’ve woke up.”

.. One in three Texans is evangelical

.. 85 percent of white evangelical voters in Texas supported Mr. Trump in 2016

.. showing Mr. Cruz leading Mr. O’Rourke 87 percent to 11 percent among evangelical activist voters.

.. “How does my vote represent the little girl that I used to be?” she said. “The Republicans used to be the party of family, and morals and values, and now they are not.”