We want to extend our sincere appreciation for the thousands of people who came together for a cause greater than themselves. The diverse group that opposed unrestricted, unregulated abortion reflected the broad-based coalition formed by Prolife Colorado that defies any simple characterization. We are Democrats, Independents, and Republicans from every race, and ethnicity. We are young and old, rich and poor, native and immigrants, religious and secular. We are defined by our common belief in the value and dignity of every human being and not by any demographic. Amendment 79 passed but that does not mean we failed. We have begun the long and arduous task of educating Coloradoans about the reality of abortion in our state. Few knew that abortion late in pregnancy on healthy women with healthy babies was common. Few knew that high risk second and third trimester abortion clinics were unregulated in our state and that women’s lives are in jeopardy. Few realized the implications of unrestricted abortion on the privileged relationship between parents and their teen daughter. Many underappreciated the fiscal impact of using public funds to streamline access to abortion through all nine months of pregnancy. Our only regret is that we didn’t have the money to share our message more broadly so that every Coloradoan could make an informed choice. The proponents of the measure raised 18 times the money we did largely from the abortion industry and wealthy out-of-state donors. They used their money to spread the myths that “abortion was healthcare” and that abortion saved women’s lives. They frequently tried to conflate elective induced abortions with miscarriages, ectopic pregnancies and treatment for life-threatening complications of pregnancy. We know that not a single women’s death has been the result of abortion restrictions and that recent highly publicized deaths in Georgia and Texas reflect the anticipated complications of drug-induced abortions compounded by physician negligence. We will continue to build a culture that respects every human life here in Colorado and envision a future where women are offered the support and the resources, they need to choose life. Women without financial resources and women of color should not feel that their only path to a successful life is through abortion. We will fight to remove the inequities in pregnancy care throughout our state and remove barriers for women facing unplanned pregnancies during their education and early careers. And yes, we look forward to the day when Coloradoans will vote to remove Amendment 79 from our constitution. Because life matters.
It is becoming more common for ideologues to gaslight the American public to promote their agenda. The latest example is the abortion industry’s attempt to have Coloradoans suspend their common sense, human decency and compassion to place Amendment 79 into the Colorado constitution. State law already protects access to abortion, but they would have us believe it is “progressive” to endorse this constitutional amendment. Amendment would enshrine unrestricted, taxpayer funded abortion into the state constitution. It would prohibit the government from “denying, impeding or discriminating” against the right to abortion. This goes far beyond Roe which was overturned by the Dobbs decision. Roe permitted regulation of abortion in the second trimester to ensure the health and safety of women and allowed states to recognize their compelling interest in protecting the life of a viable baby in the third trimester. Amendment has neither of these important features. If abortion is considered a fundamental constitutional right (unlike any other medical procedure), then a fetus, wanted or unwanted, has no constitutional rights under Amendment 79. Nobody could infringe on the exercise of abortion – no matter the circumstances. Late abortions are common in Colorado. While abortions after the limit of fetal viability only represent 3.2-3.4% of abortions each year, they account for hundreds of abortions. And we know that approximately 70% of these late abortions are performed on healthy women with healthy babies. Amendment 79 would prevent legislators from ever curtailing abortion late in pregnancy for social and economic reasons. The amendment does nothing to address the real needs of women facing financial challenges that forces them to consider late abortion. It leaves them only one regrettable choice. Is it progressive to focus solely on abortion access and forego the hard work necessary to make pregnancy more equitable for low-income women? The Colorado Department of Public Health and Environment licenses, regulates, and inspects thousands of health care facilities in the state to ensure public health and safety. The striking exception is second and third trimester abortion clinics. Abortion extremists pejoratively refer to any laws that regulate abortion clinics as TRAP laws. In their worldview the only motivation for such laws is to impede abortion access. They ignore the fact that second trimester abortions have a 10% complication rate and pose a 1.7% risk of life-threatening complications. While first trimester abortions are relatively safe procedures, the risk of dying from abortion increases by 38% for every additional week of gestation beyond 8 weeks. You would think we would have learned the danger of unregulated/uninspected abortion clinics from the Gosnell tragedy. Dr. Kermit Gosnell was responsible for the injury and death of countless women spanning decades because of the lack of governmental oversight at his Philadelphia abortion clinic. If Amendment 79 passes, legislators will be precluded from instituting prudent health/safety regulations for abortion clinics in Colorado. There would be nothing preventing a Gosnell-like horror in our state. Is it progressive to prioritize abortion access over the lives of women? A 22-week baby born prematurely enjoys all the rights and benefits of other Colorado citizens. Yet, a 22-week, pain-capable fetus in utero can be literally torn apart limb by limb during the D&E procedure favored by most abortionists in Colorado. Later in the second trimester and during the third trimester that fetus can be killed by poisoning before it is extracted during a D&X procedure. Digoxin is commonly utilized. Digoxin can cause hours of agonizing nausea, vomiting, and delirium before eliciting death. Is it progressive to define a human’s value and dignity based solely on their location or to sanction such excruciating deaths? Parental notification prior to a minor’s abortion is current law in Colorado. Guttmacher and other abortion advocacy organizations consider parental notification laws as impediments to abortion access. Amendment would eliminate this. The adolescent brain is still developing prefrontal connections that help modulate their subcortical emotional and impulsive responses to stressful situations, such as unplanned pregnancies. Without parental notification, our teen daughters may face these challenges with more input from their peers, teachers, or counselors than from the parents who love and know them best. And if parental notification is eliminated, sex traffickers will have an easier time eluding law enforcement as they coerce their young victims to have abortions. Is it progressive to remove parents from the most consequential decisions in their daughter’s lives or enable human traffickers? With Amendment 79 in the state constitution, abortions for any reason would be legal. Studies from the US and other countries document the extent that sex selection abortions occur, A Colorado late abortionist recently admitted that he has performed sex selection abortions. Is it progressive to allow abortion for blatantly sexist reasons? We know the answer. No, it is not progressive to promote unrestricted, unregulated abortion in Colorado. Abortion access is already ensured in Colorado. Amendment 79 is unnecessary, inhumane and potentially dangerous. Frances Rossi and Tom Perille MD - Founding members of Democrats for Life of Colorado
This piece was originally published in the Colorado Springs and Denver Gazette Perspective Column September 22, 2024 by Tom Perille MD (DFLCO President) and Wendy Smith What would it mean if the only medical intervention that is recognized in the Colorado Constitution’s Bill of Rights was abortion? And what would it mean if abortion was the only medical intervention that couldn’t be constitutionally excluded in private and public health insurance? Not access to basic medical care. Not pregnancy care. Not life-saving cancer treatments. Not mental health treatment. Not care for those addicted. Not affordable pharmaceuticals. Only abortion. That is what those who are pushing Amendment 79 (“Right to Abortion”) hope to accomplish. Not only would abortion at any time in pregnancy for any reason using any method become a fundamental right, but anything that “impeded” or “discriminated” against access to abortion would be prohibited. The people of Colorado have a right to know the profound and dangerous implications of such a measure which won’t be reflected in the Blue Book language. In a poll conducted in July by the Strategy Group, 71% of Colorado voters were unaware that abortion is currently legal under all circumstances in our state. Abortion access is guaranteed in Colorado law. Amendment 79 would do nothing to change that reality. Coloradoans have the right to know that with the amendment in the constitution, the people of Colorado and those working for them in the legislature could do nothing to regulate or restrict abortion in the future– even if those changes represented the overwhelming consensus of Coloradoans and protected the health and safety of women. There were between 468-486 late abortions after the limit of fetal viability (21 weeks) reported to the CDPHE in 2022 and 2023. Guttmacher estimates that there were 71% more abortions in 2023 than CDPHE reported making 500 a conservative estimate of the total number of post-viability abortions each year in Colorado. These babies can “kick” their mother, respond to her voice/touch, acquire her taste preferences, and feel pain while in the uterus. They can survive if born prematurely. Babies born at 22-weeks and later can be found lovingly cared for in neonatal intensive care units and nurseries across the state. Based on research from Boulder abortionist, Dr. Warren Hern, 70% of his late abortions are performed on healthy women with healthy babies. That translates into an estimated 350 healthy babies aborted late in pregnancy each year in Colorado for financial and social reasons. Coloradoans have the right to know that Amendment 79 does nothing to address the real needs of these women and simply streamlines access to one, tragic and regrettable choice. With Amendment 79 in place, legislators would be unable to restrict even the most extreme abortions on healthy women with healthy babies in the third trimester. Colorado parents are currently notified at least 48 hours in advance of their minor teen’s pending abortion. The abortion industry, their research allies (Guttmacher), and aligned medical professional organizations (ACOG) all consider parental notification before a minor teen’s abortion to be an impediment to abortion access. Coloradoans have the right to know that banning parental notification would be one of the most immediate consequences of Amendment 79. In practical terms, this means that the people that know and love the teen the most may be unaware of their pending abortion and unable to support their daughter. Even worse, teens may be pressured by peers or an abortion clinic counselor to pursue an action that is inconsistent with their wishes and core values. Parents may be blindsided by the potentially severe physical and mental health consequences of their teen’s abortion. And sex traffickers would be able to hide their nefarious trade by pursuing abortions for their teenage victims without the safeguard of parental notification. Trafficking is a multi-million-dollar criminal enterprise in Colorado. Victims rarely self-identify. Anyone who works with domestic minor sex trafficking knows that the very definition of trafficking involves force, fraud and/or coercion. It is also well known that girls who are trafficked often view their trafficker as their “boyfriend”, lacking the maturity and discernment to know they are being trafficked and in danger. If they refuse to do what the trafficker wants, they are often subject to physical and mental abuse until they submit. There is a growing concern over forced abortion, especially with the availability of medication and telehealth abortions. These girls are not free to choose. Without the safeguard of parental notification, minors may be exposed to continued risk. Keep in mind, minors can be brought across state borders by anyone for abortion, just to be released back to the trafficker/perpetrator. For this reason, parents have a right to know when their daughter is considering abortion so that they can seek help and intervene. Most states have regulations that pertain to abortion clinics and promote the health and safety of women. Colorado is not one of them. The abortion industry pejoratively refers to any regulation that specifically applies to abortion providers as TRAP laws. They view them as impediments to abortion access. Even though thousands of medical facilities and agencies are licensed, regulated and inspected by the Colorado Department of Public Health and Environment, second and third trimester abortion clinics are the glaring exception. This omission is especially perplexing since second trimester abortions have a 10% overall complication rate and 1.7% life-threatening complication rate. The risk of having a complication increases for each additional week of gestation. Furthermore, the risk of dying from an abortion increases 38% for each week of gestation beyond 8 weeks. We should heed the lesson from other states that have tragically witnessed the maiming and death of women when government oversight is lax or non-existent – such as Pennsylvania and Dr. Gosnell. Coloradoans have a right to know that if Amendment 79 passes, the state will be unable to impose prudent health and safety regulations for abortion clinics which may jeopardize women’s health and lives. Another goal of Amendment 79 is to facilitate publicly funded abortions. Currently, Colorado Medicaid only pays for abortions in circumstances of rape, incest, and threats to the life of the mother. If Amendment 79 passes, the prohibition against public funding in the constitution will be removed and the state will be able to underwrite elective abortions for Medicaid patients. In states where public funding for abortion is already law, they spend millions of dollars subsidizing abortion for in-state and out-of-state women. Coloradoans have the right to know that this may take precious tax dollars away from other medical priorities like pregnancy services and mental health. It may even divert money from non-medical budgets for education, affordable housing, and the environment. There is already inadequate private and public support for pregnant women in our state. One of the few shining exceptions is the 58 pregnancy resource centers. They provide millions of dollars of uncompensated care to women during and after challenging pregnancies. However, because they typically don’t offer abortion services or refer for abortions, the abortion industry has been targeting these charitable organizations. Coloradoans have the right to know that the ability of pregnancy resource centers to assist pregnant women in need may be jeopardized by the passage of Amendment 79. Under Amendment 79, the right to abortion would become absolute. Coloradoans have the right to know the implications of such an extreme position. It would strip all rights and protections from the developing fetus, even those that are wanted. The legislature couldn’t proscribe abortion methods that are especially cruel such as second trimester D&E (dismemberment) abortions on pain capable fetuses. It would jeopardize the conscious rights of medical professionals across the state who maintain medical/scientific, moral or religious objections to elective induced abortions. Since the amendment forbids “discriminating” against a woman’s desire for an abortion, even physicians and nurse practitioners who perform abortions would be unable to refuse abortions for reasons they may view as morally repugnant – such as aborting a fetus solely because of their sex (which is already occurring) or because of the ethnicity/race of their father. Abortion access is already guaranteed in Colorado law. Making the right to abortion the only medical procedure recognized in our constitution is extreme and ties the hands of Colorado citizens and legislators. It goes far beyond the abortion rights promulgated in the Roe decision. Coloradoans have the right to know that Amendment 79 would have these many unintended consequences. Given the facts, we hope that Coloradoans reject Amendment 79.
We should recognize ideological conflicts of interest in clinical research just as we recognize financial conflicts of interest in clinical research. It doesn't negate the studies, but tells us about potential biases and requires us to look more closely at the methodology and reporting.
Cobalt and other proabortion organizations are currently circulating petitions to have Initiative 89 appear on Colorado 2024 ballot. They have the money to pay circulators to get the necessary signatures so there is little doubt it will be on the ballot in November. The ballot initiative is deceptively drafted to make it appear that the primary issue is correcting an “unintended consequence” of Amendment 3. Colorado constitutional Amendment 3 narrowly passed in 1984. It prohibited the use of state public funds for induced abortions unless the life of the mother was in jeopardy. Initiative 89 backers are highlighting the lack of funding for state employees for abortions in cases of rape, incest, issues that “gravely endangers the patient’s health” or when there is a “fatal fetal condition”. They also point out the lack of an exception for state Medicaid funding for issues that “gravely endangers a patient’s health” or for a “fatal fetal condition”. What are they not saying? There already is an exception for the pregnant woman’s life which would encompass anything that “gravely endangers the patient’s health”. They are trying to blur the line between an exception for a condition that jeopardizes a woman’s life and any complication that requires treatment during pregnancy but does not threaten her life. Similarly, Medicaid already offers reimbursement for abortions related to rape or to save the mother’s life. It does not have an exception for the nebulously defined “health” of the mother, which can be treated in the normal course of obstetric practice, or for fetal conditions. A “fatal fetal condition” is a pejorative phrase with little resemblance to reality. For instance, Trisomy 18 is often referred to in this manner. The problem arises because the condition may be as much as 90% survivable if treated with standard interventions (employed on infants without Trisomy 18 diagnoses). It doesn’t mean that there aren’t life threatening fetal conditions or that some infants will have significant disabilities but describing these fetuses as “fatal” is a way to dehumanize them and justify the abortion decision. If they were really motivated to remove the barriers to the < 4% of abortions that occur for reasons of rape, incest, life of the mother, and life-limiting fetal conditions, why doesn’t Initiative 89 simply ask Coloradans add these exceptions to Amendment 3s language? The answer is clear. They want to evoke an emotional response which will override Coloradans’ qualms about unrestricted abortion. Their arguments gloss over the main purpose of Initiative 89 – to make abortion access a constitutional right without any gestational limits for any reason and to use public funding to subsidize it. They would like the public to be unaware of the fact that hundreds of healthy viable (>21 weeks) fetuses gestating in healthy women are currently aborted in Colorado. And that at least one late term abortionist (Warren Hern) has publicly acknowledged that he does abortions for absolutely any reason – including for sex selection. If the public had an inkling of the magnitude of the slaughter of prenatal humans purely for social and economic reasons, they would be appalled. There are so many other legislative initiatives that could be undertaken to provide support for pregnant women and their families so that they don’t feel compelled to consider abortion. Why don’t we focus our efforts on these life-affirming alternatives to the violence of abortion? DFLCO will be participating with Pro-Life Colorado, the state-wide umbrella organization uniting prolife groups, to defeat Initiative 89. DFLCO members should begin talking to their prochoice friends and writing letters to the editor of local media shedding light on the deceptive nature of Initiative 89 and the Trojan horse it represents for constitutionally protected unrestricted abortion. If your contacts don’t recoil at the reality that hundreds of healthy viable fetuses are being aborted for reasons as abhorrent as sex selection, then Colorado is in worse shape than any of us recognize. Initiative 89 should have no place in Colorado.
Cobalt and other proabortion organizations are currently circulating petitions to have Initiative 89 appear on Colorado 2024 ballot. They have the money to pay circulators to get the necessary signatures so there is little doubt it will be on the ballot in November. The ballot initiative is deceptively drafted to make it appear that the primary issue is correcting an “unintended consequence” of Amendment 3. Colorado constitutional Amendment 3 narrowly passed in 1984. It prohibited the use of state public funds for induced abortions unless the life of the mother was in jeopardy. Initiative 89 backers are highlighting the lack of funding for state employees for abortions in cases of rape, incest, issues that “gravely endangers the patient’s health” or when there is a “fatal fetal condition”. They also point out the lack of an exception for state Medicaid funding for issues that “gravely endangers a patient’s health” or for a “fatal fetal condition”. What are they not saying? There already is an exception for the pregnant woman’s life which would encompass anything that “gravely endangers the patient’s health”. They are trying to blur the line between an exception for a condition that jeopardizes a woman’s life and any complication that requires treatment during pregnancy but does not threaten her life. Similarly, Medicaid already offers reimbursement for abortions related to rape or to save the mother’s life. It does not have an exception for the nebulously defined “health” of the mother, which can be treated in the normal course of obstetric practice, or for fetal conditions. A “fatal fetal condition” is a pejorative phrase with little resemblance to reality. For instance, Trisomy 18 is often referred to in this manner. The problem arises because the condition may be as much as 90% survivable if treated with standard interventions (employed on infants without Trisomy 18 diagnoses). It doesn’t mean that there aren’t life threatening fetal conditions or that some infants will have significant disabilities but describing these fetuses as “fatal” is a way to dehumanize them and justify the abortion decision. If they were really motivated to remove the barriers to the < 4% of abortions that occur for reasons of rape, incest, life of the mother, and life-limiting fetal conditions, why doesn’t Initiative 89 simply ask Coloradans add these exceptions to Amendment 3s language? The answer is clear. They want to evoke an emotional response which will override Coloradans’ qualms about unrestricted abortion. Their arguments gloss over the main purpose of Initiative 89 – to make abortion access a constitutional right without any gestational limits for any reason and to use public funding to subsidize it. They would like the public to be unaware of the fact that hundreds of healthy viable (>21 weeks) fetuses gestating in healthy women are currently aborted in Colorado. And that at least one late term abortionist (Warren Hern) has publicly acknowledged that he does abortions for absolutely any reason – including for sex selection. If the public had an inkling of the magnitude of the slaughter of prenatal humans purely for social and economic reasons, they would be appalled. There are so many other legislative initiatives that could be undertaken to provide support for pregnant women and their families so that they don’t feel compelled to consider abortion. Why don’t we focus our efforts on these life-affirming alternatives to the violence of abortion? DFLCO will be participating with Pro-Life Colorado, the state-wide umbrella organization uniting prolife groups, to defeat Initiative 89. DFLCO members should begin talking to their prochoice friends and writing letters to the editor of local media shedding light on the deceptive nature of Initiative 89 and the Trojan horse it represents for constitutionally protected unrestricted abortion. If your contacts don’t recoil at the reality that hundreds of healthy viable fetuses are being aborted for reasons as abhorrent as sex selection, then Colorado is in worse shape than any of us recognize. Initiative 89 should have no place in Colorado.
There are some things I have a hard time understanding. Why do people who profess a Christian worldview support a presidential candidate who is crude, cruel, vindictive, misogynistic, narcissistic, and does not pretend to know, much less follow, basic Christian moral teachings? When the prenatal human rights movement becomes associated with such figures, we lose moral credibility and ultimately, electoral power. And why do people who are otherwise loving and compassionate fail to demonstrate any love or compassion for the preborn human being before they are killed in elective abortions? Why is it either the mother or the preborn baby and not both? Why do people go out of the way to knock down perceived barriers to abortion access, but seem disinterested in eliminating the socioeconomic barriers to giving birth and parenting? Why do people feel the only way to achieve equity between the sexes is to deny the biological realities of the sexes? Why do we primarily deal with the asymmetric burdens of human reproduction by promoting abortion? Why can’t we honor a woman’s different role by making social and economic accommodations for women so that their education and careers are prioritized during their reproductive years? Why is it that many of the same people who characterize themselves as “anti-racist” fail to recognize the systemic issues and underlying racism that result in many more preborn babies of color being aborted than White preborn babies? I don’t profess to have all the answers. But what I do know is why I am prolife. I am a physician. In medical school, I studied embryology and marveled at the remarkable and seamless journey from zygote to human birth. My textbook unequivocally stated that “development begins at fertilization, when a sperm fuses with an ovum to form a zygote; this cell is the beginning of a new human being”. Any attempt to distinguish a human being from a human person is philosophically and scientifically arbitrary. As part of my educational training at medical school, I had the terrifying experience of viewing a recently aborted second trimester baby at the bottom of a surgical bucket. You can’t unsee that. As a medical student, I witnessed an OB/GYN attending physician flaunt her wealth by driving a Rolls Royce – only to learn her wealth was predicated on a very lucrative abortion clinic practice. I know that during the most common second trimester abortion procedure, an abortionist literally dismembers the fetus without the benefit of any anesthesia. I know that during abortions after fetal viability (22 weeks), the fetus is commonly injected with a drug, digoxin, which I have witnessed causing nausea, retching, abdominal pain, and delirium at toxic levels in my adult patients. It can take up to 4 hours to kill a fetus if the drug is injected directly into the body and up to 24 hours if it is injected into the amniotic fluid surrounding the fetus. That is up to 24 hours of fetal torture/anguish. Because I am a physician, I understand that there is no connection between abortion restrictions and the medical management of a miscarriage. Because I am a physician, I know that abortion restrictions never prevent a physician from responding to a medical emergency in a pregnant patient. I know that for rare medical complications during pregnancy, a physician must deliver a baby prematurely – even if delivering the baby will foreseeably result in the death of the baby. Because I am a physician, I know that the scare tactics employed by abortion advocates are just that – scare tactics. If a woman must go to another state for urgent/emergent complications of her pregnancy, it is because of malpractice, not because of abortion restrictions. I have had men and women yell and swear at me because of my prolife position who ultimately break down in tears, and admit they were angry because they aborted their child and knew it was wrong. I have had an elderly woman come up to me outside an abortion clinic where I was offering help to abortion vulnerable women and thank me as she cried and said that if I had been there 50 years ago, she many have not made the worst decision of her life and had an abortion. I have had a woman stop her car in the middle of the street outside an abortion clinic and smile from ear to ear, explaining that because I was there two years ago, her little boy was now two years old. I know that abortion hurts women and men alike. I know that many women feel coerced by their financial situation or partners, but there is help and we won't let them stand alone. I know that sanctioning violence in the wound leads to increasing violence in our culture. I know that when we start dividing human beings into those that are worthy of rights/protections and those that are unworthy of rights/protections we undermine our own human dignity/value. So why is a majority of the electorate voting against abortion restrictions? It is true that if the mainstream media would cover the issue objectively, more could discern the truth about the reality of abortion. I also believe that if more could see what I see, they would vote to protect innocent human life in the womb. And I know that I will fight to protect the dignity and value of every human being until the day I take my last breath. I hope more of you join me. Thomas J. Perille MD
Krista Kafer nailed it. A small faction of abortion rights extremists strong-armed the Democratic caucus and pushed through SB23-190 which punitively targeted Pregnancy Resource Centers which are commonly affiliated with religious organizations. Not only did they blatantly challenge the first amendment rights of these centers, but they also didn’t hide their animus in hours of testimony at the state capitol. The bill also sought to ban the use of progesterone to mitigate the abortifacient effects of mifepristone – the first pill in the two-drug medication abortion regimen. Eliminating this option has nothing to do with improving abortion access but rather is all about denying a woman’s agency and removing her choices. Opposition to abortion pill reversal was never about the science since there is low-level, but multifaceted and compelling evidence to support the practice. Instead, their true motivations were revealed in testimony from ACOG to the Medical Board – they didn’t want to acknowledge that women change their minds about abortion since it would contradict their preferred narrative and lead to “abortion stigma”. They cared little about the desperate woman in their exam room who believed she made a tragic mistake and wanted to save her baby. I hope my fellow Democrats take the judge’s decision as a wake-up call. It is past time to look beyond a narrow proabortion focus and support all attempts to serve women who face a challenging pregnancy. Thomas J. Perille MD President, Democrats for Life of Colorado
Excerpts from Democrats for Life of Colorado's President, Thomas Perille MD, to the Colorado Medical, Nursing and Pharmacy Boards which walks through the evidence in support of abortion pill reversal: Members of the Colorado Medical Board, Board of Nursing and Board of Pharmacy, With the signature of SB23-190 into law by Governor Polis, you have been asked to evaluate a specific medical intervention to determine if it is a “generally accepted standard of practice”. As someone who has reviewed several cases for the Medical Board to determine if a provider deviated from accepted community standards, I would like to provide my perspective based on a careful review of the evidence. So called “abortion pill reversal” (APR) protocols were developed in response to the rare situation in which a woman pursuing a medication abortion regrets her choice after taking the first pill, mifepristone, but before taking the second drug, misoprostol, in the two-drug regimen. The purpose of APR is to mitigate the abortifacient effects of mifepristone and increase the odds of a continuing pregnancy. It should be no surprise that some women harbor significant ambivalence about their abortion decision. The Turnaway Study (page 126) reported that within one week of being denied an abortion, 35% of women no longer wished to have an abortion. In 2022, 31 Colorado women (approximately 0.4% of medication abortion patients) sought to pursue APR through the most prominent organization dedicated to APR – Heartbeat International . As a matter of principle, clinicians routinely honor a patient’s right to withdraw consent from any medical or surgical intervention. Therefore, addressing the needs of women who change their mind about their medication abortion should not be controversial. Mifepristone was developed in the 1980s as a progesterone antagonist. It is one drug in a whole class of Selective Progesterone Receptor Modulators (SPRMs). The drug binds progesterone receptors twice as avidly as progesterone. In the early 1990s it was studied primarily as a means to terminate early pregnancy . APR is based on the premise that mifepristone competition for the progesterone receptors is a dynamic process. By flooding the receptors with natural progesterone, one could theoretically overcome the binding of mifepristone to progesterone receptors and reduce its abortifacient effects. Some abortion researchers have questioned the potential for high dose progesterone to significantly impact mifepristone’s binding to progesterone receptors. They cite the observation that women treated with mifepristone for abortion have high progesterone levels and therefore it would seem implausible that more progesterone would make any difference. They also point to a study of the very potent progestin contraceptive implant, etonogestrel. When it was administered immediately after the ingestion of mifepristone, it did not reduce the percentage of successful medication abortions. There are animal and human data to counter these arguments. Early in the research on mifepristone it was recognized that its binding to the progesterone receptor could be reduced by increasing progesterone levels. In a study in pregnant rats, those that received mifepristone only had 33% of pups survive. In contrast, those that were given progesterone with mifepristone, 100% of pups survived. A second study in rats demonstrated a clear progesterone mediated reversal of mifepristone induced pregnancy termination in a rat model. As early as 1991, a medical review of mifepristone use in medication abortions recognized that the mifepristone binding to the progesterone receptor could be reversed by adding progesterone. Collectively, these provide proof of principle for APR. The fact that progestin can interfere with the action of a SPRM in humans is a documented concern outside of mifepristone use for medication abortion. The FDA recommends that progesterone containing hormonal contraceptives not be administered within 5 days of taking the SPRM, ulipristal, so as not to reduce its effectiveness as a form of emergency contraception. Compelling evidence that a progestin can specifically interfere with a mifepristone (and misoprostol) in a medication abortion was found during a large, randomized, multinational study of depot medroxyprogesterone acetate use as a post-abortive contraceptive. In this study, the administration of medroxyprogesterone in conjunction with the ingestion of mifepristone (Quickstart) was associated with a 400% increase in the odds of a continuing pregnancy compared to delaying the administration of medroxyprogesterone after a mifepristone/misoprostol abortion (Afterstart). While the absolute difference was small (0.9% to 3.6%), the results were statistically significant. Some researchers speculated that depot medroxyprogesterone acetate differs from other progestins, such as etonogestrel, because of its potency and rapid achievement of peak levels. The first known use of high dose progesterone to mitigate the effects of mifepristone during the course of a medication abortion was in 2006 by Dr. Matthew Harrison. A desperate woman who immediately regretted her medication abortion decision sought his help. Based on the known mechanism of action and the record of safety using progesterone to treat miscarriages, he initiated a course of high dose parenteral progesterone. This resulted in the delivery of a healthy baby girl. I would argue that even this early adoption of the APR concept met the criteria for a “generally accepted standard of practice” as defined by the Colorado Medical Board. The strategy was plausible based on the known mechanism of action of mifepristone – competitive inhibition of the progesterone receptor. Animal research supported the approach. The intervention was deemed safe in analogous OB indications (miscarriage prevention) at the time. And most importantly, the potential benefit - a life saved- justified an unproven intervention. The only alternative course of action was expectant management which would be anticipated to result in only a 20-40% chance of embryonic survival based on WHO data from 1997. In 2012, the first case series utilizing progesterone to block the abortifacient effects of mifepristone was published. Four of six (66%) women who were administered parenteral progesterone after taking mifepristone carried their pregnancies to term. A second small case series in 2017 also demonstrated a 66% continuing pregnancy rate after administration of progesterone following mifepristone. This compares to a historical rate of >>risk). The only alternative – expectant management – is associated with a much poorer outcomes and potentially worse safety - twice the embryo/fetus mortality and a possible greater risk of hemorrhage for the woman. Thank you for your consideration. Thomas J. Perille MD FACP FHM President, Democrats for Life of Colorado
