California challenge to nonprofit's abortion pill reversal promises goes to trial

OAKLAND, Calif. (CN) —  According to a pair of religious organizations, the process of medication abortion can be reversed if a pregnant person begins taking a hormone called progesterone after they’ve taken the abortion drug mifepristone.

But in a bench trial in Alameda County Superior Court Wednesday, the state of California says the claims by Heartbeat International and RealOptions Inc. — who say they provide information and access to abortion pill reversal protocol — that the treatment is safe and effective are false and misleading.

Dr. Mitchell Creinin, an OB-GYN, researcher and specialist in complex family planning at the University of California, Davis, testified as the trial’s first witness, that those claims on the safety and efficacy of abortion pill reversal rely on unsubstantiated science.

“To this day there is no science that proves anything,” Creinin said about abortion pill reversal. “I have to have some evidence, and there is just zero evidence.”

During a medication abortion, patients are typically first given mifepristone, which loosens the lining of the uterus that holds a pregnancy in place. It is followed by a second pill called misoprostol, which generally induces contractions, allowing for the expulsion of the uterus’s contents. Both pills are needed to have an effective and safe abortion, Creinin said.

The abortion pill reversal treatment requires taking high doses of progesterone after the mifepristone.

Creinin said understanding the timeline and science is important, because mifepristone alone doesn’t generally complete an abortion, and pregnant people who decide to undergo abortion pill reversal treatment are likely to remain pregnant whether they take high doses of progesterone or not.

Under questioning by Deputy Attorney General Hayley Penan, Creinin said that one study the groups lean on heavily to make their claims — which asserts abortion pill reversal protocol is effective 68% of the time in sustaining a pregnancy — was riddled with errors and cannot be viewed as a reliable authority on abortion pill reversal testing.

Alameda County Superior Judge Patrick McKinney asked the physician about specific details on how studies are vetted and what constitutes informed consent versus a retrospective study.

Creinin said studies usually go through a process that includes reporting under guidelines of an institutional review board, something absent in the studies Heartbeat International and RealOptions cite.

“They are making it up as they go along,” Creinin said.

The groups’ attorney Ethan Reimers, of Messner Reeves, said in opening statements the scientific debate is ongoing and “not settled.”

He said it was “ironic” that California was imposing itself on a “woman’s right to choose,” along with making freedom of speech and free enterprise claims.

California is asking the court to stop the false and misleading statements by the two groups and impose a penalty of up to $2,500 per violation against each group, which equals approximately $20 million for Heartbeat International and over $600,000 for RealOptions. The state said their actions are violating California’s False Advertising Law and Unfair Competition Law.

But Reimers said the services the groups offer are free of charge, and the state erred when making its calculations about violation penalties, sometimes double counting people who came to the groups for information.

The state maintains that Californians have the right to access safe and legal abortions, the right to facts about the procedure and the right to make informed decisions.

A percentage of people — 0.004% — may reconsider their decision to have an abortion in the middle of a medically induced procedure. Those people likely would experience emotional turmoil, be anxious, and not know what choices they have. They deserve accurate information, the state said.

Heartbeat International and RealOptions say abortion pill reversal is a valid option. A website for RealOptions has a part of its site dedicated to the procedure.

“Do you regret your decision and wish you could reverse the effects of the abortion pill?” the website stated. “We may be able to help! There is an effective process called abortion pill reversal. Contact us, time is of the essence!”

Currently in California, crisis pregnancy centers — like the ones operated by RealOptions — outnumber abortion provider facilities. Crisis pregnancy centers don’t provide abortions or refer people to them. They also have no comprehensive reproductive healthcare.

“They often look like and are located near real healthcare facilities,” California Attorney General Rob Bonta said in a press conference after filing the complaint in 2023.

“Access to reproductive healthcare is your right,” Bonta said. “Don’t let anyone tell you otherwise.”

Trial will continue Thursday.