“Those who are struggling with the complex decision to get an abortion deserve support and trustworthy guidance—not lies and misinformation,” said California Attorney General Rob Bonta.
California Attorney General Rob Bonta filed a lawsuit on Sept. 21 against a chain of California crisis pregnancy centers and its national parent organization for false advertising of “abortion pill reversal” (APR)—an unproven and possibly dangerous high-dose progesterone intervention the anti-abortion movement claims can “reverse” an underway medication abortion. This is the first lawsuit in the country challenging the CPC industry’s promotion of APR.
AG Bonta’s complaint charges RealOptions Obria, a five-site crisis pregnancy center chain in Northern California, and the Ohio-based Heartbeat International with violating California’s False Advertising Law and Unfair Competition law by falsely advertising “abortion pill reversal” as safe and effective. The lawsuit seeks an injunction to block further dissemination of the misleading claims, in addition to other remedies and penalties available under state law.
The lawsuit also charges RealOptions and Heartbeat International with engaging in a conspiracy to “falsely and illegally advertise APR as a valid and successful treatment option,” despite being fully aware of the lack of scientific certainty about its safety, while additionally failing to alert patients to possible side effects, such as the risk of severe bleeding.
“Those who are struggling with the complex decision to get an abortion deserve support and trustworthy guidance—not lies and misinformation,” Bonta said at a press conference announcing the lawsuit. “And let me be clear: The evidence shows that the vast majority of people do not regret their decision to have an abortion—more than 95 percent of patients who undergo an abortion later say they made the right decision.
“Heartbeat International and RealOptions took advantage of pregnant patients at a deeply vulnerable time in their lives, using false and misleading claims to lure them in and mislead them about a potentially risky procedure. We are launching today’s lawsuit to put a stop to their predatory and unlawful behavior.”
Crisis pregnancy centers (CPCs), also known as anti-abortion centers or limited service pregnancy centers (LSPCs), masquerade as reproductive health clinics to draw women and teens with unplanned pregnancies to their sites and use medical disinformation to pressure them to carry pregnancies to term.
Most CPCs are affiliated with large anti-abortion corporations and plugged into their digital infrastructure, using sophisticated strategies to appear first in online searches for abortion and collecting women’s sensitive personal and health information with no privacy protections—information that could be shared in pregnancy- or abortion-related investigations post-Roe.
Heartbeat International and RealOptions took advantage of pregnant patients at a deeply vulnerable time in their lives, using false and misleading claims to lure them in and mislead them about a potentially risky procedure.California Attorney General Rob Bonta
There are 2,600-5,000 CPCs operating nationwide, and at least 172 CPCs in California. While fewer than 62 percent of California counties have an abortion clinic, nearly 80 percent have a crisis pregnancy center, according to a database compiled by CalMatters. In rural areas of the state, where there are acute primary care shortages, the centers outnumber abortion clinics 11 to two.
“The horrifying reality is that right now there are more crisis pregnancy centers in California than abortion care clinics,” Bonta told CalMatters.
The 2021 CPC study, “Designed to Deceive,” found almost 40 percent of California CPCs were promoting “abortion pill reversal” on their websites and via referral to a national “Abortion Pill Reversal” website and hotline operated by Heartbeat International. Some 5 percent of CPCs claimed to directly provide APR.
The APR “treatment,” developed by a California-based “pro-life” family medicine physician named George Delgado, involves administering high doses of progesterone after a pregnant person has taken the first medication (mifepristone) but not the second (misoprostol) in the medication abortion regimen. Delgado claimed this intervention “reversed” the abortions of four women in 2012. The anti-abortion movement now claims that “thousands of lives” have been saved by APR.
The American College of Obstetricians and Gynecologists (ACOG) calls APR “unethical” and “not based on science.” Preeminent reproductive health researchers in The New England Journal of Medicine call APR “unproven” and “an unmonitored research experiment” on pregnant people. The only controlled clinical study of the efficacy and safety of APR was halted in 2019 due to safety concerns after three of the first 12 women enrolled suffered “severe hemorrhage requiring ambulance transport to hospital.”
Many CPCs cite a “case series” by Delgado and Mary Davenport, a California physician and current medical director of two RealOptions CPCs, as evidence of the safety and efficacy of APR, that claims “68 percent of pregnancies treated with oral progesterone were saved.” This “case series” has been roundly discredited by ACOG for having “no ethics approval, no control group, under-reporting of data, and no reported safety outcomes.”
Use of mifepristone in pregnant patients is approved by the U.S. Federal Drug Administration (FDA) only when followed by misoprostol 24-48 hours later.
The FDA has not approved—or even reviewed—the use of progesterone after misoprostol.
The American Medical Association, Society for Maternal-Fetal Medicine and Society for Family Planning have also publicly debunked APR and called for action to protect pregnant people from deceptive and dangerous claims about “abortion reversal.”
Bonta’s complaint includes an exhaustive review of the well-established research on the safety and efficacy of medication abortion, and the anti-abortion movement’s advocacy to stigmatize medical abortion (called “chemical abortion” in anti-abortion messaging), to mainstream false claims that many women regret taking the first medical abortion pill, and that women can safely stop the abortion in process with the high-progesterone APR “treatment.”
The complaint notes that, “for the vast majority of pregnant people who choose to undergo an abortion, their most common emotion is relief,” and that the “small percentage of pregnant people—0.004 percent—may reconsider their decision while in the midst of a medication abortion … need and deserve accurate, scientifically sound information about their options.”
It also alleges that, “instead of offering vulnerable pregnant people accurate information, Defendants Heartbeat International, Inc. and RealOptions provide them with false and misleading statements” and “claim that there is a way to reverse the effects of mifepristone.”
At his press conference, Bonta asserted, “There is absolutely no scientific basis to support such a claim.”
CPCs operate under the guise of helping people navigate pregnancy … In reality they spread anti-abortion misinformation and offer fraudulent services that threaten acute harm to the already vulnerable people they claim to support.Betsy Butler, executive director of the California Women’s Law Center
The California complaint also details the role the CPC industry plays in promoting the false APR claims under the direction of the global Heartbeat International corporation, which also provides affiliates with digital tools and platforms through which the company collects and stores personal and health data from CPC visitors and website users. According to Privacy International, Heartbeat International is leading the anti-abortion movement’s effort to collect and store information on pregnant people through its CPC network and APR website and hotline.
Betsy Butler, executive director of the California Women’s Law Center—which partnered with The Alliance of State Advocates to conduct the 2021 “Designed to Deceive” CPC study—applauded AG Bonta for this action.
“For years, the California Women’s Law Center and our allies have been tracking the fraudulent claims made by CPCs and the particular threat of their ‘abortion pill reversal’ claim,” Butler said. “CPCs operate under the guise of helping people navigate pregnancy, when in reality they spread anti-abortion misinformation and offer fraudulent services that threaten acute harm to the already vulnerable people they claim to support.”
“The California Women’s Law Center applauds our Attorney General, Rob Bonta, for this groundbreaking lawsuit against an anti-abortion group and their chain of crisis pregnancy centers for their deceptive marketing of APR,” Butler continued. “It is about time crisis pregnancy centers are held to account for promoting this dangerous, unethical practice.”
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